5. Bacterial mastitis
• Injury during lactation.
• Micro-organism:
• S. aureus
• Starts by localized signs of inflammation.
• Generalized cellulitis then developed.
• Abscess can develop later.
6. Treatment
• During early stage, antibiotics such as Co-amoxiclav or flucloxacillin.
• Local heat.
• Analgesia.
• Continue breast feeding.
7. Treatment
• Surgical management is indicated if:
• Infection did not improve after 48h.
• If after the milk is emptied of milk, there is area of induration.
• Other evidence of underlying abscess.
8. Breast cyst
• Often multiple, may be bilateral.
• Presented suddenly and make alarm.
• Diagnosed by US and/or aspiration.
• If solid component > Biopsy.
9. Treatment
• A solitary small cyst can be aspirated.
• If there is residual lump, or if the fluid is blood-stained, core biopsy is indicated.
• Indication of surgery:
• Cyst recure multiple times.
• Based on Needle biopsy finding.
10. Fibroadenoma
• Developed in the ages 15-25.
• The most common tumor below age of 30.
• Arises from hyperplasia of a single lobule then increase in size to 2 – 3 cm.
• Hormonal stimulation.
• Rounded with well marked capsule, mobile, firm, and usually painless.
• Usually doesn’t need excision unless high suspicion or atypia.
11. Treatment
• Indication of surgery:
• If the patient is bothered by the mass.
• Continuous increase in size.
• >2cm.
12. Phyllodes tumor.
• Similar to fibroadenoma with increased size and rapid growth.
• Still has the histologic and radiologic characteristics.
• Treatment: Excision with at least 1cm margin.
13. Atypical ductal hyperplasia.
• Benign but worrisome finding in the breast.
• Asymptomatic, incidental, often present as calcification.
• Treatment:
• If presented at core needle biopsy, the area should be excised.
15. Risk factors
• Age.
• Gender.
• Family history.
• Diet.
• Nulliparous.
• Early menarche.
• Late menopause.
• Obesity.
• Personal history of cancer.
• Previous radiation.
16. Clinical features
• Hard lump.
• Associated with indrawing of the nipple or overlying skin.
• As the disease advances, peud’ orange, frank ulceration and fixation to the chest wall.
• Nipple discharge, retraction or ulceration could happen.
18. Breast cancer spread.
• Local spread:
• The tumor increase in size and invade other portion of the skin, Pectoral muscle.
• Lymphatic spread:
• To axillary and internal mammary.
• Blood stream:
• Skeletal metastasis
19. Diagnostic investigations
• Mammography:
• Solid mass.
• Asymmetric thickening of breast tissue.
• Clustered microcalcification.
• Ultrasound:
• Irregular margins.
• Can guide biopsy.
20. Carcinoma in situ
• The cancer that did not invade basement membrane.
• LCIS: is originated in the terminal duct lobular unites.
21. Lobular Carcinoma in situ
• Originated in the terminal duct lobular unites.
• Can be presented in an area with microcalcification, but the calcification is resulted
form the adjacent tissue.
• Invasive carcinoma can develop in other breast than the one harbor LCIS.
• It is considered as a marker for increasing risk of invasive carcinoma.
23. Ductal carcinoma in situ
• ADH > DCIS > IBC.
• Can be named intraductal carcinoma.
• Increase the risk of invasive ductal carcinoma by five folds.
• Surgery:
• Lumpectomy + Radiation +/- Hormonal therapy.
• Mastectomy with SLNB.
24. DCIS
• Indication for surgery in DCIS:
• Area of DCIS is large relative to breast size.
• Large lesion.
• Failed negative margin.
• Contraindication to XRT.
26. Staging
• TNM:
• Tis: Ductal carcinoma in situ.
• T1: Tumor <=2cm.
• T2: Tumor 2-5cm.
• T3: Tumor >5cm.
• T4: any size with extension to adjacent structure.
27. Staging
• TNM:
• N1= Metastasis to mobile ipsilateral Level I and II.
• N2= Metastasis to matted or fixed ipsilateral level I and II.
• N3= Metastasis to level III or infraclavicular.
• M1: No metastasis.
• M2: Metastasis.
28. Staging
• Stage I: T1.
• Stage III:
• Any N2.
• Any N3.
• Any T4.
• T3NI
• Anything between Stage II
29. Management
• Early stage: Stage I and II:
• Breast: BCS + XRT or Mastectomy +/- Post mastectomy XRT.
• Axilla: SLNB and/or ALND.
• Adjuvant treatment:
• XRT.
• Chemotherapy.
• Hormonal therapy.
