Modified Sweat gland Lies in the deep pectoral fascia Boundaries: clavicle superiorly, the lateral border of the latissimus muscle laterally, the sternum medially inframammary fold inferiorly

1. BREAST CANCER
Dr.Nidhi Ahya
Assistant Professor
Cardiovascular & Respiratory PT
DVVPF’s College of Physiotherapy,
Ahmednagar 414111
Dr.Nidhi Ahya(MPT-CVRPT) 1

2. OBJECTIVES
• Anatomy of Breast tissue
• Breast Cancer
• Risk Factors
• Signs & Symptoms
• Cancer Grading & Stages
• Treatment
Dr.Nidhi Ahya(MPT-CVRPT) 2

3. STRUCTURE
 clavicle superiorly,
 the lateral border of
the latissimus muscle
laterally,
 the sternum medially
 inframammary fold
inferiorly
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4. BLOOD SUPPLY
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 Perforating branches of
the internal mammary
arteries
the lateral thoracic arteries
 thoracoacromial arteries
posterior intercostal
arteries

5. LYMPH
NODES
AND
LYMPHATICS
75% -Axillary nodes
25% -internal
mammary
Carcinoma of breast
spreads mostly along
the lymphatic to the
regional lymph nodesDr.Nidhi Ahya(MPT-CVRPT) 5

6. MUSCULAR RELATIONS
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7. BREAST CANCER
• Abnormal mass of tissue, the growth of which
exceeds and is uncoordinated with that of the
normal tissues and persists in the same
manner after the cessation of stimuli which
evoked the change.
• Breast cancer is cancer originating in the
breast tissue.
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8. • WHO world cancer report 2009- 192370
women diagnosed with breast cancer
• About 13.7% deaths in women due to breast
cancer globally
• In India number of breast cancer cases is
1,15,000 per year and expected to rise to
2,50,000 new cases by 2015
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9. Risk factors
• Gender
• Increased age
• Family history
• Lack of child bearing or breast feeding
• Higher hormone levels
• Late age of menopause
• Alcohol
• Dense breast tissue
• Diethylstibesterol exposureDr.Nidhi Ahya(MPT-CVRPT) 9

10. Signs and Symptoms
• Lump in the breast
• Changes in the breast size or
shape
• Skin dimpling
• Nipple inversion
• Spontaneous discharge from
nipple
• Change in texture of the skin
• Pain Dr.Nidhi Ahya(MPT-CVRPT) 10

11. Types of Breast Cancer
• Non-invasive: ductal carcinoma in-situ
lobar carcinoma in-situ
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12. • Invasive : Invasive ductal carcinoma
Invasive lobar carcinoma
• Inflammatory breast cancer
• Phyllodes tumor
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13. Diagnosis
• Clinical Breast Examination
• Mammography
• Ultrasound
• MR imaging
• Fine Needle Aspiration &
Cytology ( FNAC)
• Core Biopsy
• Excisional biopsy
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14. MAMOGRAPHY
Mammography is a special
type of low-powered x-ray
technique
It gives detailed images of
the internal structure of
the breast.
High resolution
mammogram films can
demonstrate micro
calcifications smaller than
100μm
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15. ULTRASOUND IMAGING
Ultrasound is an adjunct
modality that can be used
in the assessment of a
breast cancer.
Its usefulness lies in its
ability to distinguish solid
from cystic lesions.
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16. Stages of Breast Cancer
• Staging of breast cancer done by using the
TNM classification
• The American Joint Committee on Cancer
recommends this classification
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17. Dr.Nidhi Ahya(MPT-CVRPT) 17

18. • Stage 0: non-invasive carcinoma or
carcinoma in situ
• Stages I and II: early
• Stage III: advanced; tumor > 2 cm across
and spread to underarm LNs or is extensive
in underarm LNs or spread to LNs near
breastbone or other tissue near breast
• Stage IV: spread beyond breast and
underarm LNs to other body parts
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19. Treatment
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SURGICAL
• Radical Mastectomy
• Modified Radical
Mastectomy
• Simple/Total
Mastectomy
• Breast Conserving
Surgery
CHEMOTHERAPY
• Neo-Adjunctive
Chemotherapy
• Adjunctive
Chemotherapy
• Chemotherapy for
Advanced
Metastatic Disease
RADIATION
• Intra-operative
Irradiation
• External beam
Radiotherapy
• Brachytherapy

20. Chemotherapy
• Treatment of cancer with one
or more cytotoxic anti-
neoplastic drugs.
• It can be either curative or
palliative
• It is often used in
conjugation with radiation
therapy or surgery
• Chemotherapeutic agents act
by killing cells that divide
rapidly- one of the main
properties of cancerous cells
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21. • Common combination of chemotherapy
regime for breast cancer patients is-
 Cyclophosphomide
 Methotraxate
 5-Flurouracil
• Drug Delivery-
Intravenous
 PVC
 CVC
 PICC
 IP
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22. • Treatment Strategies
 Induction therapy- for curative purpose as
the first line of treatment
 Neoadjunctive- chemotherapy given prior to
local treatment
 Adjunctive Chemotherapy- Given after a
local treatment or when little evidence or
suspicion about reoccurrence or subclinical
cancer is present
 Maintenance Chemotherapy- repeated low
dosage treatment given for prolong
remission
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23. Side effects of Chemotherapy:
• Immunosuppression and
myelosuppression
• Gastrointestinal distress
• Anemia
• Fatigue
• Hair loss
• Infertility
• Peripheral Neuropathy
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24. Radiation Therapy
• It involves medical use
of ionizing radiation,
used in cancer
treatment
• It can be used as a
curative, adjunctive or
palliative care
• Ionizing radiation work
by damaging the DNA
of cancerous tissues
leading to cellular
death.
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25. • Dossage is calculated in unit
Gray (Gy)
• It depends upon the type,
stage of cancer being treated
• For curative purpose typical
dose is between 60-80 Gy
For preventive or Adjunctive
purpose- 45- 60 Gy
• Treatment Methods:
 External beam radiation
therapy
 Brachytherapy
 Radioisotope therapy
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26. Dr.Nidhi Ahya(MPT-CVRPT) 26

27. Side effects of Radiation Therapy
• Acute-
Nausea,vomiting,damage to
epithelial cells, Lymphedma
or infertility
• Late- Fibrosis of exposed
tissue, Hair loss occur with
>30Gy and may br
permanent. May also lead to
dryness of mouth and eyes
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28. Radical Mastectomy
• Excision of
 complete breast tissue
 pectoral muscles
 axillary lymph nodes
 associated skin and
subcutaneous tissue
• Performed in case of
advanced last stage
breast cancer that has
invaded the muscle wall
under the breast tissue
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29. • Associated Post-operative Impairments:
 Incisional Pain
 Lymphedema due to removal of axillary
lymph nodes which disrupts the normal
circulation of lymph
 Weakness of horizontal adductors of the
shoulder, serratus anterior
 Postural asymmetry and dysfunction
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30. Modified Radical Mastectomy
• Excision of
 Entire breast tissue
 Fascia over the chest
muscles
 Axillary lymph nodes
• Pectoral muscles remain
intact
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31. • Benefits:
 Reduces cosmetic deformity
 Upper extremity dysfunction can be
prevented
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32. Simple/Total Mastectomy
• It involves surgical removal of entire breast
tissue, but lymphatic tissue and pectoral
muscles are preserved
• Involves a low to moderate risk of
Lymphedema due to post-operative radiation
therapy
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33. Breast Conserving Surgery
This involves –
 Lumpectomy- Surgical removal
of lump, margin of normal
tissue surrounding lump. May
include sampling or removal of
axillary lymph nodes.
 Segmental Mastectomy-
Excision of mass along with
some portion of breast tissue
 Quadrectomy – excision of
affected quadrant of the breast
tissue
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34. Breast Reconstruction
• Breast reconstruction is regarded as an integral
part of modern day breast cancer management
• Various techniques available include:
 Silicone Implants
 Lattissimus Dorsi myocutaneous flaps (LD)
 Transverse Rectus abdominus myocutaneous
flaps
( TRAM)
 Gluteal Free Flap

35. SUMMARY
• Anatomy of Breast tissue
• What is Breast Cancer
• Risk Factors
• Signs & Symptoms
• Cancer Grading & Stages
• Treatment
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