Recommended
More Related Content
What's hot
What's hot (20)
Similar to breast.pptx
Similar to breast.pptx (20)
More from WinstonM3
More from WinstonM3 (20)
Recently uploaded
Recently uploaded (20)
breast.pptx
- 1. BENIGN AND MALIGNANT BREAST CONDITIONS Dr Winston Makanga, M.B.Ch.B, M.MEd (Surg) Consultant General and Laparoscopic Surgeon
- 2. Objectives of the lecture • Anatomy • Classification • Benign disease • Cancer of the breast
- 3. Anatomy • Skin appendage with glandular tissue • Axillary tail • Ligament of cooper • Nipple areolar complex • Nodal drainage (anterior, posterior, lateral) • Sentinel node
- 4. • Premenstrual rise of estrogen • Ovulation • Progesterone rise • Failure of implantation and menses • Drop in both E2 and P2 leads to cyclic involution • ANDI = abberations of normal development and involution • Cysts • Fibrosis • Epithelial hyperplasia • Papilomatosis
- 5. Benign • Proliferative vs non proliferative • Fibrocystic disease • Fibroademoma • Traumatic fat necrosis • Gynecomastia • Galactocele • Infection/inflammation • Mastitis • Breast abscess • Periductal mastitis
- 6. Borderline • Phyllodes tumor • Intraductal papilloma
- 7. Malignant disease • Ductal carcinoma • Lobular carcinoma • Paget’s disease
- 8. Syndromic presentations • Lump • Cyst • Hematoma or traumatic fat necrosis (TFN) • Fibroadenoma • Fibroadenosis • Cancer • Discharge • Galactorrhea • Intraductal papilloma or carcinoma • Ductectasia • Fibrocystic disease • Pagets disease • Infection = periductal mastitis • Invasive carcinoma
- 9. Syndromic • Breast pain • Cyclic Mastalgia • Noncyclic mastalgia • Fibroadenosis • Skin disease • Eczema • Paget’s disease
- 10. Mastalgia • Cyclic • Bilateral, worst premenstrually • <35 yo • Caffeine, fats, OCP, HRT • Rx – NSAIDs, primrose oil, danazol, GnRH agonists, tamoxifen • Non cyclic • Fibrocystic dx, abscess, cancer, non breast conditions • Rx: primary dse, NSAIDS • ***must investigate***
- 11. Traumatic fat necrosis • Post trauma – blunt or surgical • May present as painless mass • Risk is in its mimicry of ca breast • Should resolve with time • Radiologic evidence of cyst or scar • Rx: triple assessment to r/o malignancy then excision biopsy
- 12. Mastitis and breast abscess • Acute mastitis • Lactational • Cellulitis progressing to abscess • Staph aureus • If non-lactational; usually strep, bacteroides, enterococci – in immune suppressive conditions • Pain, erythema, tenderness, swelling, fever, tachycardia • Abscess : progression from mastitis – fluctuance, pointing • Rx: antibiotics, analgesics, needle aspiration, IND
- 13. Ductectasia • Involutional changes in menopause • Unusual dilatation of terminal ducts with collection of secretions • P/W dischcharge • Secondary infection may occur • Diagnosis by US or ductography • Rx: complex ductectomy
- 14. Cystic disease • Perimenopausal • Metaplasia of epithelium with obstruction of ductal/lobular outflow • P/W acute/ sub-acute painful tender cystic masses • May have a small risk of ca breast • Diagnosis U/S • Rx – aspiration or excision
- 15. Fibroadenoma • Arise from lobule with a mix of glandular and stromal content • No risk of malignancy • Age 15-35 • Painless firm, discreet, mobile breast lump – single or multiple • Diagnosis: US, FNA, core biopsy • Rx: rule of thirds. Excise if increasing in size, painful, patient request
- 16. Gynecomastia • Proliferation of breast male tissue • Physiologic vs pathologic, true vs pseudogynecomastia • Causes: drugs: digoxin, spironolactone, cimetidine, estrogens, cirrhosis, renal failure, hypogonadism, adrenal/testicular tumours, idiopathic • Diagnosis: US… must r/o malignancy and underlying cause • Rx: observe, liposuction, excision
- 17. Ductal papilloma • Epithelial proliferation in the large subareolar ducts • Single or multiple • P/W spontaneous serous or bloody discharge • Increased risk of cancer • Diagnosis: US, ductography • Rx: microductectomy
- 18. Phyllodes tumor • Presentation similar to fibroadenoma but…. • Age: 40 – 50 • Generally larger in size >5cm and do not involute • Have a spectrum from low to high grade • Rarely mets but may locally invade/recur • Diagnosis: US, mammo, core biopsy • Rx: depends on size… must get a 1-2 cm margin; mastectomy if necessary
- 19. Paget’s disease • Eczema of nipple-areolar complex with underlying intraductal carcinoma • P/W: erythema, Scaling, Itching, Ulceration, discharge, bleeding • Diagnosis: incisional biopsy, Mammo to R/o multifocality • Rx: partial excision in limited disease, modified radical mastectomy in extensive disease.. With or without adjuvant chemo/radio
- 20. BREAK
- 21. Invasive carcinoma • Preceded by carcinoma in situ = DCIS* • Breach of basement membrane = invasive disease • Can be ductal or lobular carcinoma LCIS is more of a marker of risk rather than disease per se
- 22. Risk factors NO RISK INCREASED RISK
- 23. Gail model
- 24. Pathology • In situ carcinoma – no breach of basement membrane (LCIS, DCIS) • Ductal carcinoma – arises from the epithelium of the ducts • Lobular carcinoma – epithelium of the lobules • Inflammatory carcinoma – blockage of lymphatics with malignant cells causing swelling
- 25. Spread • Local • Skin • Chest wall • Nodal • Axillary • Lateral, anterior, posterior, central, apical • Internal mammary • Subclavian • Distant • Bones: vertebrae, ribs, femur, skull • Liver • Lung • Brain
- 26. Presentation • Hard lump • Nipple retraction • Discharge • Peau d’orange • Fixation of breast • Ulcerating mass
- 27. Staging • Manchester clinical staging
- 28. TNM • Tumor • T1 - <2cm • T2 – 2-5 cm • T3 - >5 cm • T4 – attaches to chest wall or ulcerates the skin • Nodes • N1 • N2 • Metastasis • M0 – no mets • M1 – distant mets
- 29. Investigation • FHG, LFT, CXR • Triple assessment = clinical, radiologic, biopsy • Histology should include E2, P2, HER2 • Ultrasound if <35 years • Mammogram • Irregular diffuse margins, spiculated • Clustered microcalcifications • Large nodes • Assess for multifocal/multicentric disease • MRI breast • Staging CT • Abdominal Ultrasound • Bone scan
- 30. Management • Surgery • Breast conservation • MRM • Palliative mastectomy • Chemotherapy • Neoadjuvant, adjuvant or sandwitch • CDF, CMF, second line: taxanes • Radiotherapy • In combination with chemo – if <2mm • Local vs axillary (extensive nodal disease) • Endocrine therapy • Targeted therapy
- 31. Prognostication • Axillary spread • Tumor size • Tumor grade • Perineural and lymphovascular invasion • Estrogen, Progesterone, HER 2 neu status Nottingham prognostic Index
- 32. Review • Anatomy • Classification • Benign disease • Cancer of the breast