Breast cancer diagnosis staging screening....koustav

1,856 views

Published on

COMMONEST CANCER AMONG FEMALE IN INDIA.....SEMINER PRESENTED IN MEDICAL COLLEGE & HOSPITAL, KOLKATA ..

Published in: Education
1 Comment
10 Likes
Statistics
Notes
No Downloads
Views
Total views
1,856
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
171
Comments
1
Likes
10
Embeds 0
No embeds

No notes for slide

Breast cancer diagnosis staging screening....koustav

  1. 1. LYMPHATIC DRAINAGE, DIAGNOSIS,TNM CLASSIFICATION OF BREASTCANCER Dr. KOUSTAV MAZUMDER MD PGT, DEPT of RADIOTHERAPY MEDICAL COLLEGE & HOSPITAL, KOLKATA
  2. 2. • Breast cancer may be one of the oldest known forms of cancerous tumors in humans.• The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.• The French surgeon Jean Louis Petit (1674–1750) and later the Scottish surgeon Benjamin Bell (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle .• Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882• The first case-controlled study on breast cancer epidemiology was done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health
  3. 3. • LYMPHATIC DRAINAGE• DIAGNOSIS• TNM CLASSIFICATION
  4. 4. SUPLACLAVICULAR LN INTERNAL MAMMARY LNAXILLARYLN AXILLARY LN
  5. 5. LEVEL III LEVEL IILEVEL I
  6. 6. Axillary vein Central Axillary Nodes Apical axillary nodes Lateral Axillary Anterior Nodes axillary nodesPosterior PectoralisAxillary nodes minor Lateral Thoracic vein Subscapular vein
  7. 7. Pectoralis minor Pectoralis major Interpectoral node Internal mammary node
  8. 8. LYMPHTIC DRAINAGE OF BREASTDraining the PARENCHYMA Draining the overlying SKIN except of BREAST AREOLA and NIPPLEIncluding AREOLA and NIPPLE
  9. 9. Draining the overlying SKIN except AREOLA and NIPPLE SupraclavicularInfraclavicula LN LN Internal mammary LNAxillary LN Anterior abdominal wall
  10. 10. Draining the overlying SKIN except AREOLA and NIPPLE SupraclavicularInfraclavicula LN LN Internal mammary LNAxillary LN Subperitoneal lymphatic plexus Sub Diaphragmatic Hepatic Nodes node
  11. 11. Draining the PARENCHYMA of BREAST Including AREOLA and NIPPLE Chest wallSubareolar plexusof sappay Pectoralis major lobules nipple areola Lymphatic Lake of Haller Lactiferous duct Retromammary fat
  12. 12. Draining the PARENCHYMA of BREAST Including AREOLA and NIPPLE SupraclavicularInfraclavicula LN LN Internal mammary LNAxillary LN 75%
  13. 13. Draining the PARENCHYMA of BREAST Including AREOLA and NIPPLE SupraclavicularInfraclavicula LN LN Internal mammary LNAxillary LN
  14. 14. •LYMPHATIC DRAINAGE•DIAGNOSIS
  15. 15. SCREENING• CLINICAL BREAST EXAMINATION• BREAST AWARENESS• RADIOLOGICAL INVESTIGATION
  16. 16. MAMMOGRAPHYBI-RADS (Breast Imaging Reporting And Data System)
  17. 17. PERFORMS=PERsonal perFORmance inMammographic Screening
  18. 18. SCREENING GUIDELINE in NCCN 2012 Woman at normal risk Woman at increased risk •Prior Thoracic irradiation •>35 yrs20-39 yrs >40 yrs •Lifetime risk >20%•CBE every 1-3 yrs •Annual CBE •F/H or genetic predisposition•Breast awareness •Breast awareness •LCIS/ Atypical hyperplasia •Mammography •H/O Breast Cancer
  19. 19. DIAGNOSIS• HISTORY & CLINICAL EXAMINATION• RADIOLOGICAL EVALUATION• BIOPSY
  20. 20. RADIOLOGICAL EVALUATION• Diagnostic Mammography Spot compression view or magnifiacation view• Breast ultrasonography woman< 30 yrs of age, woman>30 yrs age (BIRADS 1-3) spontaneous nipple discharge/ skin change BIRADS category 0• Diagnostic Breast MRI BIRADS 1-3, IBC
  21. 21. BREAST BIOPSY• Fine needle aspiration(FNA) Biopsy• Core needle Biopsy Non palpable lesion• Excisional Biopsy Atypical hyperplasia, LCIS, mucin producing tumor, Phylloids• Duct excision(with or without ductography) Non sponteneous discharge from duct with BIRADS 1-3
  22. 22. Guidelines for the basic elements of a pathology report for breast cancerhave been established by the College of American Pathologists
  23. 23. • LYMPHATIC DRAINAGE• DIAGNOSIS• TNM CLASSIFICATION
  24. 24. • PRIMARY TUMOR (T)• REGIONAL LYMPH NODE(N)• DISTANT METASTASES(M)
  25. 25. PRIMARY TUMOR (T)REGIONAL LYMPH NODE(N) CLINICAL PATHOLOGICAL
  26. 26. N1Metastasis to movable ipsilateral level I, II axillary lymph node(s)
  27. 27. N2aMetastasis in ipsilateral level I, II axillary lymph nodes fixed toone another (matted) or to other structures
  28. 28. N2bMetastasis only in clinically detected ipsilateral internal mammarynodes and in the absence of clinically evident level I, II axillary lymphnode metastasis
  29. 29. N3aMetastasis in ipsilateral infraclavicular lymph node(s)
  30. 30. N3bMetastasis in ipsilateral internal mammary lymph node(s) andaxillary lymph node(s)
  31. 31. N3cMetastasis in ipsilateral supraclavicular lymph node(s)
  32. 32. pN1aMetastasis in 1 to 3 axillary lymph nodes(atleast one >2 mm)
  33. 33. pN1bMetastasis in internal mammary nodes with micrometastasis ormacrometastasis detected by SLNB but not clinically detected
  34. 34. pN1cMetastasis in 1 to 3 axillary lymph nodes and in internal mammary lymphnodes with micrometastasis or macrometastasis detected in SLNB but notclinically detected
  35. 35. pN2aMetastasis in 4 to 9 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm)
  36. 36. pN2bMetastasis in clinically detected internal mammary lymph nodes in theabsence of axillary lymph node metastases
  37. 37. pN3aMetastasis in 10 or more axillary lymph nodes(at least one tumor deposit >2 mm
  38. 38. pN3ametastasis to the infraclavicular (level III) lymph nodes
  39. 39. >1 pN3bMetastases in clinically detected ipsilateral internal mammary lymphnodes in the presence of 1 or more positive axillary lymph nodes
  40. 40. 2 pN3b more than 3 axillary lymph nodes and in internal mammary lymph nodeswith micrometastases or macrometastases detected by sentinel lymph nodebiopsy but not clinically detected
  41. 41. pN3cMetastasis in ipsilateral supraclavicular lymph nodes
  42. 42. • PRIMARY TUMOR (T)• REGIONAL LYMPH NODE(N)• DISTANT METASTASES(M)
  43. 43. Distant Metastasis (M)
  44. 44. Stage 0 Stage IIIA• Tis, N0, M0 T0, N2, M0 T1, N2, M0Stage IA T2, N2, M0• T1, N0, M0 T3, N2, M0 T3, N1, M0Stage IB•• T0, N1mi, M0 T1, N1mi, M0 Stage IIIB T4, N0, M0Stage IIA T4, N1, M0 T4, N2, M0• T0, N1, M0• T1, N1, M0• T2, N0, M0 Stage IIIC Any T, N3, M0Stage IIB• T2, N1, M0 Stage IV• T3, N0, M0 Any T, Any N, M1
  45. 45. HISTOLOGIC GRADE (G) ELSTON- ELLIS modification of SCARFF- BLOOM- RECHARDSON grading system• TUBULE FORMATION• NUCLEAR PLEOMORPHISM• MITOTIC COUNT

×