Carcinoma of the breast is the most common cause of cancer death in middle-aged women in western countries. In 2004, approximately 1.5 million new cases were diagnosed worldwide. In England and Wales, one in 12 women will develop breast cancer during their lifetime. The document discusses risk factors, clinical presentation, investigations, pathology, staging, prognosis, and treatment of breast cancer.
This document discusses uterine cancer, vulva and vagina cancer. It provides detailed information on:
1. Types of uterine cancers including endometrial carcinoma, leiomyosarcoma, and malignant mixed mullerian tumor. Risk factors, pathogenesis, classification and clinical presentations are described.
2. Gross and microscopic images of various uterine cancers like endometrial adenocarcinoma and leiomyosarcoma are shown along with summaries.
3. Vulvar cancer is defined and risk factors like HPV infection, aging, and conditions like VIN are explained. Clinical images show appearances of VIN lesions on the vulva.
This document provides an overview of breast cancer, including:
- Breast cancer develops from breast tissue and occurs when breast cells proliferate abnormally and invade surrounding tissues.
- Common symptoms include breast swelling, pain, skin changes, and lumps.
- Diagnostic tests include biopsy, imaging like mammography and MRI, and cancer marker blood tests.
- The most common types are ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and lobular carcinoma in situ (LCIS).
- Treatment depends on factors like hormone receptor status and may include targeted drugs, surgery, radiation, chemotherapy.
1. Breast carcinoma is classified based on histology, with invasive ductal carcinoma accounting for 70-85% of cases. Common risk factors include age, family history, and genetic mutations like BRCA1/2.
2. Presentation varies but may include a breast lump, nipple changes, or asymptomatic findings on screening. Diagnosis involves history, exam, and imaging tests.
3. Spread occurs via lymphatics to axillary nodes or bloodstream to distant sites like bone and lung. Prognosis depends on stage, with early-stage disease having better survival.
This document provides information about carcinoma of the breast, including:
- Breast cancer is the most common cancer in women and the second most common cause of cancer death. It affects 1 in 9 women in the US.
- Risk factors include family history, early menarche, nulliparity, late age of first childbirth, fibrocystic changes, hereditary factors like BRCA1/2 mutations, and lifestyle/environmental factors.
- Breast cancer is classified as non-invasive (in situ) or invasive. Invasive ductal carcinoma is the most common type, accounting for 80% of cases. Other types include invasive lobular carcinoma and rare histological variants.
- Staging
This document discusses cervical carcinoma stage IIIa and its treatment through a multidisciplinary approach. It describes the medical and paramedical teams involved, including gynecologists, oncologists, radiotherapists, nurses and social workers. The standard treatment is concurrent chemo-radiation therapy. Various disciplines work together to provide preventative, diagnostic, treatment and recovery care, with the goal of designating one person, such as an oncology nurse, to act as case manager and coordinate the patient's overall care.
The pathologist plays an important role in managing advanced breast cancer by confirming the metastatic nature of lesions, identifying the breast as the primary site, and re-evaluating the biological features and predictive markers of the tumor. Tumors can change over time and between primary and metastatic sites, with 3-28% of metastases showing changes in estrogen receptor expression and 3-25% showing changes in HER2 status. It is important to double check marker status when tumors progress or change in order to guide optimal treatment decisions.
Prognostic factors in carcinoma breast pptSwati Wadhai
Carcinoma of the breast is the most common malignancy and leading cause of death in women. Several prognostic factors are used to determine the severity and risk of recurrence of breast cancer, including patient age, tumor size and characteristics, lymph node involvement, histologic grade, and biomarkers like hormone receptor status. Combining these factors can provide prognostic groups that help guide treatment decisions. The sentinel lymph node biopsy procedure also helps predict the involvement of other lymph nodes and prognosis.
This document provides an overview of ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer. It discusses the pathology, risk factors, diagnosis via mammography and biopsy, grading, treatment options including surgery and radiation therapy, and management of recurrence of DCIS. DCIS is defined as a pre-invasive proliferation of epithelial cells confined to the breast ducts. Left untreated, DCIS has an inherent tendency to progress to invasive breast cancer.
This document discusses uterine cancer, vulva and vagina cancer. It provides detailed information on:
1. Types of uterine cancers including endometrial carcinoma, leiomyosarcoma, and malignant mixed mullerian tumor. Risk factors, pathogenesis, classification and clinical presentations are described.
2. Gross and microscopic images of various uterine cancers like endometrial adenocarcinoma and leiomyosarcoma are shown along with summaries.
3. Vulvar cancer is defined and risk factors like HPV infection, aging, and conditions like VIN are explained. Clinical images show appearances of VIN lesions on the vulva.
This document provides an overview of breast cancer, including:
- Breast cancer develops from breast tissue and occurs when breast cells proliferate abnormally and invade surrounding tissues.
- Common symptoms include breast swelling, pain, skin changes, and lumps.
- Diagnostic tests include biopsy, imaging like mammography and MRI, and cancer marker blood tests.
- The most common types are ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and lobular carcinoma in situ (LCIS).
- Treatment depends on factors like hormone receptor status and may include targeted drugs, surgery, radiation, chemotherapy.
1. Breast carcinoma is classified based on histology, with invasive ductal carcinoma accounting for 70-85% of cases. Common risk factors include age, family history, and genetic mutations like BRCA1/2.
2. Presentation varies but may include a breast lump, nipple changes, or asymptomatic findings on screening. Diagnosis involves history, exam, and imaging tests.
3. Spread occurs via lymphatics to axillary nodes or bloodstream to distant sites like bone and lung. Prognosis depends on stage, with early-stage disease having better survival.
This document provides information about carcinoma of the breast, including:
- Breast cancer is the most common cancer in women and the second most common cause of cancer death. It affects 1 in 9 women in the US.
- Risk factors include family history, early menarche, nulliparity, late age of first childbirth, fibrocystic changes, hereditary factors like BRCA1/2 mutations, and lifestyle/environmental factors.
- Breast cancer is classified as non-invasive (in situ) or invasive. Invasive ductal carcinoma is the most common type, accounting for 80% of cases. Other types include invasive lobular carcinoma and rare histological variants.
- Staging
This document discusses cervical carcinoma stage IIIa and its treatment through a multidisciplinary approach. It describes the medical and paramedical teams involved, including gynecologists, oncologists, radiotherapists, nurses and social workers. The standard treatment is concurrent chemo-radiation therapy. Various disciplines work together to provide preventative, diagnostic, treatment and recovery care, with the goal of designating one person, such as an oncology nurse, to act as case manager and coordinate the patient's overall care.
The pathologist plays an important role in managing advanced breast cancer by confirming the metastatic nature of lesions, identifying the breast as the primary site, and re-evaluating the biological features and predictive markers of the tumor. Tumors can change over time and between primary and metastatic sites, with 3-28% of metastases showing changes in estrogen receptor expression and 3-25% showing changes in HER2 status. It is important to double check marker status when tumors progress or change in order to guide optimal treatment decisions.
Prognostic factors in carcinoma breast pptSwati Wadhai
Carcinoma of the breast is the most common malignancy and leading cause of death in women. Several prognostic factors are used to determine the severity and risk of recurrence of breast cancer, including patient age, tumor size and characteristics, lymph node involvement, histologic grade, and biomarkers like hormone receptor status. Combining these factors can provide prognostic groups that help guide treatment decisions. The sentinel lymph node biopsy procedure also helps predict the involvement of other lymph nodes and prognosis.
This document provides an overview of ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer. It discusses the pathology, risk factors, diagnosis via mammography and biopsy, grading, treatment options including surgery and radiation therapy, and management of recurrence of DCIS. DCIS is defined as a pre-invasive proliferation of epithelial cells confined to the breast ducts. Left untreated, DCIS has an inherent tendency to progress to invasive breast cancer.
This document summarizes ductal carcinoma in situ (DCIS), a non-invasive breast cancer confined to the breast ducts. It discusses the increasing incidence of DCIS due to mammogram screening, challenges in management, histologic features, mammographic appearance, prognostic factors, and treatment options including observation, breast-conserving surgery with or without radiation, and mastectomy. Controversy remains regarding optimal treatment, with the goal being eradication of cancer and prevention of invasive breast cancer.
Histopathological dignosis of carcinoma of breastNazia Ashraf
This document discusses the pathogenesis, histopathology, diagnosis, and prognosis of breast carcinoma. It notes that breast cancer is the most common non-skin cancer in women. The major risk factors include hormone exposure, age of menarche/menopause, and family history/genetic factors. Biopsy procedures are used for diagnosis. There are different histological subtypes with varying characteristics, biomarkers, and clinical behaviors. Prognostic factors include tumor size and stage, lymph node involvement, and molecular subtype. Recent advances include identifying intrinsic subtypes and cancer stem cells.
Breast cancer is the most common cancer in women worldwide and the second most common cancer in Indian women. Staging and grading of breast cancer provides important prognostic information to help determine appropriate treatment and assess survival rates. The major prognostic factors include tumor size, lymph node involvement, and distant metastasis, with larger tumor size and presence of lymph node or distant metastases indicating poorer prognosis. Other minor prognostic factors like histological grade, hormone receptor status, and HER2 expression level also impact prognosis and treatment responses. Together, accurate staging and consideration of prognostic factors are essential for personalized treatment and evaluation of breast cancer outcomes.
This document provides an overview of cancer presented by Aditya Bhatt. It defines cancer as uncontrolled cell growth and discusses the properties of cancer cells, including immortality and rapid growth. The causes of cancer are described as chromosomal changes that can be caused by mutations from chemical carcinogens, physical carcinogens, viruses, and heredity. The types of cancer are outlined as carcinomas, sarcomas, lymphomas and leukemia. Risk factors are explored for different cancer types including social, psychological, dietary, viral and medical factors. The document concludes by previewing topics to be covered in part 2 such as colon cancer development and mutations in growth regulatory and tumor suppressor genes.
This document discusses breast cancer histopathology, including carcinoma in situ (LCIS and DCIS), invasive breast cancers (Paget's disease, medullary carcinoma, etc.), and breast cancer therapy approaches based on cancer type and stage. Key points include: LCIS and DCIS can be multicentric or multifocal; invasive cancers like invasive ductal carcinoma are the most common type; breast conservation is the standard treatment for early-stage cancers; and neoadjuvant therapy and endocrine therapy are options for locally advanced or metastatic cancers.
Breast cancer is the most common cancer in women, affecting 1 in 9 women in the United States. It usually presents as a solitary, painless lump that is detected by self-examination. The incidence is highest in perimenopausal women and is rare before age 25. While the majority of breast cancers are invasive ductal carcinomas, other types include invasive lobular carcinoma, tubular carcinoma, medullary carcinoma, and Paget's disease of the nipple. Risk factors include family history, early menarche, late first childbirth, and genetic mutations such as BRCA1 and BRCA2.
This document discusses breast cancer and is divided into multiple sections contributed by different medical students. The introduction provides epidemiological data on breast cancer worldwide and in India, noting an increasing incidence and average age of onset in India. Risk factors are then covered, including hormonal factors like early menarche and genetic factors such as BRCA gene mutations. The pathology section describes different types of breast cancers like ductal carcinoma in situ and infiltrating ductal carcinoma. Later sections discuss the clinical presentation, investigations including imaging, and staging of breast cancer.
1. Breast cancer is the most common cancer in women worldwide, accounting for 33% of all female cancers.
2. Risk factors include hormonal factors like early menarche, late menopause, and genetic factors such as mutations in the BRCA1 and BRCA2 genes.
3. Diagnostic tools include mammography, ultrasound, and MRI. Mammography is the standard screening tool but has limitations in detecting cancers in dense breasts or in young women. Ultrasound and MRI can help identify cancers not seen on mammography.
This document discusses carcinomas and precancerous conditions of the penis. It describes several precancerous conditions that have potential to develop into penile cancer, including penile intraepithelial neoplasia, balanitis xerotica obliterans, and Buschke-Lowenstein tumour. Squamous cell carcinoma is the most common type of penile cancer. Risk factors include age, pre-existing lesions, lack of circumcision, HPV infection, and smoking. Treatment involves surgery for the primary tumor as well as lymphadenectomy for lymph node involvement.
The document provides information on breast cancer, including its epidemiology, risk factors, classification, clinical features, diagnosis, and management. It states that breast cancer is the second most common cancer worldwide and the most common cancer among women in Nepal. Risk factors include family history, genetic mutations, reproductive factors, and breast density. Diagnosis involves history, physical exam, imaging like mammography, and biopsy. Treatment options are also discussed.
Cervical cancer is the fourth most common cancer in women globally, with over 500,000 new cases occurring in 2012. Certain strains of human papillomavirus (HPV), such as HPV-16 and HPV-18, are the primary cause of cervical cancer. HPV works by degrading tumor suppressor proteins and disrupting cell cycle regulation through its E6 and E7 proteins. Regular Pap smear screening can detect pre-cancerous lesions and reduce cervical cancer deaths by up to 80% by allowing for early treatment. Risk factors for cervical cancer include early age of first sexual intercourse, multiple sexual partners, low socioeconomic status, smoking, and HIV/AIDS.
A 46-year-old woman presented with a lump in her right breast. Mammography and ultrasound revealed a multi-lobulated mass with ductal extension and clustered microcalcifications in the right breast, along with enlarged lymph nodes. A biopsy was performed and the pathology results confirmed ductal carcinoma of low grade. Ductal carcinoma is the most common type of breast cancer, arising from the ducts of the breast. It is classified based on features like presence of central necrosis and differentiation. Treatment options include mastectomy or lumpectomy with radiation depending on the size and grade of the tumor.
This document summarizes key information about breast cancer epidemiology and pathology. It states that in 2006 there were approximately 429,900 new breast cancer cases and 131,900 deaths from breast cancer in Europe. Risk factors for breast cancer include being female, older age, family history, obesity, lack of physical activity, reproductive factors, and prior radiation exposure. Prognostic factors associated with worse outcomes include larger tumor size, lymph node involvement, higher histologic grade, lymphovascular invasion, and hormone receptor-negative or HER2-positive status. The TNM staging system is described.
This document presents a case summary of a 34-year-old woman who presented with a painless lump in her left breast and bloody nipple discharge. Examination found a 2x1.5 cm lump in the lower medial quadrant of the left breast. Diagnostic investigations including ultrasound, mammogram and FNAC confirmed infiltrating ductal carcinoma. The patient underwent microdochectomy and lumpectomy of the left breast lump, which showed infiltrating ductal carcinoma on histopathology. She subsequently had a modified radical mastectomy of the left breast, which showed no residual tumor but metastasis in 1 of 10 lymph nodes. This was diagnosed as stage II breast cancer.
This document summarizes a case series of 4 patients whose breast cancers were initially misdiagnosed as ductal carcinoma in situ (DCIS) but were later found to be invasive ductal carcinoma based on immunohistochemistry and lymph node involvement. In these cases, the cancers had a morphology that closely mimicked DCIS with central necrosis (comedo-type DCIS) but lacked a myoepithelial cell layer. Immunostains for myoepithelial markers were needed to correctly diagnose the cancers as invasive rather than DCIS and guide appropriate treatment. This case series highlights the importance of confirming DCIS diagnoses with immunohistochemistry to avoid misdiagnosing invasive breast cancers as non-invasive DCIS.
This document provides information about breast anatomy, noncancerous breast conditions, breast cancer, risk factors for breast cancer, staging of breast cancer, types of breast cancer, signs and symptoms of breast cancer, methods of detecting breast cancer including clinical examination, mammography, breast self-examination, serum tumor markers, sonogram, scintimammography, magnetic resonance imaging, positron emission tomography, fine-needle aspiration, and core-needle biopsy. It describes the components of the breast including lobes, ducts, lymph nodes, and their functions. It also outlines risk factors, types, staging, detection, and diagnosis of breast cancer.
This document provides an overview of chemotherapy for breast cancer. It begins by introducing breast cancer as the second leading cause of cancer deaths in women. It then discusses the history and improvements in diagnosis and treatment over the last 30 years, moving from radical mastectomies to more targeted surgical options. The rest of the document covers risk factors, clinical manifestations, diagnosis, various treatment options including surgery, radiation therapy, chemotherapy and hormone therapy, and side effects of treatment.
This document discusses a case of invasive cribriform carcinoma in a 63-year-old female patient. Key details include a lump found in the patient's left breast, enlarged lymph nodes found, and biopsy results showing invasive cribriform carcinoma. The document then provides information on cribriform carcinoma, including epidemiology, clinical features, microscopy, hormone receptor status, staging, prognosis, and molecular classification. Cribriform carcinoma has a generally favorable prognosis and is classified as a luminal A subtype.
Vulvar cancer accounts for about 4% of gynecologic cancers. The most common type is squamous cell carcinoma, which typically affects women ages 65-75. Risk factors depend on whether the cancer is related to HPV infection or vulvar dystrophy. Treatment involves surgical excision, with laser ablation and wide local excision being main options. Topical imiquimod and 5-fluorouracil can also be used to treat preinvasive high-grade lesions. Long-term surveillance after treatment is important due to the risk of recurrence.
Fibrocystic breasts are quite common in women, with over 50% experiencing some form of fibrocystic breast changes at one point or another. Doctors and medical professionals have actually stopped calling the condition a disease, but now merely refer to them as fibrocystic breast changes, as the condition does not really involve any serious risks that can cause it to be considered a disease.
This document summarizes ductal carcinoma in situ (DCIS), a non-invasive breast cancer confined to the breast ducts. It discusses the increasing incidence of DCIS due to mammogram screening, challenges in management, histologic features, mammographic appearance, prognostic factors, and treatment options including observation, breast-conserving surgery with or without radiation, and mastectomy. Controversy remains regarding optimal treatment, with the goal being eradication of cancer and prevention of invasive breast cancer.
Histopathological dignosis of carcinoma of breastNazia Ashraf
This document discusses the pathogenesis, histopathology, diagnosis, and prognosis of breast carcinoma. It notes that breast cancer is the most common non-skin cancer in women. The major risk factors include hormone exposure, age of menarche/menopause, and family history/genetic factors. Biopsy procedures are used for diagnosis. There are different histological subtypes with varying characteristics, biomarkers, and clinical behaviors. Prognostic factors include tumor size and stage, lymph node involvement, and molecular subtype. Recent advances include identifying intrinsic subtypes and cancer stem cells.
Breast cancer is the most common cancer in women worldwide and the second most common cancer in Indian women. Staging and grading of breast cancer provides important prognostic information to help determine appropriate treatment and assess survival rates. The major prognostic factors include tumor size, lymph node involvement, and distant metastasis, with larger tumor size and presence of lymph node or distant metastases indicating poorer prognosis. Other minor prognostic factors like histological grade, hormone receptor status, and HER2 expression level also impact prognosis and treatment responses. Together, accurate staging and consideration of prognostic factors are essential for personalized treatment and evaluation of breast cancer outcomes.
This document provides an overview of cancer presented by Aditya Bhatt. It defines cancer as uncontrolled cell growth and discusses the properties of cancer cells, including immortality and rapid growth. The causes of cancer are described as chromosomal changes that can be caused by mutations from chemical carcinogens, physical carcinogens, viruses, and heredity. The types of cancer are outlined as carcinomas, sarcomas, lymphomas and leukemia. Risk factors are explored for different cancer types including social, psychological, dietary, viral and medical factors. The document concludes by previewing topics to be covered in part 2 such as colon cancer development and mutations in growth regulatory and tumor suppressor genes.
This document discusses breast cancer histopathology, including carcinoma in situ (LCIS and DCIS), invasive breast cancers (Paget's disease, medullary carcinoma, etc.), and breast cancer therapy approaches based on cancer type and stage. Key points include: LCIS and DCIS can be multicentric or multifocal; invasive cancers like invasive ductal carcinoma are the most common type; breast conservation is the standard treatment for early-stage cancers; and neoadjuvant therapy and endocrine therapy are options for locally advanced or metastatic cancers.
Breast cancer is the most common cancer in women, affecting 1 in 9 women in the United States. It usually presents as a solitary, painless lump that is detected by self-examination. The incidence is highest in perimenopausal women and is rare before age 25. While the majority of breast cancers are invasive ductal carcinomas, other types include invasive lobular carcinoma, tubular carcinoma, medullary carcinoma, and Paget's disease of the nipple. Risk factors include family history, early menarche, late first childbirth, and genetic mutations such as BRCA1 and BRCA2.
This document discusses breast cancer and is divided into multiple sections contributed by different medical students. The introduction provides epidemiological data on breast cancer worldwide and in India, noting an increasing incidence and average age of onset in India. Risk factors are then covered, including hormonal factors like early menarche and genetic factors such as BRCA gene mutations. The pathology section describes different types of breast cancers like ductal carcinoma in situ and infiltrating ductal carcinoma. Later sections discuss the clinical presentation, investigations including imaging, and staging of breast cancer.
1. Breast cancer is the most common cancer in women worldwide, accounting for 33% of all female cancers.
2. Risk factors include hormonal factors like early menarche, late menopause, and genetic factors such as mutations in the BRCA1 and BRCA2 genes.
3. Diagnostic tools include mammography, ultrasound, and MRI. Mammography is the standard screening tool but has limitations in detecting cancers in dense breasts or in young women. Ultrasound and MRI can help identify cancers not seen on mammography.
This document discusses carcinomas and precancerous conditions of the penis. It describes several precancerous conditions that have potential to develop into penile cancer, including penile intraepithelial neoplasia, balanitis xerotica obliterans, and Buschke-Lowenstein tumour. Squamous cell carcinoma is the most common type of penile cancer. Risk factors include age, pre-existing lesions, lack of circumcision, HPV infection, and smoking. Treatment involves surgery for the primary tumor as well as lymphadenectomy for lymph node involvement.
The document provides information on breast cancer, including its epidemiology, risk factors, classification, clinical features, diagnosis, and management. It states that breast cancer is the second most common cancer worldwide and the most common cancer among women in Nepal. Risk factors include family history, genetic mutations, reproductive factors, and breast density. Diagnosis involves history, physical exam, imaging like mammography, and biopsy. Treatment options are also discussed.
Cervical cancer is the fourth most common cancer in women globally, with over 500,000 new cases occurring in 2012. Certain strains of human papillomavirus (HPV), such as HPV-16 and HPV-18, are the primary cause of cervical cancer. HPV works by degrading tumor suppressor proteins and disrupting cell cycle regulation through its E6 and E7 proteins. Regular Pap smear screening can detect pre-cancerous lesions and reduce cervical cancer deaths by up to 80% by allowing for early treatment. Risk factors for cervical cancer include early age of first sexual intercourse, multiple sexual partners, low socioeconomic status, smoking, and HIV/AIDS.
A 46-year-old woman presented with a lump in her right breast. Mammography and ultrasound revealed a multi-lobulated mass with ductal extension and clustered microcalcifications in the right breast, along with enlarged lymph nodes. A biopsy was performed and the pathology results confirmed ductal carcinoma of low grade. Ductal carcinoma is the most common type of breast cancer, arising from the ducts of the breast. It is classified based on features like presence of central necrosis and differentiation. Treatment options include mastectomy or lumpectomy with radiation depending on the size and grade of the tumor.
This document summarizes key information about breast cancer epidemiology and pathology. It states that in 2006 there were approximately 429,900 new breast cancer cases and 131,900 deaths from breast cancer in Europe. Risk factors for breast cancer include being female, older age, family history, obesity, lack of physical activity, reproductive factors, and prior radiation exposure. Prognostic factors associated with worse outcomes include larger tumor size, lymph node involvement, higher histologic grade, lymphovascular invasion, and hormone receptor-negative or HER2-positive status. The TNM staging system is described.
This document presents a case summary of a 34-year-old woman who presented with a painless lump in her left breast and bloody nipple discharge. Examination found a 2x1.5 cm lump in the lower medial quadrant of the left breast. Diagnostic investigations including ultrasound, mammogram and FNAC confirmed infiltrating ductal carcinoma. The patient underwent microdochectomy and lumpectomy of the left breast lump, which showed infiltrating ductal carcinoma on histopathology. She subsequently had a modified radical mastectomy of the left breast, which showed no residual tumor but metastasis in 1 of 10 lymph nodes. This was diagnosed as stage II breast cancer.
This document summarizes a case series of 4 patients whose breast cancers were initially misdiagnosed as ductal carcinoma in situ (DCIS) but were later found to be invasive ductal carcinoma based on immunohistochemistry and lymph node involvement. In these cases, the cancers had a morphology that closely mimicked DCIS with central necrosis (comedo-type DCIS) but lacked a myoepithelial cell layer. Immunostains for myoepithelial markers were needed to correctly diagnose the cancers as invasive rather than DCIS and guide appropriate treatment. This case series highlights the importance of confirming DCIS diagnoses with immunohistochemistry to avoid misdiagnosing invasive breast cancers as non-invasive DCIS.
This document provides information about breast anatomy, noncancerous breast conditions, breast cancer, risk factors for breast cancer, staging of breast cancer, types of breast cancer, signs and symptoms of breast cancer, methods of detecting breast cancer including clinical examination, mammography, breast self-examination, serum tumor markers, sonogram, scintimammography, magnetic resonance imaging, positron emission tomography, fine-needle aspiration, and core-needle biopsy. It describes the components of the breast including lobes, ducts, lymph nodes, and their functions. It also outlines risk factors, types, staging, detection, and diagnosis of breast cancer.
This document provides an overview of chemotherapy for breast cancer. It begins by introducing breast cancer as the second leading cause of cancer deaths in women. It then discusses the history and improvements in diagnosis and treatment over the last 30 years, moving from radical mastectomies to more targeted surgical options. The rest of the document covers risk factors, clinical manifestations, diagnosis, various treatment options including surgery, radiation therapy, chemotherapy and hormone therapy, and side effects of treatment.
This document discusses a case of invasive cribriform carcinoma in a 63-year-old female patient. Key details include a lump found in the patient's left breast, enlarged lymph nodes found, and biopsy results showing invasive cribriform carcinoma. The document then provides information on cribriform carcinoma, including epidemiology, clinical features, microscopy, hormone receptor status, staging, prognosis, and molecular classification. Cribriform carcinoma has a generally favorable prognosis and is classified as a luminal A subtype.
Vulvar cancer accounts for about 4% of gynecologic cancers. The most common type is squamous cell carcinoma, which typically affects women ages 65-75. Risk factors depend on whether the cancer is related to HPV infection or vulvar dystrophy. Treatment involves surgical excision, with laser ablation and wide local excision being main options. Topical imiquimod and 5-fluorouracil can also be used to treat preinvasive high-grade lesions. Long-term surveillance after treatment is important due to the risk of recurrence.
Fibrocystic breasts are quite common in women, with over 50% experiencing some form of fibrocystic breast changes at one point or another. Doctors and medical professionals have actually stopped calling the condition a disease, but now merely refer to them as fibrocystic breast changes, as the condition does not really involve any serious risks that can cause it to be considered a disease.
The document provides details about the anatomy, histology, development, disorders and examination of the breast. It describes that the breast is made up of glandular, fibrous and fatty tissue arranged into lobes and lobules that drain into lactiferous ducts. The blood supply comes from perforating branches of the internal mammary, intercostal and axillary arteries. Lymphatic drainage is primarily to axillary lymph nodes. Benign breast disorders include fibrocystic changes, fibroadenomas, cysts and infections. A proper breast examination involves inspection for symmetry and skin changes followed by palpation of the breasts, axillae and supraclavicular areas.
This document discusses various topics related to breast cancer risk assessment and management, including:
1. It describes several risk assessment tools used to evaluate a patient's risk of developing breast cancer based on factors like family history, age, biopsy history, and genetic factors.
2. It discusses various imaging modalities used in breast cancer screening and diagnosis, such as mammography, MRI, and molecular breast imaging.
3. It provides an overview of surgical options for breast cancer, including lumpectomy techniques, mastectomy approaches, and the use of breast-conserving therapy when possible.
Breast problems can include developmental issues, masses, infections, and cancers. The breast tissue contains glands, ducts, fat and connective tissue. Additional nipples or breasts can occur along the "milk line". During adolescence, asymmetric growth is normal and masses are usually benign. Changes occur during pregnancy like tender breasts and darkening nipples. Issues like mastitis (infection), nipple cracks, cyclic or non-cyclic pain, and discharges require evaluation. Benign breast conditions include cysts, fibroadenomas and fat necrosis. Breast cancer risk increases with age and family history.
Presentation1.pptx, radiological imaging of malignant breast diseases.Abdellah Nazeer
The document discusses various types of breast cancers and their radiological appearances. It begins by describing breast cancer in general, noting that it usually occurs in women and can begin in the ducts or lobules. It then summarizes the main types of breast cancers like ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, inflammatory breast carcinoma, and rare types like mucinous carcinoma and phyllodes tumor. For each type, it provides details on their clinical and radiological features like mammography and MRI appearances to aid in diagnosis.
Physiology of Pregnancy for Undergraduatesthezaira
The document summarizes the physiological changes that occur throughout a woman's body during pregnancy. Key changes include enlargement and increased blood flow to the uterus, breasts, and major organs. Other changes are weight gain and fluid retention, increased blood volume and altered metabolism to support the growing fetus. The various body systems also adapt to pregnancy through respiratory alkalosis, circulatory adjustments and neurological/hormonal responses.
The document provides information about the anatomy, histology, phases, pathology, and neoplasms of the breast. It discusses the normal lobule structure and phases of the breast. It describes different types of benign and malignant pathologies including cysts, inflammation, in situ and infiltrating carcinomas. It also lists risk factors and prognostic factors for breast cancer.
This document provides information on diagnosing pregnancy and antenatal care. Some key points include:
1. Pregnancy is usually diagnosed based on amenorrhea and a positive pregnancy test, but can be more complex for women with irregular periods. Other symptoms like nausea and breast changes may also indicate pregnancy.
2. Antenatal care aims to ensure the health of the mother and baby through regular checkups. Appointments become more frequent in the third trimester, with exams including measuring fundal height and listening for the fetal heartbeat.
3. Investigations done during antenatal visits include blood tests to check hemoglobin, blood type, and for infections. Ultrasounds are also used
This document discusses techniques for breast examination and signs of breast cancer. It describes various types of lumps, skin changes, and nipple disorders that may indicate breast cancer, including hard or soft lumps, skin dimpling or redness, nipple inversion or discharge. It also summarizes ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, and how cancer can spread through lymph or blood vessels. Risk factors like genetics, lifestyle, and environment that may contribute to breast cancer development are outlined. Diagrams depict breast anatomy and different stages of cancer progression.
Breast cancer is the second leading cause of death and second most common cancer in women. It occurs when abnormal cells in the breast grow in an uncontrolled way and form tumors. The breasts contain lobes and lobules which produce milk, connected by ducts. The two main types are ductal carcinoma, originating in the ducts, and lobular carcinoma, originating in the lobules. Risk factors include gender, age, family history, obesity, lack of exercise, alcohol consumption, and hormone therapy. Screening methods include breast self-exams, clinical exams by a doctor, and mammography. Treatment options depend on cancer stage and may involve surgery, radiation, chemotherapy, and hormone therapy. With early detection and treatment, the
This document provides information on carcinoma of the breast, including:
- Breast cancer is the most common cause of death in middle-aged women in western countries.
- Aetiological factors for breast cancer include geographical, age-related, genetic, dietary, endocrine, and previous medical history factors.
- Breast cancer can be diagnosed through clinical examination, imaging tests, and biopsy. Staging evaluation determines the extent of the cancer and is important for determining prognosis and appropriate treatment.
This document provides information on types and management of breast cancer. It discusses non-invasive and invasive breast carcinomas, including specific types like colloid carcinoma. Prognostic factors are described such as tumor grade and stage. Management of triple negative breast cancer is also covered, noting it is more aggressive and difficult to treat. A new vaccine study aims to prevent triple negative breast cancer.
Breast cancer is the most common cancer in women. There are several types including ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), and invasive ductal carcinoma. Treatment depends on cancer type and stage. For early-stage disease, lumpectomy with radiation or mastectomy are equivalent options. Lumpectomy is preferred for cosmetic reasons when possible. Reconstruction options are available for patients undergoing mastectomy.
This document discusses malignant tumors of the salivary glands. It covers risk factors like smoking, alcohol consumption and radiation exposure. It also discusses various types of salivary cancers like acinic cell carcinoma, mucoepidermoid carcinoma and adenoid cystic carcinoma. For each cancer, it describes characteristics like prevalence, presentation, histology, treatment options and prognosis. It highlights the importance of surgery and radiation therapy in treating these cancers. Molecular techniques are providing new insights but clinical applications are still limited.
Breast Carcinoma.
Breast cancer is a malignant (cancerous) tumor that starts in the cells of the breast and spread to other tissues.
The most common form of cancer among women
It is estimated that each year more than 83,000 cases of breast cancer are reported in Pakistan. Nearly 40,000 women die, just due to this deadly disease
Carcinoma of the breast occurs commonly in the western world,accounting for 3–5% of all deaths in women. In developing countries it accounts for 1–3% of death
The most common form of cancer among women
The second most common cause of cancer related mortality
1 of 8 women (12.2%)
Ovarian cancer is the second most common gynecological cancer. Risk factors include low parity, infertility, family history of breast or ovarian cancer, and genetic mutations. Symptoms are often vague until late stages. Most cancers are epithelial in origin and present at advanced stage III or IV at diagnosis, contributing to poor prognosis. Treatment involves surgical staging and tumor debulking followed by chemotherapy. Screening methods to improve early detection are still lacking.
This document discusses oncologic disorders and breast cancer. It provides details on carcinogenesis, cancer development and progression, breast cancer risk factors and presentation, diagnosis, staging, prognostic factors, and treatment approaches for early, locally advanced, and metastatic breast cancer. Treatment involves surgery, radiation, chemotherapy, endocrine therapy, targeted therapies, and palliation depending on the cancer stage and characteristics. The goal is cure for early-stage cancer and disease control for advanced or metastatic cancer through prolonging survival and improving quality of life.
The document discusses premalignant and malignant disorders of the uterine corpus, specifically endometrial carcinoma. It covers the epidemiology, risk factors, classification, clinical presentation, diagnosis, staging, prognosis, differential diagnosis, and treatment of endometrial carcinoma. The highest incidence is in white North Americans over age 60. Risk factors include obesity, diabetes, nulliparity, late menopause, and unopposed estrogen use. Diagnosis involves endometrial biopsy and ultrasound. Prognosis depends on stage - stage I has an 85% 5-year survival rate. Treatment involves hysterectomy, with radiation for higher stages or risk factors.
This document discusses malignant disease of the uterus, including endometrial cancer. It notes that there are two main types of endometrial cancer - type 1 and type 2. Type 1 cancers are more common, estrogen dependent, occur in younger women, and have a better prognosis. Type 2 cancers occur in older women, are less dependent on estrogen, and have a poorer prognosis. The document provides details on risk factors, symptoms, diagnosis, staging, histopathological classification, treatment including surgery and adjuvant therapies, survival rates, recurrence rates, and rare tumor types like adenosarcoma.
This document provides an overview of benign and malignant breast pathology, including:
1. It outlines the differences between symptomatic and screen-detected breast disease, and describes various types of benign breast disease like cysts, duct ectasia, and fibroadenomas.
2. It discusses risk factors for breast malignancy and the process of non-operative diagnosis using triple assessment and multidisciplinary review meetings.
3. The document covers types of breast cancer treatment and classifications like in situ versus invasive carcinoma, and explains prognostic indicators in invasive carcinoma like tumor grade and lymph node status.
Cervical cancer was once a leading cause of cancer death in women but screening has led to a 70% reduction in mortality. It is caused by persistent HPV infection and affects women mostly in their 50s-60s. Risk factors include lack of screening, multiple sexual partners, smoking, and HIV/AIDS. Early stages are often asymptomatic but can cause abnormal bleeding while advanced stages may invade nearby organs. Treatment depends on stage but may include surgery, radiation, and chemotherapy. Overall survival rates decline with more advanced stages and spread beyond the cervix.
This document discusses gallbladder tumors and cancer. It covers the epidemiology, etiology, pathology, clinical presentation, and radiologic investigation of gallbladder cancer. The key points are:
- Gallbladder cancer is the sixth most common cancer of the gastrointestinal tract. Surgical removal is the only potentially curative treatment but long-term survival is limited due to late diagnosis and early spread.
- Risk factors include chronic gallbladder inflammation from conditions like cholelithiasis. Tumors often invade locally into the liver and spread via lymph nodes and blood vessels at an early stage.
- Clinical presentation can include right upper quadrant pain, weight loss, jaundice, or an incidental finding after ch
This document discusses ovarian cancer, including its presentation, types, staging, and management. It notes that ovarian cancer is the second most common gynecological cancer and a major cause of death. Epithelial ovarian cancer accounts for about 90% of cases and often presents at an advanced stage with vague symptoms. Treatment typically involves surgery to remove as much of the tumor as possible followed by chemotherapy. The document reviews the different histological types of ovarian cancer and sex cord-stromal tumors and germ cell tumors, which each have distinct characteristics and management approaches focused on fertility preservation when possible.
This document discusses cervical cancer, including its incidence, risk factors, diagnosis, staging, treatment, and prognosis in Bangladesh. It notes that cervical cancer rates are high in Bangladesh due to lack of screening and various social risk factors. Diagnosis involves examination, biopsy, and imaging. Staging follows the FIGO system and considers tumor size and spread. Treatment options include surgery, radiation, chemotherapy, or combinations. Prognosis depends on stage, tumor size and type, age, lymph node involvement, and HPV status.
This document provides information about breast cancer including its epidemiology, risk factors, clinical examination, imaging, biopsy, pathology, staging, histological types, management of early and locally advanced breast cancer, and inflammatory breast cancer. Some key points include:
- Breast cancer is the most common cancer in women with a lifetime risk of 1 in 8.
- Risk factors include family history, late age of first pregnancy, obesity, radiation exposure, and genetic factors like BRCA1/2 mutations.
- Clinical examination involves inspection and palpation of the breasts and lymph nodes. Imaging includes mammography, ultrasound, and MRI.
- Biopsy is used to obtain a definitive diagnosis and can include fine needle aspiration
gynaecology.Carcinoma of the endometrium.(dr.rojan)student
Carcinoma of the endometrium is one of the most common gynecological cancers, especially in postmenopausal white women between the ages of 60-70. There is no effective screening program, but abnormal cervical smears or thickened endometrial lining on ultrasound may indicate further testing is needed. Risk factors include prolonged estrogen exposure without progesterone, obesity, nulliparity, and family history. Postmenopausal bleeding is the most common symptom. Diagnosis involves endometrial biopsy or hysteroscopy. Treatment options depend on staging and include surgery, radiation, chemotherapy, or hormonal therapy. Prognosis depends on stage, with 5-year survival rates ranging from 85% for stage
Colorectal cancer is the third most common cancer in the United States. The risk increases with age, with over 90% of cases being diagnosed in patients over 50 years old. Colorectal cancer can develop from pre-cancerous polyps through a process known as the adenoma-carcinoma sequence. Genetic and environmental factors can contribute to the development of colorectal cancer. Staging systems such as Dukes staging and TNM staging are used to determine the prognosis and appropriate treatment.
This document provides an overview of ovarian cancer, including definitions, anatomy, screening, epidemiology, symptoms, risk factors, types, classification, diagnosis, and treatment. It notes that ovarian cancer has no effective screening test and often presents at a late stage. The most common type is epithelial ovarian cancer, which mainly affects postmenopausal women. Diagnosis involves various tests and biopsy. Treatment typically involves surgical staging and debulking followed by chemotherapy for malignant cases.
Discovery of Merging Twin Quasars at z=6.05Sérgio Sacani
We report the discovery of two quasars at a redshift of z = 6.05 in the process of merging. They were
serendipitously discovered from the deep multiband imaging data collected by the Hyper Suprime-Cam (HSC)
Subaru Strategic Program survey. The quasars, HSC J121503.42−014858.7 (C1) and HSC J121503.55−014859.3
(C2), both have luminous (>1043 erg s−1
) Lyα emission with a clear broad component (full width at half
maximum >1000 km s−1
). The rest-frame ultraviolet (UV) absolute magnitudes are M1450 = − 23.106 ± 0.017
(C1) and −22.662 ± 0.024 (C2). Our crude estimates of the black hole masses provide log 8.1 0. ( ) M M BH = 3
in both sources. The two quasars are separated by 12 kpc in projected proper distance, bridged by a structure in the
rest-UV light suggesting that they are undergoing a merger. This pair is one of the most distant merging quasars
reported to date, providing crucial insight into galaxy and black hole build-up in the hierarchical structure
formation scenario. A companion paper will present the gas and dust properties captured by Atacama Large
Millimeter/submillimeter Array observations, which provide additional evidence for and detailed measurements of
the merger, and also demonstrate that the two sources are not gravitationally lensed images of a single quasar.
Unified Astronomy Thesaurus concepts: Double quasars (406); Quasars (1319); Reionization (1383); High-redshift
galaxies (734); Active galactic nuclei (16); Galaxy mergers (608); Supermassive black holes (1663)
Signatures of wave erosion in Titan’s coastsSérgio Sacani
The shorelines of Titan’s hydrocarbon seas trace flooded erosional landforms such as river valleys; however, it isunclear whether coastal erosion has subsequently altered these shorelines. Spacecraft observations and theo-retical models suggest that wind may cause waves to form on Titan’s seas, potentially driving coastal erosion,but the observational evidence of waves is indirect, and the processes affecting shoreline evolution on Titanremain unknown. No widely accepted framework exists for using shoreline morphology to quantitatively dis-cern coastal erosion mechanisms, even on Earth, where the dominant mechanisms are known. We combinelandscape evolution models with measurements of shoreline shape on Earth to characterize how differentcoastal erosion mechanisms affect shoreline morphology. Applying this framework to Titan, we find that theshorelines of Titan’s seas are most consistent with flooded landscapes that subsequently have been eroded bywaves, rather than a uniform erosional process or no coastal erosion, particularly if wave growth saturates atfetch lengths of tens of kilometers.
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆Sérgio Sacani
Context. The early-type galaxy SDSS J133519.91+072807.4 (hereafter SDSS1335+0728), which had exhibited no prior optical variations during the preceding two decades, began showing significant nuclear variability in the Zwicky Transient Facility (ZTF) alert stream from December 2019 (as ZTF19acnskyy). This variability behaviour, coupled with the host-galaxy properties, suggests that SDSS1335+0728 hosts a ∼ 106M⊙ black hole (BH) that is currently in the process of ‘turning on’. Aims. We present a multi-wavelength photometric analysis and spectroscopic follow-up performed with the aim of better understanding the origin of the nuclear variations detected in SDSS1335+0728. Methods. We used archival photometry (from WISE, 2MASS, SDSS, GALEX, eROSITA) and spectroscopic data (from SDSS and LAMOST) to study the state of SDSS1335+0728 prior to December 2019, and new observations from Swift, SOAR/Goodman, VLT/X-shooter, and Keck/LRIS taken after its turn-on to characterise its current state. We analysed the variability of SDSS1335+0728 in the X-ray/UV/optical/mid-infrared range, modelled its spectral energy distribution prior to and after December 2019, and studied the evolution of its UV/optical spectra. Results. From our multi-wavelength photometric analysis, we find that: (a) since 2021, the UV flux (from Swift/UVOT observations) is four times brighter than the flux reported by GALEX in 2004; (b) since June 2022, the mid-infrared flux has risen more than two times, and the W1−W2 WISE colour has become redder; and (c) since February 2024, the source has begun showing X-ray emission. From our spectroscopic follow-up, we see that (i) the narrow emission line ratios are now consistent with a more energetic ionising continuum; (ii) broad emission lines are not detected; and (iii) the [OIII] line increased its flux ∼ 3.6 years after the first ZTF alert, which implies a relatively compact narrow-line-emitting region. Conclusions. We conclude that the variations observed in SDSS1335+0728 could be either explained by a ∼ 106M⊙ AGN that is just turning on or by an exotic tidal disruption event (TDE). If the former is true, SDSS1335+0728 is one of the strongest cases of an AGNobserved in the process of activating. If the latter were found to be the case, it would correspond to the longest and faintest TDE ever observed (or another class of still unknown nuclear transient). Future observations of SDSS1335+0728 are crucial to further understand its behaviour. Key words. galaxies: active– accretion, accretion discs– galaxies: individual: SDSS J133519.91+072807.4
Mapping the Growth of Supermassive Black Holes as a Function of Galaxy Stella...Sérgio Sacani
The growth of supermassive black holes is strongly linked to their galaxies. It has been shown that the population
mean black hole accretion rate (BHAR) primarily correlates with the galaxy stellar mass (Må) and redshift for the
general galaxy population. This work aims to provide the best measurements of BHAR as a function of Må and
redshift over ranges of 109.5 < Må < 1012 Me and z < 4. We compile an unprecedentedly large sample with 8000
active galactic nuclei (AGNs) and 1.3 million normal galaxies from nine high-quality survey fields following a
wedding cake design. We further develop a semiparametric Bayesian method that can reasonably estimate BHAR
and the corresponding uncertainties, even for sparsely populated regions in the parameter space. BHAR is
constrained by X-ray surveys sampling the AGN accretion power and UV-to-infrared multiwavelength surveys
sampling the galaxy population. Our results can independently predict the X-ray luminosity function (XLF) from
the galaxy stellar mass function (SMF), and the prediction is consistent with the observed XLF. We also try adding
external constraints from the observed SMF and XLF. We further measure BHAR for star-forming and quiescent
galaxies and show that star-forming BHAR is generally larger than or at least comparable to the quiescent BHAR.
Unified Astronomy Thesaurus concepts: Supermassive black holes (1663); X-ray active galactic nuclei (2035);
Galaxies (573)
Anti-Universe And Emergent Gravity and the Dark UniverseSérgio Sacani
Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional ‘dark’ gravitational force describing the ‘elastic’ response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton’s constant and the Hubble acceleration scale a0 = cH0, and provide evidence for the fact that this additional ‘dark gravity force’ explains the observed phenomena in galaxies and clusters currently attributed to dark matter.
Physics Investigatory Project on transformers. Class 12thpihuart12
Physics investigatory project on transformers with required details for 12thes. with index, theory, types of transformers (with relevant images), procedure, sources of error, aim n apparatus along with bibliography🗃️📜. Please try to add your own imagination rather than just copy paste... Hope you all guys friends n juniors' like it. peace out✌🏻✌🏻
Embracing Deep Variability For Reproducibility and Replicability
Abstract: Reproducibility (aka determinism in some cases) constitutes a fundamental aspect in various fields of computer science, such as floating-point computations in numerical analysis and simulation, concurrency models in parallelism, reproducible builds for third parties integration and packaging, and containerization for execution environments. These concepts, while pervasive across diverse concerns, often exhibit intricate inter-dependencies, making it challenging to achieve a comprehensive understanding. In this short and vision paper we delve into the application of software engineering techniques, specifically variability management, to systematically identify and explicit points of variability that may give rise to reproducibility issues (eg language, libraries, compiler, virtual machine, OS, environment variables, etc). The primary objectives are: i) gaining insights into the variability layers and their possible interactions, ii) capturing and documenting configurations for the sake of reproducibility, and iii) exploring diverse configurations to replicate, and hence validate and ensure the robustness of results. By adopting these methodologies, we aim to address the complexities associated with reproducibility and replicability in modern software systems and environments, facilitating a more comprehensive and nuanced perspective on these critical aspects.
https://hal.science/hal-04582287
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
1. Carcinoma of the breast: is the most
common cause of death in middle aged
women in western countries. In 2004
approximately one and half million new
cases were diagnosed worldwide. In
England and Wales one in 12 women
will develop the disease during their life
time.
2.
3.
4. • (1) Geographical: it occurs most commonly in
western world, accounting 3-5% of all death in
women. In developing countries it accounts for
1-3% of death.
• (2) Age: it is extremely rare below the age of 20
years but thereafter the incidence steadily rise
that by the age of 90 years nearly 20% of
women are affected.
• (3) Gender: it is less than 0.5% of patients with
breast cancer are male.
5. • (4) Genetics: it occurs more commonly in
women with a family history of breast cancer
than in general population. Breast cancer
related to specific mutation account for about
5% of breast cancer.
• (5) Diet: there is some evidence that there is a
link with diets low in phytoestreogen, a high
intake of alcohol is associated with increase risk.
Diets are recommended are walnut, broccoli,
peach and curcuma.
6.
7. • (6) Endocrine: it is more common in
nulliparous women and breast feeding in
particular approved to be protective. Also
protective in having a first child at an early
age, especially if associated with late
menarche and early menopause. It is known
that in postmenopausal, breast cancer is
more in obese. This is thought to be because
of increased conversion of steroid hormone
to oestrodiol in the body fat.
8. • (7) previous radiation; this was considered to be
historical interest, with the majority of women
exposed to the atomic bombs at Hiroshima and
Nagasaki having dead, again using of utilized
uranium in Iraq war play a role in this disease. It
is, however a real problem in women who have
been treated with mantle radiotherapy as a part of
the management of Hodgkin lymphoma disease, in
which significant dose of radiation is received.
The risk appears about decade after treatment and
is higher if radiotherapy occurred during breast
development.
9.
10. • Pathology: breast cancer may arise from the
epithelium of the duct system anywhere from the
nipple end of major lactiferous ducts to the
terminal duct unit, which is in breast lobule. The
disease may be entirely in situ, an increasingly
common finding with the advent of breast cancer
screening or may be invasive cancer. The degree of
differentiation of the tumor is usually described
using three grades as well differentiation,
moderately differentiation or poorly differentiation.
Commonly numerical grading system based on the
scoring of the three individual factors (nuclear
pleomorphism, tubular formation, and mitotic rate)
is used in grade 111 cancers roughly equating the
poorly differentiated group.
11.
12. • Previously, descriptive terms were used to
classify breast cancer scirrhous meaning woody
or medullary meaning brain like. More recently
histological descriptions have been used.
however with the increasing application of
molecular markers there will be a change in the
way that the breast cancers are classified, and it
is likely that much more information about
individual tumor will be routinely reported, such
as its likelihood of metastases, and to which
therapeutic agents it will be susptible. Gene
array analysis of breast cancer has identified five
subtypes. Some of these correlate with known
markers such as estrogen receptor status.
13. • Current nomenclature: ductal carcinoma: is
the most variant with lobular carcinoma
occurring about 15% of cases, there are
subtypes of lobular carcinoma including the
classical type which carries a better prognosis
than the pleomorphic type, occasionally
pictures may be mixed with both ductal and
lobular features. There are different pattern
of spread depending on histological type.
14. • If there is doubt whether as tumor is
predominantly lobular in type,
immunohistochemical analysis using the e-
cadherin antibody which reacts positively in
lobular carcinoma will help in diagnosis. Rare
histological variants, usually carrying a better
prognosis, include colloid carcinoma whose
cells produce a abundant mucin.
15. • . Medullary carcinoma with solid sheets of
large cells usually associated with a marked
lymphocytic reaction. Invasive lobular
carcinoma is commonly multifocal and or
bilateral. Cases detected via screening
program are often smaller and better
differentiation than those presenting to
symptomatic and are of a special type.
16.
17. • Cases detected via screening program are
often smaller and better differentiation than
those presenting to symptomatic and are of a
special type. Inflammatory carcinoma is a
fortunately rare, highly aggressive that
present as painful swollen breast which is
warm with cutanous edema; this is result of
blockage of the subdermal lymphatics with
cancer cells. Inflammatory carcinoma usually
involves at least 1l3 of the breast and may
mimic breast abscess.
18. • A biopsy will confirm the diagnosis and show
undifferentiated cells, it used to be rapidly
fatal but with aggressive chemotherapy and
radiotherapy and with salvage surgery the
prognosis has improved considerably. In situ
carcinoma is a preinvasive cancer that has
not breached the epithelium basement
membrane.
19.
20. • This was previously a rare usually asymptomatic,
finding in breast biopsy specimens but is becoming
increasingly common because of the advent of
mammographic screening. In situ carcinoma may be
ductal (DCIS) or lobular (LCIS). The latter is often
being multifocal and bilateral. Both are markers for
later development of invasive cancers which will
develop in at least 20% of patients. Although
mastectomy is curative, this constitutes
overtreatment in many cases. The best treatment for
carcinoma in situ is depend if it is a high grade tumor
treated by excision and radiotherapy, whereas those
of low grade whose tumor completely excised need
no further treatment.
21. • Staining for estrogen and progesterone receptors is
now considered routine, as their presence will
indicate the use of adjuvant hormone therapy with
tamoxifin or the newer aromatase inhibitors as
anastrazole. Tumors also stained foe c- erb2( a growth
factor receptor)as patients who are positive can be
treated with monoclonal antibody as trastuzumab
(herciptin) either in the adjuvant or relapse sitting.
The pathologist is an important member of breast
cancer team (MDT) and will increasingly help decide
which adjuvant therapies will be appropriate.
22. • Paget's disease of the nipple: is a superficial
manifestation of underlying disease of the breast
carcinoma. It presents as eczema- like condition of
the nipple and areola which persists despite local
treatment. The nipple is eroded slowly and eventually
disappears. If it left the underlying carcinoma will
sooner or later become clinically evident. Nipple
eczema should biopsied if there any doubt of its
cause. Microscopically Paget's disease characterized
by the presence of a large ovoid cells with abundant,
clear, pale staining cytoplasm in malpighian layer of
the epithelium.
23.
24.
25.
26. • Spread of the breast cancer:
• (1) Local spread: the tumor increases in size
and invade other portion of the breast. It
tends to involve the skin and to penetrate the
pectorals muscles and even the chest wall if
diagnosed later.
27. • (2) Lymphatic metastasis: it occurs primarily to
axillary and internal mammary lymph nodes. A
tumor in the posterior one third tends to spread
to internal mammary lymph nodes. The
involvements of lymph nodes have both
biological and chronological event in the spread
of carcinoma and it also a marker of metastases
potential of that tumor. Involvement of the
supraclavicular lymph nodes and of any of the
contra lateral breast represents advanced
disease.
28.
29.
30.
31. • (3) Blood streams: it is by this route skeletal
metastases occur. In order of the frequency
the lumbar vertebrae, femur, thoracic
vertebrae, rib and skull are affected and
these deposits are generally osteolytic.
Metastases may also commonly occur in the
liver, lung, brain, and occasionally adrenal
glands and ovaries.
32.
33.
34.
35. • Clinical presentation: although any portion of
the breast including axillary tail may be
involved breast cancer is found most
frequently in the upper outer quadrant most
carcinoma will present as a hard lump which
may be associated with indrawing of the
nipple, as the disease advances locally there
may be skin involvement with peau d orange
or frank ulceration and fixation to the chest
wall.
36.
37.
38. • This is described as cancer en-cuirasses when
disease progress around chest wall. About 5%
carcinoma in UK presented as locally
advanced or symptoms of metastatic disease
this figure is much higher in developing
countries. These patients under goes staging
evaluation so this will include a careful
clinical examination, chest x-ray, CT scan
chest and abdomen and isotope scan, bone
scan.
39. • This will be important for both prognosis and treatment. A
patient with wide spread visceral metastases may obtain
an increased length and quality of survival from systemic
hormone therapy or chemotherapy but is unlikely to
benefit from surgery as she will die from her metastases
before local disease becomes a problem. In contrast,
patients with relatively small tumors less than 5 mm in
diameter confined to the breast and ipsilateral lymph
nodes, rarely need staging beyond a good clinical
examination as puck up rate for distant metastases is so
low. Currently, a chest x-ray, full blood count , liver
function test are all that recommended for screening of
the patient with early breast cancer.
40. • Investigations: ( 1) mammaography: soft
tissue radiographs are taken by placing the
breast in direct contact with ultrasensitive
film and exposing it to low-voltage, high
amperage x-rays. The dose of radiation is
very low so it is a safe investigation. The
sensitivity of this investigation increases with
age as the breast becomes less dense. In
total, 5% of breast cancers are missed by
population –based mammographic screening
programme , even in retrospect , such
carcinoma are not apparent.
41.
42.
43. • . Thus, a normal mammogram does not
exclude the presence of carcinoma. Digital
mammography is being introduced, which
allow manipulation of the images and
computer aided diagnosis. Tomo-
mammography is also being assessed as a
more sensitive diagnostic modality.
44. • (2)ultrasound: ultrasound is particularly
useful in young women with dense breasts in
whom mammograms are difficult to
interprets, and in distinguishing cysts from
solid lesions. It also can be used to localize
impalpable areas of breast pathology. It is
useful as screening tool and remains operator
dependent. Increasingly, ultrasound of the
axillary tissue is performed when cancer is
diagnosed and guided percutaneous biopsy
of any suspicious glands may be performed.
45.
46.
47. • (3)magnetic resonance imaging (MRI); MRI is
of increasing interest to breast surgeons in a
number of setting: it can distinguish scar
from recurrence in women who have had
previous breast conservation therapy for
cancer. It is the best imaging modality for the
breast of women with implants. It has proven
to be a useful as screening tool in a high risk
women because of a family history. It is less
useful than ultrasound in the management of
the axilla in both primary breast cancer and
recurrent diseases.
48.
49.
50. • (4) needle biopsy/ cytology: histology can be
obtained under local anesthesia using a spring
loaded core needle biopsy device. Cytology is
obtained using a 21 G or 23G needle and 10 ml
syringe with multiple passes through the lump
with negative pressure in the syringe. The
aspirate is then smeared on to a slide which is
air dried or fixed. Fine needle aspiration
cytology (FNAC) is the least invasive technique
of obtaining a cell diagnosis and is a rapid and
very accurate if both operator and cytologist are
experienced.
51.
52. • However, false negative do occurs, mainly
through sampling error, and invasive cancer
cannot distinguished from in situ disease. A
histological specimen taken by a core biopsy
allows a definitive preoperative diagnosis,
differentiates between duct carcinoma in situ
and invasive disease and also allows the
tumor to be stained for receptor status.
53. • This is important before commencing
neoadjuvant therapy. (5)large needle biopsy
with vacuum systems: the sampling error
decreases as the biopsy volume increases and
using 8G or 11G needles allows more
extensive biopsies to be taken this is useful in
management of micro calcifications or in
complete excision of benign lesions such as
fibroadenomas.
54. • Triple assessment: the diagnosis should be
made by a combination of clinical
assessment, radiological imaging and a tissue
sample taken for either cytological or
histological analysis, the so called triple
assessment. The positive predictive value of
this combination should exceed 99.9%.
55. • Staging of breast cancer: classical staging
of breast cancer by means of TNM ( tumor,
nodes, metastasis) criteria is used less often
as we gain more knowledge of the biological
variable that affect prognosis. It is becoming
increasingly clear that it is these factors
rather than anatomical mapping that
influence the outcome of the disease and
treatment. As shown below
56. group Approximate 5 year
survival
example treatment
Very low risk 90% Screen detected DCIS Local
Low risk prim tumor 70-90% Node negative with
favorite histology
Locoregional with or
without systemic
High risk prim tumor <70% Node positive or
unfavorite histology
Locoregional with
systemic
Loca
lly advanced
<30% Large prim or
inflammatory type
Primary systemic
metastatic ------------ ------------------- Primary systemic
57. • Prognosis of breast cancer: the best
indicator of likely prognosis in breast cancer
remains tumor size and lymph node status. It
is realized that some large tumors remain
confined to the breast for decades whereas
some very small tumors are incurable at time
of diagnosis. Hence the prognosis of a cancer
depends not on chronological age but on its
invasive and metastatic potential.
58. • In attempt to define which tumor will behave
aggressively and thus require early systemic
treatment, a host of prognostic factors have
been described. These include histological
grade of tumor, hormone receptors status,
measure of tumor proliferation such as S-
phase fraction, growth factor analysis and
oncogene or oncogene product
measurement.
59. • Prognostic indices as Nottingham prognostic
index have combined these factors to allow
subdivision of patients in to discrete
prognostic group. Others put gene profile
with other group indicator to give recurrence
score but still unproven at moment. Others
develop gene signatures said able to detect
cancers of good or poor prognosis but still
again unproven
60. • Nottingham prognostic index: it depends on
pathological size of the tumor in cms and
node status as score 1 if no node is involved,
score 2 if 1-3 nodes are involved score 3 if
four or more nodes are involved. And also
depend on grade of the tumor as score 1 if
grade 1 and score 2 if grade 2 and score3 if
grade 3.
64. • Treatment of breast cancer: the two basic principles of
treatment are to reduce the chance of local recurrence
and the risk of metastatic spread. The treatment of early
breast cancer will usually involve surgery with or without
radiotherapy. Systemic therapy such as chemotherapy or
hormone therapy is added if there are adverse prognostic
factors such as lymph nodes involvement, indicating a
high likelihood of metastases relapse. At other end of
spectrum locally advanced or metastatic disease is usually
treated by systemic therapy to palliate symptoms with
surgery playing a much smaller role. Algorithm for
management of breast cancer is shown in summary as
65.
66. • (1) Achieve local control
• (2) Appropriate surgery include (a) wide local
excision (clear margin)+radiotherapy (b)
mastectomy+- radiotherapy immediate or
delayed. Combined with axillary procedure.
• (3) Treat risk of systemic disease by
chemotherapy if prognostic factors are poor
and hormone therapy if estrogen and
progesterone receptor are positive.
67. • Details of local treatment or early breast
cancer: local control is achieved through
surgery and or radiotherapy. The aim of
treatment is to (1) cure: likely in some cases
but late recurrence is possible. (2)Control
local disease in breast and axilla. (3)
Conservation of local form and function.
(4)Prevention or delay of occurrence of
distant metastases.
68. • Surgery: still has central role to play in the
management of breast cancer but have been
gradual shifts toward more conservative
techniques, that might show equal efficacy
between mastectomy and local excision
followed by radiotherapy. It was initially hoped
that avoiding mastectomy would help to
alleviate the considerable psychological
morbidity associated with breast cancer but
recent studies as has shown that over 30% of
women develop significant anxiety and
depression following both radical and
conservative surgery .
69. • After mastectomy women tend to worry the
effect of operation on their appearance and
their relationship whereas after conservative
surgery they may remain fearful of
recurrence. Mastectomy indicated for(1) a
large tumor in relation to size of 5he breast
(2) central tumor beneath or involving g the
nipple(3) multifocal disease(4) local
recurrence (5) patient preference.
70. • Types of operation: the radical Halsted mastectomy
including excision of breast axillary lymph nodes +
pectorals major and minor, this operation is no longer
preformed it cause excessive morbidity with no
survival benefits. The modified radical (Patey)
mastectomy is more commonly performed by
preservation of pectorals major and division of
pectorals minor. Simple mastectomy, wide local
excision. Conservative breast surgery is aimed at
removing the tumor plus a rim of at least 1 cm of
normal breast tissue this called wide local excision.
Lumpectomy is removal of benign lump.
Quadrantectony involve removing f entire segment of
the breast that contains the tumor.
71.
72.
73. • Radiotherapy: it performs to the chest wall
after mastectomy in selected patient in whom
the risk of local recurrence is high. This includes
patient with large tumor and those with large
numbers of nodes or extensive lymph vascular
invasion. it improve survival in women with
node positive breast cancer. It is conventional to
combine conservative surgery with radiotherapy
to remaining breast tissue. Recently
radiotherapy can be given intraoperatively at
one sitting or as accelerated postoperative
course.
74. • Adjuvant systemic therapy: it was targeted at
these putative micrometastases that might
expect to delay relapse and prolong survival for
about 30% relapse free. So women with
hormone receptors positive tumors will obtain
worthwhile benefit from about 5 years of
endocrine therapy, either 20mg daily of
tamoxifin if she s premenopausal or newer
aromatase inhibitors as anastrazole (femara) or
letrozole and exemstane if she is
postmenopausal. No need to give these drugs in
hormone negative receptors tumors.
75. • Hormone therapy: tamoxifin (antiestrogen) is most
widely used treatment in breast cancer. It reduces the
annual rate of recurrence by 25% with 17% reduction
in annual rate of death. It is also useful in reduce the
tumor in contralateral breast. Other hormone
includes LHRH agonist which induces reversible
ovarian suppression and has beneficial effect as
surgical or radiation induced ovarian ablation in
premenopausal receptor positive tumor. It also used
in recurrent tumor as it is superior on tamoxifin. The
third drug is aromatase inhibitor has benefit on
relapse free and less side effect.
76. • Chemotherapy: first generation regime such
as a six monthly cycle as cyclophosamide,
methotraxate and 5flurouracil all is called
(CMF) it reduces relapse by 25% over 10-15
years period. Modern regime include
anthrocycline (doxorubicin) and newer agent
such as taxanes suitable for premenopausal
with poor prognosis. Recently it also given to
postmenopausal patients.
77. • Primary chemotherapy (neoadjuvant): it is
being used in many centers for a large tumor but
operable that requires mastectomy. The idea is
to shrink the tumor before surgery to enable
breast conserving surgery to be performed.
Newer biological agent used frequently as
molecular targets as trastuzumab (herciptin) it is
active against tumor containing growth receptor
c-erb2. Others as bevacizumab a vascular
growth receptor inhibitor, still is not widely
used.
78. • Follow up of breast cancer: she is followed for life
to detect recurrence and dissemination, so yearly or 2
yearly mammography of treated and contra lateral
breast. Ultrasound of breast and abdomen can also
be used; tumor marker is not routine checking for the
patients.
• Multidisciplinary team approach (MDT): this team
including surgeon, medical oncologist , radiotherapist,
and histopathologist also physiotherapist and
psychologist working together for treatment decisions
in breast cancer. This has been shown good for the
patient to achieve good treatment
79. • Phenomena resulting from lymphatic
obstruction in advanced and breast cancer:
• peau d'orange :- caused by coetaneous
lymphatic edema when the infiltrated skin is
tethered by the sweat ducts .it cannot swell
leading to appearance like orange skin. it also
seen in chronic abscess . late edema of the
arm in troublesome complication of breast
cancer threats .fortunately seen less often
now that radical axillary dissection and radio
therapy are rarely combined .
80.
81. • it might appears at any time from months to
years after treatment .there is usually no
precipitating cause but recurrent tumors
should be excluded because infiltratation
block both lymphatic and venous
.edematous limb is susceptible for bacterial
infection following quite minor trauma and
this requite vigorous antibiotics .treatment
of limb edema is difficult but limb elevation,
elastic arm stocking and pneumatic
compressive devices can be useful.
82. • cancer-en-cuirasses:- the skin of the chest is
infiltrated with carcinoma and has been likened to
coat ,it may be associated with grossly swollen arm .it
usually occurred with local recurrence of the
mastectomy and following irradiation to the chest
wall .it has poor prognosis.
• lymphangiosarcoma:- is rare complication of
lymphadema with an onset many years after the
original treatment it take form of multiple
subcutaneous nodule in the upper limb and must be
distinguish from recurrent tumor .it has poor
prognosis.
83.
84. • Familial breast cancer: - recent development
in molecular genetics and the identification
of number of breast cancer predisposition
gene (BRCA, BRCA2, P53) have done much to
stimulation interest in this area .yet women
whose breast cancer is due to inherited
genetic change actually account for less than
5% of all cases of breast cancer . These
women have a risk of developing breast
cancer that in 2-10 times above baseline .
85. • pregnancy and breast cancers :- breast cancer
presenting during pregnancy or lactation tends to be
at late stage ,presumably because the symptoms are
masked by the pregnancy ,however in other respect
it behaves in similar way to the breast cancer in non
pregnancy women .treatment is similar with some
modification ,radiotherapy should be avoided
,chemotherapy is not used in first trimester but
appears safe subsequently ,most tumors are hormone
receptor negative and so hormonal treatment .which
is potentially teratogenic is not required . For women
they have breast cancer, they should wait for 2 years
before be pregnant as it is within this time that
recurrence most often occurs.
86. • Benign breast disorder:-
• fibroadenoma :- this is usually arise in the fully developed
breast between the age of 15-25 years although occasionally they
occur in much older women .they arise from hyperplasia of single
lobule and usually grow up to 2-3 cm in this case ,they surrounded
by well marked capsule and can thus be enucleated through
cosmetically appropriate incision. fibroadenoma does not require
excision unless associated with suspicious cytology ,it becomes
very large or the patient expressly desire the lump to be removed
.Giant fibroadenoma occasionally occur during puberty they are
over 5cm in diameters and are often rapidly growing but in other
respects are similar to smaller fibroadenoma and can be
enucleated through submammary incision .
87.
88. • Phyllodes Tumors: these benign Tumors
previously sometimes known as serocystic
disease of Brodie or cystosacroma phyllodes,
usually occur in women over the age of 40
years ,but can appear in younger women.
They present as large, sometimes massive,
tumor with unevenly bosselated surface,
occasionally ulceration of over lying skin
occurs because of pressure necrosis, despite
their size they remain mobile on the chest
wall.
89.
90.
91. • Histologically there is a wide variation in their
appearance with some of low malignant
potential resembling a fibroadenoma and others
having mitotic index which histologically
worrying, the latter may recur locally but
despite the name of cystosaroma phyllodes,
they are rarely cystic and only very rarely
develop features of sarcomatous Tumor . These
may metastases via blood stream. Treatment for
benign type is enucleation in young women or
wide local excision. Massive Tumor, recurrent
tumors and those of the malignant type will
require mastectomy.
92. • Galactocele: is rare, usually present as a
solitary, subareolar cyst and always dates from
lactation , it contain milk and in longstanding
cases its wall tend to calcify .
• Aberration of normal development and
involution (ANDI)
• Nomenclature: - the names are confusing. The
name (ANDI) has been applied to this condition
including fibrocystic disease, fibroadenosis,
chronic mastitis and mastopathy.
93.
94.
95. • Etiology: - the breast is a dynamic structure that
undergoes changes throughout a women's
reproductive life and superimposed up on this ,
cyclical changes throughout the menstrual cycle,
the pathogenesis of ANDI involve the
disturbance in the breast physiology extending
from perturbation of normality to well defined
disease process. There is little correlation
between the histological appearance of the
breast and symptoms. Pathology of the breast
consists essentially of four features that may
vary in extent and degree in any one breast.
96. • (1)Cyst formation (variable in size), (2) fibrosis: -
fat and elastic tissue disappear and replaced
with dense white fibrous trabeculae, the
interstitial tissue is infiltrated with chronic
inflammatory cell. (3) Hyperplasia of epithelium
in the lining of the ducts and acini may occur
with or without atypia. (4) Papillomatosis: - the
epithelium hyperplasia may be so extensive that
it results in papillomatous overgrowth within
the ducts.
97. • Clinical features:-the symptoms of ANDI are
may as the term is used to encompass a wide
range of benign conditions, but often include
an area of lumpiness (seldom of discrete)
and/or breast pain ( mastalgia )A benign
discrete lump in the breast is commonly a
cyst or fibroadenoma . The true lipoma
occurs rarely. Lumpiness may be bilateral
commonly in the upper outer quadrant or
less commonly confined to one quadrant of
the breast.
98. • The changes may be cyclical with an increase
in both lumpiness and often tenderness
before menstrual period. Non cyclical
mastalgia is more common in peri
menopausal than post menopausal women.
it should be distinguish from referred pain
due to musculoskeletal disorder . Breast pain
in post menopausal women not taking
hormone replacement therapy is usually
derived from the chest wall. About 5% of
breast cancers exhibit pain at presentation.
99. • Treatment of lumpy breast: - if the clinician is
confident that she is not dealing with discrete
abnormality and clinical confidence is
supported by mammography and or
ultrasound scanning if appropriate, then
initially the women can be offered firm
reassurance. It is worth while reviewing the
patient at a different point in menstrual cycle
for example 6 weeks after initial visit and
often the clinical signs will have resolved by
that time.
100. • There is tendency for women with lumpy breasts to
be rendered un necessarily anxious and to be
submitted to multiple biopsies because the clinician
lacks courage of lies or conviction. treatment of
mastalgia :- Rx recommended of the pain interfere
with women's life ,disturb her sleep and impair
sexual activity ,initially firm reassurance that the
symptoms are not associated with cancer will help
the majority of the women . acknowledgement that
this is a real symptom , non dismissive attitude and
an explain of etiology are all helpful in managing the
conditions .in first instance , an appropriately fitting
and supportive bra should be worn throughout the
day and a soft bra ( such as sports bra ) worn at night .
101. • Avoiding caffeine drinks is said to be help. A patient
symptoms diary helps her to chart the pattern of pain
throughout the month and determine whether this is
cyclical mastalgia. If these measures are not enough in
treatment with evening primrose oil (it is Gammalinolenic
acid metabolized to anti inflammatory prostaglandin)
adequate dose given over 3 months will help more than
half of these women, it appears to achieve higher
response rates in those over 40 years of age rather than
younger age. For those of intractable pain,
antigonadotrophin drug such as danazol cap 200mg, or
prolactin inhibitor (parlodel tab promocriptin) may be
tried. Very rarely it is necessary to prescribe anti estrogen
for example tamoxifin or LHRH agonist to deprive the
breast epithelium of estrogenic derives. .
102. • Duct ectasia :-( periductal mastitis):
pathology. this is dilatation of the breast
ducts which is often associate with periductal
inflammation . the pathogenesis is obscure
and almost certainly not uniform in all cases.
Although the disease in much more common
in smokers. it is dilatation in one or more of
the larger lactiferous ducts which fill with a
stagnant brown or greenish secretion , this
may discharge .these fluids then set up an
irritant reaction in surrounding tissue leading
to periductal mastitis or even abscess and
fistula formation.
103.
104. • In some cases a chronic indurations has forms
.beneath the areola, which is mimes as
carcinoma .fibrosis eventually develops
which cause may slit like nipple retraction.
Some believes it is anaerobic bacterial
infection and smoking causing arteriopathy.
Clinical features: nipple discharge of any
color, subareolar mass, abscess, mammary
duct fistula and nipple retraction are most
common symptoms.
105. • Treatment: in case of a mass or nipple retraction
carcinoma must be excluded by obtaining
mammography and negative cytology or
histology. Any suspicion should be excised.
Antibiotics should be tried co-amoxiclav or
flucloxacillin and metronidazole. Surgery is often
the only option likely to bring about cure of this
condition; this consists of excision of all major
ducts (Hadfield's operation). It is particularly
important to shave the back of the nipple to
ensure that all terminal ducts are removed,
failure to do so will lead to recurrence.
106. • Bacterial mastitis: it is the most common
variety of mastitis and is associated with
lactation in majority of the cases. Etiology:
lactational mastitis is seen less frequently than
previously. Most of the cases caused by staph,
infective from the hospital or from infants who
50% of them harbor staph in their nasopharynx.
Although ascending infection from a sore and
cracked nipple may initiate mastitis, in many
cases the lactiferous ducts will first become
blocked by epithelial debris leading to stasis,
this theory is supported by relatively high
incidence of mastitis in women with a retracted
nipple.
107.
108. • Once within ampulla of the duct, staph.
cause clotting of the milk and with clot
bacteria multiply. Clinical features: classical
signs of acute inflammation (pain, fever,
rigor, edema, erythema, tender swelling) and
start as general cellulitis end by abscess
formation. Treatment: during cellulitis stage
patient should be treated by appropriate
antibiotics as flucloxacillin or amoxiclav.
109. • Feeding from the affected breast side may
continue if the patient can do, local heat and
analgesia will help to relieve pain. If an
antibiotic is used in presence of undrained
pus an antibioma may form. This is large,
sterile, brawny edematous swelling that take
many weeks to resolve.
110. • It is used to recommended that the breast
should be incised and drained if the infection did
not resolve within 48 hours or if after being
emptied of milk there was an area of tense
indurations or other evidence of underlying
abscess, this advice has been replaced with
recommendation that repeated aspiration under
antibiotics cover and ultrasound guide be
performed. This often allows resolution without
need foe incision scar and also allows carrying
on breast feeding.pus should be sending for
culture and sensitivity.
111. • Breast abscess: if there is lactational abscess and
marked skin thinning drainage can be done under
local or general anesthesia. Drainage is done by
opening all loculi by removing septi between loculi to
make one room or loculi, with this procedure we
ensure we draining the entire abscess.
• Mondor's disease: it is superficial thrombophlibitis
of superficial veins of the breast and anterior chest
wall, it appears as subcutaneous cord. It should be
distinguish from cancer permeation.
112.
113.
114. • Congenital abnormalities of the breast: amazia:
congenital absence of the breast on one or both sides, it
might be associated with absence of pectorals major or
absence of the nipple. Polymazia: accessory breast has
been recorded in axilla most often, buttock and thigh.
• Mastitis in infant: equal in boys and girls and usually in
3rd or 4th day of life, if pressed lightly a drop of colorless
fluid can be expressed or milky secretion and usually
disappear at 3rd week , this called witch's milk. It caused
by stimulation of the fetal breast by prolactin in response
to drop in maternal estrogen and it essentially
physiological, mastitis usually due to staph. aurous.
115. • Diseases of the nipple: absence of the nipple is
rare and usually associated with amazia.
Supernumerary nipples not un commonly occurs
along a line extending from the anterior fold of the
axilla to the fold of the groin this is called milk line.
• Retraction of the nipple: this may be occurred at
puberty or later in life in puberty is called simple
nipple inversion and of unknown etiology. It might be
bilateral in 25%, usually it cause problems with breast
feeding and infection can occur specially during
lactation, recent retraction of nipple may be of
considerable pathological significance.
116. • Discharge of the nipple; it can occur from one or more
lactiferous ducts, management depends on the presence
of lump and presence of blood in discharge from single
duct. Mammography is done to exclude presence of
underlying mass. Cytology is useful to exclude malignancy.
a clear serous fluid means physiological in parous women,
or it might associated with duct papilloma or mammary
dysplasia.## blood stained discharge occurs in duct
papilloma, duct carcinoma and in duct ectasia. Black or
green secretion usually occurs in duct ectasia. Treatment:
carcinoma should be excluded by occult blood and
cytology. Surgical treatment of single duct is done by
excision of the duct by microdecotomy, or multiple duct
excision by core excision of major ducts.
117.
118. • Discharge from the nipple
• ------------------------------------------------------------------
• associated with lump no lump present
• remove the lump localized to one duct from many ducts
• Microdecotomy Hb+ve Hb-ve
• over40 year under 40 years observe
and repeat
• core excision
• discharge disappear
• Locloised tone duct--
microdectomy
• Lump appears---lumpectomy
119. • Gynecomastia: hypertrophy of a male breast, may
be unilateral or bilateral. The breast enlarges at
puberty and sometimes present the characteristic
female breast causes
• (1) Hormonal cause as in patient with carcinoma of
prostate and treated by stilbestrol (now rarely used),
in teratoma of the testis, anarchism, after castration,
bronchial carcinoma, adrenal and pituitary disease
and using of steroids in young body builder.
• (2) associated with leprosy due to bilateral testicular
atrophy.
120. • (3) associated with liver failure as in cirrhosis
due to failure of metabolism of estrogen.
• (4) drugs as cemitidine, digoxine and
spirenolactone.
• (5) Klinefelter, s syndrome: sex chromosome
anomaly has 47 XXY trisomy.
• Treatment: reassurance, drugs as dostinix
(antiprolactin), parlodel, or surgery by
mastectomy with preservation of nipple and
areola.