Breast disorders are described in a nutshell

1. Disorders of
breastMs. Susmita Halder
Tutor
School of Nursing Asia Heart Foundation

3. Benign breast disorders
 Mastalgia
Cyclic or premenstrual
Non cyclic
Extra mammary
 Fibrocystic changes
 Fibroadenoma
 Carcinoma

4. Mastalgia
Mastalgia is a common problem for majority of women

5. Mastalgia aur breast pain is the most common breast
related complaint in women
mastalgia maybe true from breast only
Or referred chest wall
The true breast pain is associated with swelling and
nodularity symptoms may be worse with
menstruation or by use of exogenous hormones like
combined oral contraceptives for hormone
replacement therapy

6. Types
 Cyclic mastalgia coincides with menstrual cycle it is described as diffused
breast tenderness or heaviness. Breast pain may last 2 to 3 days or most of
the month. The pain is related to hormonal sensitivity and symptoms of n
decrease with menopause
 Non cyclic mastalgia has no relationship to the menstrual cycle and can
continue into menopause. It may be constant or intermittent throughout
the month and last for several years. Symptoms include burning aching
919 in breast. The main maybe from trauma fat necrosis doctor autocratic
pain in chest on neck radiating to breast

7. Diagnosis
Diagnosis is made from careful history taking
examination and mammography for women
above 35 years of age and above 5% of
women with breast cancer present with breast
pain

10. Management
 Management is primary aim to exclude cancer
 The woman should be reassured and drugs and measures commonly used
with proven benefits are
1. Acetaminophen or nonsteroidal anti-inflammatory drugs
2. Phytoestrogens such as soya milk
3. Reduction of dietary fat
4. Tamoxifen 10 mg daily during luteal phase of cycle
5. Danazol 100 mg to 200 mg daily
6. Gonadotropic releasing hormone analogues

11. Fibrocystic breast disease

13. Incidence
 Fibrocystic breast disease is the most common Benign leison
 It is generally observed between 20 to 50 years of age
 Fibrocystic changes occur most frequently in women between 35 to 50 years but
often begin as early as 20 years of age

14. Etiology
 The etiology is not known it may be due to alter oestrogen and progesterone ratio
or relative decrease in progesterone or as the breast tissues are more sensitive to
prolactin
 stress factor me at time be related
 Histologically fibrocystic mass is characterized by adenosis fibrosus ductal
epithelial proliferation and papillomatosis

15. Types
 Two types are observed localised and diffuse
 Vast majority that is 70% are non proliferative
 Of the proliferative relations only 4% present with cellular attack Priya whereas the
risk of breast cancer is high
 Risk factors are nali parity and delayed menopause

16. Clinical features
 The patients are usually premenopausal
 The patient complains of breast pain present throughout the cycle but aggregate
premenstrually
 The pain is either dull continuous or intermittent and severe
 Examination reviews affection of both of the breasts one is more than other
 On palpation kosli nodular areas reassembling in define lamps either localised or
diffused are failed these are prominent in premenstrual face the patients become
anxious of malignancy and positions are confused to navigate it careful palpation
mammography ultrasound and aspiration biopsy is helpful to exclude malignancy

17. Treatment
 Assurance and re-examination at intervals
 to wear very fitting inner garments day and night
 To reduce intake of methyl xanthene like coffee tea chocolate caffeinated soda and
tobacco
 Vitamin E 400 MG daily may be helpful
 In refractory cases any of the following may be tried
 Combined oestrogen progesterone preparations
 Danazol 200 mg daily in divided doses
 Bromocriptine 2.5 to 5mg daily at bedtime
 Surgery is indicated rarely

18. Fibroadenoma
It is the most common benign tumor of breast occurring among the younger
20 to 35 years of women

19. Features
 It is symptom less being accidentally discovered by self palpation
 On palpation and uniform farm mobile painless and well defined mass is felt
 Fibroadenoma with size more than 5 cm is known as giant fibroadenoma
 Histologically they have an epithelial and a stromal component a young patient
have a word may be reviewed 6 months as the risk of malignancy is less than. 2%

20. Treatment
Surgical excision and biopsy is indicated only when
the mass in largest and or report of fine needle
aspiration cytology is in conclusive
Ultrasound-guided cryoablation is a treatment
option

21. Nipple discharge
Nipple discharge when spontaneous persistent and unrelated to lactation is considered
abnormal. Any significant nipple discharge must be thoroughly evaluated with following
information
• Nature of discharge
• Unilateral or bilateral
• From a single duct or multiple ducts
• Association of any mass in the breast
• History of any drug intake
• Premenopausal for postmenopausal

24. Breast infections

33. Non inflammatory painful breast disorders
Mastodynia

40. Breast carcinoma

41. Breast cancer is the commonest approximately 30% of
all cancers and is II next to lung cancer common cause
of Cancer death in women. Out of 8 of city gynecologic
patients is likely to develop breast carcinoma at some
time during her adult life in USA and western countries.
Akshit akshit and gynecologist examine millions of
patients on a regular basis. As such they are expected
to evaluate breast problems with breast oriented
history physical examination cytology and imaging
studies for to formulate the management

45. Screening and diagnostic methods
 Breast self examination
 Clinical breast examination by a physician
Inspection
Palpation
 Breast imaging
Screening mammography
Diagnostic mammography
Ultrasonography
Magnetic resonance imaging
Digital mammography
Positron emission tomography

46.  Breast biopsy
Fine needle aspiration biopsy
stereotactic and ultrasound guided core biopsy
Open biopsy
Excisional biopsy
Incisional biopsy
Screening and diagnostic methods

50. Staging of breast cancer
 TNM staging
 The breast cancer TNM staging system is the most common
way that doctors stage breast cancer.
 TNM stands for Tumour, Node, Metastasis.
 scans and tests give some information about the stage of your
cancer.
 But your doctor might not be able to tell you the exact stage
until you have surgery.

51. The TNM system
Here is a slightly
simplified description
of the TNM staging
system for breast
cancer.

52. Tumor (T)
 Tumour describes the size of the tumour (area of cancer). This is a simplified
description of the T stage.
 TX means that the tumour size can't be assessed.
 Tis means ductal carcinoma in situ (DCIS).

53. T1
 T1 means that the tumour is 2 centimetres
(cm) across or less.
 T1 is further divided into 4 groups:
 T1mi means the tumour is 0.1cm across or
less
 T1a means the tumour is more than 0.1
cm but not more than 0.5 cm
 T1b means the tumour is more than 0.5
cm but not more than 1 cm
 T1c means the tumour is more than 1 cm
but not more than 2 cm

54. T2
T2 means that the
tumour is more than 2
centimetres but no
more than 5
centimetres across.

55. T3
T3 means the
tumour is bigger
than 5
centimetres
across.

56. T4
T4 is divided into 4 groups:
T4a means the tumour has spread into the chest wall
(the structures surrounding and protecting the lungs)
T4b means the tumour has spread into the skin and
the breast might be swollen
T4c means the tumour has spread to both the skin
and the chest wall
T4d means inflammatory carcinoma – this is a
cancer in which the overlying skin is red, swollen and
painful

57. Node (N)
 Node (N) describes whether the cancer has spread to the
lymph nodes.
 NX means that the lymph nodes can't be assessed (for
example, if they were previously removed).
 N0 means there are no cancer cells in any nearby nodes.
 Isolated tumour cells (ITCs) are small clusters of cancer
cells less than 0.2 mm across, or a single tumour cell, or a
cluster of fewer than 200 cells in one area of a lymph node.
Lymph nodes containing only isolated tumour cells are not
counted as positive lymph nodes.

58. N1
 N1 means cancer cells are in the lymph nodes in the armpit but the nodes are not
stuck to surrounding tissues.
 pN1mi means one or more lymph nodes contain areas of cancer cells called
micrometastases that are larger than 0.2mm. Or the nodes contain more than 200
cancer cells but are less than 2mm.
 pN1a means that cancer cells have spread (metastasised) into 1 to 3 lymph nodes
and at least one is larger than 2mm.
 pN1b means there are cancer cells in the lymph nodes behind the breastbone (the
internal mammary nodes) found with a sentinel node biopsy but the areas are too
small to feel.
 pN1c means there are cancer cells in 1 to 3 lymph nodes in the armpit and in the
lymph nodes behind the breastbone, but they are too small to feel.

59. N2
N2 is divided into 2 groups:
N2a means there are cancer cells in the lymph
nodes in the armpit, which are stuck to each other
and to other structures.
N2b means there are cancer cells in the lymph
nodes behind the breast bone (the internal mammary
nodes), which have been seen on a scan or felt by
the doctor. There is no evidence of cancer in lymph
nodes in the armpit.

60. N3
 N3 is divided into 3 groups:
 N3a means there are
cancer cells in lymph nodes
below the collarbone.
 N3b means there are
cancer cells in lymph nodes
in the armpit and behind the
breastbone.
 N3c means there are
cancer cells in lymph nodes
above the collarbone.

61. Metastasis (M)
 Metastasis (M) describes whether the
cancer has spread to a different part of the
body.
 M0 means that there is no sign that the
cancer has spread.
 cMo(i+) means there is no sign of the
cancer on physical examination, scans or x-
rays. But cancer cells are present in blood,
bone marrow, or lymph nodes far away from
the breast cancer – the cells are found by
laboratory tests
 M1 means the cancer has spread to another
part of the body.

64. Treatment
 The stage of your cancer helps your doctor to decide which treatment you need. Treatment
also depends on:
 your type of cancer (the type of cells the cancer started in)
 where the cancer is
 other health conditions that you have
 The stage of the cancer and these other factors can also give an idea of your outlook
(prognosis).
 Other factors that may influence treatment are:
 the grade of your cancer cells
 whether you have had your menopause
 whether your cancer cells have receptors for particular cancer drugs

65. Treatment may include
 Treatment may include:
 surgery
 radiotherapy
 chemotherapy
 hormone therapy
 targeted cancer drug therapy
 a combination of these treatments

67. Internal radiation
therapy Or
brachytherapy

68. Surgery
Types of surgery
There are many different types of surgery for
breast cancer.
the size of the cancer
Location
the size of breasts
 personal wishes and feelings

72. Steps of reconstruction surgery

76. Thank you 