BREST CARSINOMA and its anatomy,resources.

1. BREAST CARSINOMA
by:-
Dr.RAJESH KAKKERI

2. Anatomy of breast

3. Introduction
• The term “breast Caner ” refers to a malignant tumor that has
developed from cell in the breast . Breast cancer occure
anywhere in the breast, but most are found in the Upper
outer quadrant,where most breast tissue is located. Usually
breast cancer either begins in the cells of the lobules, which
are the milk- producing glands, or the ductsz the passages
that Drain milk from the lobules to the nipple.less commonly,
breast cancer can begin in the stromal tissues, which include
the fatty and fibrous connective tissue of the breast.

4. Definition
• Breast cancer is a malignant tumor that starts in the cells on
the breast.

7. Forms of breast cancer
1. Invasive ductal carcinoma- This type of breast cancer develops in
the milk ducts and account for about 79% of cases. It can break through
the duct wall and invade the breasts fatty tissue, then metastasize(spread)
to other part of the body through the bloodstream or lymphatic system.

8. 2. Invasive lobular carcinoma
• This type of breast cancer accounts for about 10% of cases and
originates in the breasts milk- producing lobules. It also can spread to
the breasts fatty tissue and other place in the body.
3. Medullary, mucinous and tubular
carcinomas
• These are three slow- growing types of breast cancer. Together they
represent about 10% of all breast cancer.

9. 4. Pagets Diseases
• This type accounts for about 1 % of all cases. Of all breast cancers,
inflammatory carcinoma is the most aggressive and difficult to treat,
because it spread so quickly.
5. Inflammatory carcinoma
• This type represents about 1% of breast cancers. It starts in the milk
ducs of the nipple and can spread to the areola (dark circles around the
nipple). Women who get pagets Diseases usually have a history of nipple
crusting, scaling, itching or inflammation.

10. Ductal carcinoma in situ ( DCIS)
• DCIS occurs when cancer cells fill the ducts but haven’t yet
spread through the walls into fatty tissue. Nearly all women
diagnosed at this early stage can be cured. Without treatment,
about 25% of DCIS case will lead to invasive breast cancer
within 10 years.

12. Lobular carcinoma in situ ( LCIS)
• LCIS is less common and less of a treat than DCIS. It develops
in the breasts milk- producing lobules. LCIS doesn’t require
treatment, but it does increase a women’s risk of developing
breast cancer.

14. Risk factors
No one know the exact cause of breast cancer. A “risk factor” is
anything that in creases your risk of developing breast cancer.
Studies have found the following risk factors for breast cancer.
• Age
• Gender
• Personal history of breast cancer
• Family history
• Certain breast changes
• Gene change
• Reproductive and menstrual history
• Radiation therapy to the chest
• Breast density
• Atypical hyperplasia
• Hormone replacement therapy
• Oral contraceptive use
• Overweight or obese after • Lack of physical activity
• Drinking alcohol

16. Stages of breast cancer
Stage Definition
Stage-0 Carsinoma in situ .
Cancer cell remain inside the brest ducts, without invasion into normal adjacent breast
tissue.
Stage-I Cancer is 2 cm or less and is confined to the breast .
Cancer cells have not spread beyond the breast.
Stage-II The tumor is larger than 2 but no larger than 5cm and has not spread to the axillary
lymph nodes.

17. Contt….
Stage-II Locally advanced cancer. It is decided into stage IIIA, IIIB, and IIIC .
Stage-III A
No tumor is found in the brest. Cancer is found in axillary lymph nodes
that are sticking together or to other structures, or cancer
maybe found in lymph nodes near the breastbone or the
tumor is any size. Cancer has
spread to the axillary lymph nodes, which are sticking together or to other structures,
or cancer may be found in lymph nodes near the breastbone.
Stage-III B
The tumor may be any size and has spread to the chest wall and /or skin of the breast and may have
spread to
axillary lymph nodes that are clumped together or sticking to other structures or cancer may
have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at
least stage IIIB.

18. Contt….
Stage-III C
There may either be no sign of cancer in the breast or a tumor
may be any size and may have spread to the chest wall and/or
the skin of the breast and the cancer has spread to lymph nodes
either above or below the collarbone and the cancer may have
spread to axillary lymph nodes or to lymph nodes near the
breastbone.
Stage-IV The cancer has spread or metastasized to other parts of the body.

20. Clinical manifestation
According to American Cancer Society, any of the following unusual changes in
the breast can be a symptom of breast cancer:
• A lump or thickening in or near the breast or in the
underarm area
• A change in the size or shape of the breast
• The skin of the breast, areola, or nipple may be scaly,red, or swollen.
• Skin irritation or dimpling
• Breast pain
• Nipple pain or tenderness
• A nipple turned inward into the breast
• Unilateral nipple discharge other than breast milk
• Enlarged axillary or supraclavicular lymph nodes

22. Diagnostic evaluations
• Diagnostic mammogram
• Ultrasound
• Magnetic resonance imaging
• Biopsy
• Hormone receptor test
• CT- scan
• Bone scan

24. Screening and early detection
• Screening for breast cancer before there are symptoms can be important.
Screening can help doctors find and treat cancer early. Doctor may suggest
the following screening test for breast cancer.
• Yearly mammograms are recommended starting at age 40 and continuing for
as long as a women is in good health. A mammograms can often show a breast
lump before it can be felt.
• Clinical breast exam ( CBE) about every 3 years for women in their 20s and
30s and every year for women 40 and over. A through clinical breast exam may
take about 10 min . During ba clinical breast exam, your health care provider
checks your breasts . Health care provider looks for differences in size or shape
between your breasts. The skin of your breasts is checked for a rash, dimpling,
or other abnormal signs.Your nipples may be squeezed to check for fluid.

26. Management
• Women with breast cancer have many treatment options. These
include surgery, radiation therapy, chemotherapy, hormone therapy,
and biological therapy. Many women receive more then one type of
treatment. Cancer treatment is either local therapy or systemic
therapy:
• Local therapy: Surgery and radiation therapy are local treatment.
They remove or destroy cancer in the breast . When breast cancer is
spread to other parts of the body, local therapy may be use to control
the Diseases in thode specific areas.
• Systemic therapy: Rest of the therapies are systemic treatment. They
enter the bloodstream and destroy or control cancer throughout the
body. Some women with breast cancer have systemic therapy to
shrink the tumor before surgery or radiation. Others have systemic
therapy after surgery and /or radiation to prevent the Cancer from
coming back . Systemic treatments also are used for cancer that has
spread.

27. A. Surgery
Surgery is the most common treatment for breast cancer.
There are several type of surgery.
1. Mastectomy: an operation to remove the breast ( or as
much of the breast tissue as possible) is a mastectomy. This
procedure is generally done for carcinoma in situ. In the most
caaes, the surgeon also removes lymph nodes under the arm.
Some women have radiation therapy after surgery. It can be
done in several forms:
• Total mastectomy
• Redical mastectomy
• Modified redical mastectomy

28. 2. Lymph node Dissection
• The surgeon often Removes the underarm lymph nodes as well. A separate
incisions is made. This procedure is called an axillary lymph node Dissection. It
shows whether cancer cells have enter the lymphatic system.
3 Breast sparing surgery
• An operation to remove the cancer but not thebreast is breast sparing surgery. It is
also called breast conserving surgery, lumpectomy, segmental mastectomy, parital
mastectomy and removal of axillary lymph nodes. Sometime an excisional
biopsy serves as a lumpectomy because the
surgeon removes the whole lump. After breast- sparing surgery, most women
receive radiation therapy to the breast . This treatment destroys cancer cells that
may remain in the breast.

29. 4. Prophylactic ovary removal
• It is a preventive Surgery that lowers the amount of estrogen in the
body, making it harder for estrogen to stimulate the development of
breast cancer.
5. Cryotherapy
• Cryotherapy, is also called cryosurgery, uses extreme cold to freeze
and kill cancer cells . It also use to control pain and control bleeding
. Right now , cryotherapy is an experimental treatment for breast
cancer.All cells, including cancer cells, contain water. When
cryotherapy freeze the cells, the water turns to ice crystal. These ice
crystals, along with the cold it self, destroy the cancer cells.

30. 6. Breast reconstructive surgery
• Breast reconstruction is the rebuilding of the breast after
mastectomy and sometimes lumpectomy. Reconstruction
can take place at the same time as cancer removing surgery,
or months to year later. It is done to hence body image to
provide symmetry of breast.

32. B. Radiation therapy
 External radiation
 Internal radiation
C. Chemotherapy
D. Hormon therapy
E. Biological therapy

33. Post- operative
Mastectomy exercises

42. Evaluation
1. What is breast cancer?
2. Enlist the types of breast cancer?
3. What are the risk factor of breast cancer?
4. What are the diagnostic evaluation done to
detect breast cancer?