for medicine

1. TYPES OF BREAST CANCER
Ductal
Carcinoma
Invasive Ductal
Carcinoma
Ductal Carcinoma
in situ (DCIS)
Inflammatory
Breast Cancer
(IBC)
Lobular
Carcinoma
Invasive Lobular
Carcinoma
Lobular Carcinoma
in situ (LCIS)

2. INFLAMMATORY BREAST CANCER (IBC)
 Uncommon (1% to 3% of all breast cancers)
 Invasive Brest Cancer.
 No lump or tumor.
 Mistaken for infection in its early stages.

3. INFLAMMATORY BREAST CANCER (IBC)
 IBC makes the skin of the breast look red and feel warm.
 It also may make the skin look thick and pitted and may have an
orange peel feel.
 The breast may get bigger, hard, tender, or itchy

4. INFLAMMATORY BREAST CANCER (IBC)

5. INFLAMMATORY BREAST CANCER (IBC)

6. DUCTAL CARCINOMA IN SITU
(DCIS)
 Non – invasive
 contained within the milk ducts .
 May become invasive (pre – cancer).

7. DUCTAL CARCINOMA IN SITU
(DCIS)
Picture

8. INVASIVE (OR INFILTRATING)
DUCTAL CARCINOMA (IDC)
 Most common breast cancer.
 Accounts for about 8 out of 10 invasive breast
cancers.
 Lining of the ducts Grows /invades
the breast tissues
Spreads to lymph nodes
Other organs

9. INVASIVE (OR INFILTRATING) DUCTAL
CARCINOMA (IDC)

10. LOBULAR CARCINOMA IN SITU (LCIS)
 Non – Invasive.
 Contained in the lobules and does not spread to the tissues of the
breast.
 May become malignant .

11. LOBULAR CARCINOMA IN SITU (LCIS)
 picture

12. INVASIVE (INFILTRATING) LOBULAR
CARCINOMA (ILC)
 About 1 in 10 Invasive breast cancers are ILC.
 Formed in the lobules.
 Grows through the wall of the lobules.
 Spreads

13. INVASIVE (INFILTRATING) LOBULAR
CARCINOMA (ILC)

14. MALIGNANT TUMORS
• Infiltrating Ductal Carcinoma
• Most common invasive breast cancer (80% of cases).
• Most common in perimenopausal and postmenopausal
women.
• Ductal cells invade stroma in various histologic forms
described as scirrhous,
• medullary, comedo, colloid, papillary, or tubular.
• Metastatic to axilla, bones, lungs, liver, brain.
14

15. • Infiltrating Lobular Carcinoma
• Second most common type of invasive breast cancer (10% of
cases)
• Originates from terminal duct cells and, like LCIS, has a high
likelihood of being bilateral
• Presents as an ill-defined thickening of the breast
• Like LCIS, lacks microcalcifications and is often multicentric
• Tends to metastasize to the axilla, meninges, and serosal surfaces
15

16. • Paget’s Disease (of the Nipple)
• 2% of all invasive breast cancers
• Usually associated with underlying LCIS or ductal carcinoma
extending
• within the epithelium of main excretory ducts to skin of nipple and
areola
• Presentation: Tender, itchy nipple with or without a bloody discharge
• with or without a subareolar palpable mass
• Treatment: Usually requires a modified radical mastectomy
16

17. • Inflammatory Carcinoma
• 2 to 3% of all invasive breast cancers.
• Most lethal breast cancer.
• Vascular and lymphatic invasion commonly seen at pathologic
evaluation.
• Frequently presents as erythema, “peau d’orange,” and nipple retraction.
• Treatment: Consists of chemotherapy followed by surgery and/or
radiation,
• depending on response to chemotherapy.
17

18. BREAST CANCER
• Epidemiology
• One in eight women will develop breast cancer in their
lifetime.
• Second most common cause of cancer death among women
overall (lung cancer number 1).
• Incidence increases with increasing age.
• One percent of breast cancers occur in men
18

19. Risk Factors
• Early menarche (< 12)
• Late menopause (> 55)
• Nulliparity or first pregnancy > 30 years
• White race
• Old age
• History of breast cancer in mother or sister (especially if bilateral or
premenopausal)
• Genetic predisposition (BRCA1 or BRCA2 positive, Li–Fraumeni syndrome)
• Prior personal history of breast cancer
• Previous breast biopsy
• DCIS or LCIS
• Atypical ductal or lobular hyperplasia
• Postmenopausal estrogen replacement (unopposed by progesterone)
• Radiation exposure
19

20. Breast Cancer in Pregnant and Lactating Women
• Three breast cancers are diagnosed per 10,000 pregnancies.
• A FNA should be performed. If it identifies a solid mass, then it should be followed
by biopsy.
• Mammography is possible as long as proper shielding is used.
• Radiation is not advisable for the pregnant woman. Thus, for stage I or II cancer, a
modified radical mastectomy should be done rather than a lumpectomy with axillary
node dissection and postoperative radiation.
• If lymph nodes are positive, delay chemotherapy until the second trimester.
• Suppress lactation after delivery.
• Termination of pregnancy is not part of the treatment plan for breast cancer and
does not improve survival.
20

21. Breast Cancer in Males
• Predisposing factors: Klinefelter’s syndrome, estrogen therapy, elevated
• endogenous estrogen, previous irradiation, and trauma.
• Infiltrating ductal carcinoma most common histologic type (men lack breast lobules).
• Diagnosis tends to be late, when the patient presents with a mass, nipple retraction,
and skin changes.
• Stage by stage, survival is the same as it is in women. However, more men are
diagnosed at a later stage.
• Treatment for early-stage cancer involves a modified radical mastectomy and
postoperative radiation.
• Males with breast cancer often have direct extension to the chest wall at diagnosis.
21

22. 22

23. Screening Recommendations (from the American Cancer
Society)
• Screening reduces mortality by 30–40%.
• Begin monthly breast self-examinations at age 20.
• First screening mammogram at age 35.
• Consult MD for individualized recommendations regarding
mammograms between ages 40 and 50.
• Annual mammograms after age 50
23

24. DIAGNOSIS AND TREATMENT
Diagnostic Options
• Ultrasound
• (++) No ionizing radiation
• (+) Good for identifying cystic disease and can also assist in
therapeutic aspiration
• (+) Results easily reproducible
• (−) Resolution inferior to mammogram
• (−) Will not identify lesions < 1 cm
24

25. • FNA (Aspiration of Tumor Cells with Small-Gauge Needle)
• (+) Low morbidity
• (+) Cheap
• (+) Only 1–2% false-positive rate
• (−) False-negative rate up to 10%
• (−) Requires a skilled pathologist
• (−) May miss deep masses
• Needle Localization Biopsy
• (+) Locates occult cancer in > 90%
• Core Biopsy
• (−) Chance of sampling error
• Stereotactic Core Biopsy
• (+) Fewer complications compared to needle localization biopsy
• (+) Less chance of sampling error than core biopsy alone 25

26. Mammography
• Identifies 5 cancers/1,000 women.
• Sensitivity 85–90%.
• False positive 10%, false negative 6–8%.
• If cancer is first detected by mammogram, 80% have negative lymph nodes (vs. 45% when detected
clinically).
• Suspicious Findings
• Stellate, speculated mass with associated microcalcifications
• Reporting Mammogram Results
• I: No abnormality
• II: Benign abnormality
• III: Probably benign finding
• IV: Suspicious for cancer
• V: Highly suspicious for cancer
26

27. Treatment Decisions
Types of Operations
• Radical mastectomy: Resection of all breast tissue, axillary nodes, and
• pectoralis major and minor muscles (rarely preferred)
• Modified radical mastectomy: Same as radical mastectomy except pectoralis
muscles left intact
• Simple mastectomy: Same as radical mastectomy except pectoralis muscles left
intact and no axillary node dissection
• Lumpectomy and axillary node dissection: Resection of mass with rim of normal
tissue and axillary node dissection—good cosmetic result
• Sentinel node biopsy: Recently developed alternative to complete axillary
• node dissection:
• Based on the principle that metastatic tumor cells migrate in an orderly fashion to
first draining lymph node(s).
• Lymph nodes are identified on preoperative scintigraphy and blue dye is injected
in the periareolar area.
• Axilla is opened and inspected for blue and/or “hot” nodes identified by a gamma
probe.
27

28. • When sentinel node(s) is positive, an axillary dissection is
completed.
• When sentinel node(s) is negative, axillary dissection is not
performed
• unless axillary lymphadenopathy identified.
28

29. TNM System for Breast Cancer
• Tx: Cannot assess primary tumor
• T0: No evidence of primary
tumor
• T1: ≤ 2 cm
• T2: ≤ 5 cm
• T3: > 5 cm
• T4: Any size, with direct
extension to chest wall or with
skin edema or ulceration
• Nx: Cannot assess lymph nodes
• N0: No nodal mets
• N1: Movable ipsilateral axillary nodes
• N2: Fixed ipsilateral axillary nodes
• N3: Ipsilateral internal mammary
nodes
• Mx: Cannot assess mets
• M0: No mets
• M1: Distant mets or supraclavicular
nodes
29

30. • 5-year survival rates by stage:
• Stage 5-Year Survival Rate
• I 92%
• II 87%
• III 75%
• IV 13%
30

31. Staging system for breast cancer.
• Stage 0 DCIS or LCIS
• Stage I Invasive carcinoma ≤ 2 cm in size (including carcinoma in situ with microinvasion)
without nodal involvement and no distant metastases.
• Stage II Invasive carcinoma ≤ 5 cm in size with involved but movable axillary nodes and
no distant metastases, or a tumor > 5 cm without nodal involvement or distant
metastases
• Stage III Breast cancers > 5 cm in size with nodal involvement; or any breast cancer with
fixed axillary nodes; or any breast cancer with involvement of the ipsilateral internal
mammary lymph nodes; or any breast cancer with skin involvement, pectoral and chest
wall fixation, edema, or clinical inflammatory carcinoma, if distant metastases are absent
• Stage IV Any form of breast cancer with distant metastases (including ipsilateral
supraclavicular lymph nodes)
31

32. • Hormonal Therapy: Tamoxifen
• Selective estrogen receptor modulator that blocks the uptake of
estrogen by target tissues
• Side effects: Hot flashes, irregular menses, thromboembolism,
increased
• risk for endometrial cancer
• Survival benefit for pre- and postmenopausal women
• May get additional benefit by combining tamoxifen with
chemotherapy
32

33. MASTECTOMY
 Surgically removing the breast and other
infected components.
Mastectomy
A simple
mastectomy.
A Radical
mastectomy.
Modified radical
mastectomy.

34. MASTECTOMY
 Simple mastectomy : removing the lobules,
ducts, fatty tissue, nipple, areola, and some skin.
 Modified radical mastectomy: simple
mastectomy combined with the removal of the
axillary lymph nodes.
 Radical mastectomy: a simple mastectomy
combined with removing the lymph nodes and
muscles of the chest wall.

35. 35

36. 36

37. 37

38. 38