The breast develops from mammary ridges in the embryo. It is composed of lobes and lobules that produce milk during lactation. The breast develops further at puberty in response to hormones and reaches full development during pregnancy. Benign breast conditions are common and include cysts, fibroadenomas, and fibrocystic changes. Proliferative disorders without atypia present a slightly increased cancer risk, while atypical hyperplasias present a higher risk and require close monitoring. Understanding normal breast anatomy, development, and benign conditions is important for evaluating breast symptoms and assessing cancer risk.
lecture 5b The breast and pectoral region.pdfNatungaRonald1
The breast lies in the pectoral region and develops during puberty under the influence of female sex hormones. It is composed of lobules that radiate from the nipple. The breast undergoes changes during pregnancy and menopause. Cancer is a major health concern and can spread via the lymphatic drainage pathways.
The pectoral region contains muscles that act on the arm including the pectoralis major and minor. The serratus anterior muscle rotates the scapula. All three muscles receive nerve innervation from branches of the brachial plexus. Knowledge of the anatomical structures of the breast and pectoral region is important for clinical diagnosis and management.
Breast cancer with anatomy physiology and staging .pptxDoctorDeath3
The document provides details about the anatomy of the breast. It describes how the breast is composed of ductal and lobular structures that produce and carry milk. It notes the blood, nerve and lymphatic supply of the breast and how these systems are involved in the physiology of lactation. The document also discusses common breast pathologies like invasive ductal carcinoma and outlines investigations and treatments for breast cancer.
This document summarizes the anatomy and embryological development of the breast. It describes how the breast develops from mammary ridges in the embryo and can have accessory breasts or nipples from failed regression. The blood supply, innervation, and lymphatic drainage of the breast is outlined. Infectious disorders of the breast are also summarized, including bacterial infections commonly caused by Staphylococcus aureus and Streptococcus in the postpartum period. Treatment involves antibiotics and may require surgical drainage for abscesses.
Breast - Anatomy and Phsiology with Congenital anomalies - Dr. Vijayandra.pptxJhansi897032
This document provides an overview of the anatomy, physiology, and congenital anomalies of the breast. It begins with the embryological development of the breast from mammary ridges. The anatomy sections describe the structure, blood supply, lymphatic drainage and microscopic anatomy. Physiology sections cover development during puberty, the menstrual cycle, pregnancy, lactation and involution. The document concludes with descriptions of common congenital anomalies such as accessory nipples, hypoplasia, amastia and Poland's syndrome.
The breast is made up of glandular tissue, fibrous tissue, and fatty tissue. In females, the breast fully develops at puberty. The breast extends from the 2nd to 6th ribs and contains 15-20 lobes drained by lactiferous ducts that open onto the nipple. During pregnancy and lactation, the breasts undergo proliferation and changes to support milk production. The blood supply comes from branches of the axillary, internal thoracic, and intercostal arteries, while lymphatic drainage is primarily to the axillary nodes. Breast carcinoma is more common in females and prognosis is generally worse for males. Treatment options for breast cancer include breast-conserving surgery or mastectomy depending on tumor characteristics and
The breast is a modified sweat gland derived from ectoderm that lies within the superficial fascia. It extends from the 2nd to 6th ribs vertically and from the lateral border of the sternum to the anterior axillary line horizontally. The breast is comprised of 15-20 lobes that drain via lactiferous ducts into the nipple. Lymph drainage is primarily to axillary lymph nodes but also occurs to internal mammary and contralateral lymph nodes. During lactation, hormones such as progesterone, estrogen, and prolactin facilitate milk production and ejection.
This document provides information on the embryology, anatomy, histology, blood supply, lymphatic drainage and types of breast cancer. It begins with the embryological development of the breast from mammary ridges. It then describes the anatomy of the breast including its location, layers of tissue, blood and lymphatic drainage pathways. The histology section outlines the different cell types found in breast tissue. Finally, it discusses the different forms of breast cancer including non-invasive (DCIS, LCIS) and invasive types (ductal carcinoma, lobular carcinoma, medullary carcinoma).
This document provides information on the anatomy of the breast and axillary region. It describes the lobes, ducts, blood and lymphatic supply of the breast. It also discusses the diagnosis of breast diseases through patient history, physical examination, and various imaging modalities. Key points include the importance of family history and reproductive factors in diagnosis. Physical exam focuses on inspecting for masses, skin changes, nipple retraction or discharge. Palpation examines the breast tissue and lymph nodes for abnormalities.
lecture 5b The breast and pectoral region.pdfNatungaRonald1
The breast lies in the pectoral region and develops during puberty under the influence of female sex hormones. It is composed of lobules that radiate from the nipple. The breast undergoes changes during pregnancy and menopause. Cancer is a major health concern and can spread via the lymphatic drainage pathways.
The pectoral region contains muscles that act on the arm including the pectoralis major and minor. The serratus anterior muscle rotates the scapula. All three muscles receive nerve innervation from branches of the brachial plexus. Knowledge of the anatomical structures of the breast and pectoral region is important for clinical diagnosis and management.
Breast cancer with anatomy physiology and staging .pptxDoctorDeath3
The document provides details about the anatomy of the breast. It describes how the breast is composed of ductal and lobular structures that produce and carry milk. It notes the blood, nerve and lymphatic supply of the breast and how these systems are involved in the physiology of lactation. The document also discusses common breast pathologies like invasive ductal carcinoma and outlines investigations and treatments for breast cancer.
This document summarizes the anatomy and embryological development of the breast. It describes how the breast develops from mammary ridges in the embryo and can have accessory breasts or nipples from failed regression. The blood supply, innervation, and lymphatic drainage of the breast is outlined. Infectious disorders of the breast are also summarized, including bacterial infections commonly caused by Staphylococcus aureus and Streptococcus in the postpartum period. Treatment involves antibiotics and may require surgical drainage for abscesses.
Breast - Anatomy and Phsiology with Congenital anomalies - Dr. Vijayandra.pptxJhansi897032
This document provides an overview of the anatomy, physiology, and congenital anomalies of the breast. It begins with the embryological development of the breast from mammary ridges. The anatomy sections describe the structure, blood supply, lymphatic drainage and microscopic anatomy. Physiology sections cover development during puberty, the menstrual cycle, pregnancy, lactation and involution. The document concludes with descriptions of common congenital anomalies such as accessory nipples, hypoplasia, amastia and Poland's syndrome.
The breast is made up of glandular tissue, fibrous tissue, and fatty tissue. In females, the breast fully develops at puberty. The breast extends from the 2nd to 6th ribs and contains 15-20 lobes drained by lactiferous ducts that open onto the nipple. During pregnancy and lactation, the breasts undergo proliferation and changes to support milk production. The blood supply comes from branches of the axillary, internal thoracic, and intercostal arteries, while lymphatic drainage is primarily to the axillary nodes. Breast carcinoma is more common in females and prognosis is generally worse for males. Treatment options for breast cancer include breast-conserving surgery or mastectomy depending on tumor characteristics and
The breast is a modified sweat gland derived from ectoderm that lies within the superficial fascia. It extends from the 2nd to 6th ribs vertically and from the lateral border of the sternum to the anterior axillary line horizontally. The breast is comprised of 15-20 lobes that drain via lactiferous ducts into the nipple. Lymph drainage is primarily to axillary lymph nodes but also occurs to internal mammary and contralateral lymph nodes. During lactation, hormones such as progesterone, estrogen, and prolactin facilitate milk production and ejection.
This document provides information on the embryology, anatomy, histology, blood supply, lymphatic drainage and types of breast cancer. It begins with the embryological development of the breast from mammary ridges. It then describes the anatomy of the breast including its location, layers of tissue, blood and lymphatic drainage pathways. The histology section outlines the different cell types found in breast tissue. Finally, it discusses the different forms of breast cancer including non-invasive (DCIS, LCIS) and invasive types (ductal carcinoma, lobular carcinoma, medullary carcinoma).
This document provides information on the anatomy of the breast and axillary region. It describes the lobes, ducts, blood and lymphatic supply of the breast. It also discusses the diagnosis of breast diseases through patient history, physical examination, and various imaging modalities. Key points include the importance of family history and reproductive factors in diagnosis. Physical exam focuses on inspecting for masses, skin changes, nipple retraction or discharge. Palpation examines the breast tissue and lymph nodes for abnormalities.
This document provides an overview of breast anatomy and pathology. It begins with an introduction to breast structure, then discusses the skin, parenchyma, stroma, blood supply, lymphatic drainage, nerve supply, lymph nodes, and development of the breast. It also covers benign breast diseases such as fibroadenoma, adenoma, radial scars, microglandular adenosis, granulosa cell tumors, and various cysts and miscellaneous tumors that can present in the breast. The document aims to classify benign breast conditions based on pathology, clinical features, symptoms, and management.
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
The document discusses the anatomy and physiology of mammary glands. It begins by defining mammary glands as breasts in medical terminology, originating from the Latin word for breasts. It then describes the basic structure of mammary glands, which consist of skin, parenchyma (lobes and ducts), and stroma (connective tissue). The document outlines the development of mammary glands from an embryonic ridge, and their histology in non-pregnant, pregnant, and lactating states. It also reviews the blood supply, lymphatic drainage, and clinical aspects such as breast cancer.
The breast lies in the superficial fascia of the pectoral region and is divided into four quadrants. It extends from the 2nd to 6th ribs horizontally and from the sternum to the midaxillary line vertically. The breast contains lobules that produce milk via lactiferous ducts which drain at the nipple. Lymphatic drainage is primarily to the axillary lymph nodes but also occurs to internal mammary and intercostal nodes. The breast develops from the mammary ridge in utero.
1) The breast is composed of adipose tissue, lactiferous ducts and tubules, blood vessels, nerves and lymphatics. It extends from the 2nd to 6th ribs and medially from the lateral border of the sternum to the mid-axillary line.
2) The breast parenchyma contains 15-20 lobes made up of lobules that empty into lactiferous ducts. It also contains stromal connective and fatty tissue.
3) Lymphatic drainage of the breast primarily follows the blood supply to the axillary lymph nodes but may also drain to internal mammary or intercostal nodes. Sentinel lymph node biopsy is used to help determine cancer stage
The mammary gland is modified sweat gland tissue located in the superficial fascia of the anterior chest wall. In females, it is well-developed and plays an important role in reproduction through milk production. The breasts are composed of lobules that drain into lactiferous ducts which open onto the nipple. Lymphatic drainage of the breast is important for staging breast cancer as the disease commonly spreads via lymphatics. The breast receives its blood supply from intercostal and thoracoacromial arteries and drains venously into axillary veins.
Anatomy of Breast in clinical perspective-Dr.GosaiDr.B.B. Gosai
This document provides an anatomical overview of the female breast. It describes the breast's position and structure, including the skin, glandular tissue, stroma, blood and lymphatic supply. Development from the embryonic stage through puberty is addressed. Clinical correlations are discussed, such as breast cancer development and spread, as well as other common breast conditions like mastitis and cysts. Early detection of breast cancer through examination and mammography is emphasized for improved prognosis.
This document provides an overview of the anatomy of the pectoral region. It describes the surface landmarks, superficial fascia containing cutaneous nerves, vessels and the platysma muscle. The breast composition and blood supply are explained. The muscles of the pectoral region including pectoralis major, pectoralis minor, subclavius, and serratus anterior are also detailed. Finally, the clavipectoral fascia enclosing the pectoralis minor is briefly outlined.
The document summarizes fetal development from the 9th week of gestation through birth. It describes how the fetus grows in length and weight each month. It also discusses the development of organs and tissues like the brain, lungs, skin, and muscles. The document then covers the fetal membranes - the amnion, chorion, yolk sac, allantois, and umbilical cord. It explains their roles in protecting the fetus and transporting nutrients. The placenta forms from the chorion and develops branched villi to facilitate nutrient exchange between mother and fetus.
The document summarizes the anatomy and physiology of the breast. It describes the structures of the breast including the lobules, lactiferous ducts, nipple, areola, and supporting stroma. It discusses the blood supply, lymphatic drainage, and nerve innervation of the breast. It also covers the development and changes of the breast during puberty, pregnancy, and lactation. Common anatomical variations are also listed. In summary, the document provides a comprehensive overview of the normal structure and function of the human breast.
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.
It's about the microstructure of breast. Function of the breast and words that will help guide you in anatomy. Having little knowledge about caring for yourself and others make a better nation . Breast cancer is real so let's all be aware . People are somehow careless by taking good care of the breast and also feeding the young ones . With this text made will guide more of the lactating moms to care for the young ones
This document summarizes a lecture on the mammary gland given by Dr. Abdul Waheed Ansari. The lecture covers the gross anatomy, histology, development, and clinical importance of the breast. Specific learning outcomes include identifying the location and structure of the breast, distinguishing normal breast histology, analyzing lymphatic drainage, correlating development, and interpreting mammograms. The lecture discusses the location, blood supply, lymphatic drainage, development, histology of lactating and non-lactating breasts, and clinical significance including metastasis routes. Key clinical points are made about skin dimpling, cancer spread routes, and abnormal mammogram findings.
The document discusses the anatomy and physiology of the Fallopian tubes, fetal development through the three trimesters of gestation, and the three stages of labor and delivery. It describes the layers, cell types and segments of the Fallopian tubes. It outlines the key developments that occur in each trimester of gestation. It then explains the three stages of labor as the dilation stage, expulsion stage, and placental stage. For each stage, it discusses potential complications and common interventions.
The Fallopian tubes extend from the outer edges of the uterus and assist in transporting ova and sperm. They are composed of three layers: mucosa, muscularis, and serosa, each made up of different cell types. Gross anatomy shows they are 10-12 cm long and situated between the ovaries and uterus. Pathophysiological variants include pyosalpinx (pus in the Fallopian tubes) and salpingitis (inflammation of the Fallopian tubes).
Gestation, the development of a fetus, takes 40 weeks and is divided into three trimesters. In the first trimester the embryo develops major organs and limbs. The second trimester sees bone formation and sex appearance.
The placenta develops from the chorionic villi and connects the developing fetus to the uterine wall to allow for nutrient, gas, and waste exchange between mother and fetus. During development, the chorionic villi mature from early mesenchymal villi to immature and mature intermediate villi and finally to terminal villi. By the third trimester, the placenta has highly vascularized and smaller terminal villi. The placenta should be examined at autopsy in cases of fetal or maternal conditions like stillbirth, prematurity, infection, or abnormalities to identify any pathological processes that may have interfered with placental function.
This document provides tips for using a PowerPoint presentation (ppt) on human anatomy. It recommends:
- Freely editing, modifying, and adding your name to the ppt.
- Not worrying about the number of slides, as half are blank except for titles to facilitate discussion.
- Showing blank slides first to elicit what students already know before providing information.
- Rerunning the presentation in an active learning format.
- Using it also for self-study, with bibliography notes provided.
The mammary gland develops through distinct stages in females. During puberty, estrogen and progesterone stimulate ductal growth and lobular development. In pregnancy, placental hormones induce remarkable lobuloalveolar growth. Lactation is stimulated by prolactin and oxytocin to produce milk. Menopause causes glandular tissue shrinkage. Disorders include cancers, cysts, and fibroadenomas. Diagnosis involves exams, imaging, and biopsies. Treatments range from surgery to chemotherapy and reconstruction.
breast is the mammary gland with lobes and ductules with lactiferous ducts.
it extends from 2nd intercostal to 6 intercostal ribs and lies over pectoralis major muscle
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
This document provides an overview of breast anatomy and pathology. It begins with an introduction to breast structure, then discusses the skin, parenchyma, stroma, blood supply, lymphatic drainage, nerve supply, lymph nodes, and development of the breast. It also covers benign breast diseases such as fibroadenoma, adenoma, radial scars, microglandular adenosis, granulosa cell tumors, and various cysts and miscellaneous tumors that can present in the breast. The document aims to classify benign breast conditions based on pathology, clinical features, symptoms, and management.
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
The document discusses the anatomy and physiology of mammary glands. It begins by defining mammary glands as breasts in medical terminology, originating from the Latin word for breasts. It then describes the basic structure of mammary glands, which consist of skin, parenchyma (lobes and ducts), and stroma (connective tissue). The document outlines the development of mammary glands from an embryonic ridge, and their histology in non-pregnant, pregnant, and lactating states. It also reviews the blood supply, lymphatic drainage, and clinical aspects such as breast cancer.
The breast lies in the superficial fascia of the pectoral region and is divided into four quadrants. It extends from the 2nd to 6th ribs horizontally and from the sternum to the midaxillary line vertically. The breast contains lobules that produce milk via lactiferous ducts which drain at the nipple. Lymphatic drainage is primarily to the axillary lymph nodes but also occurs to internal mammary and intercostal nodes. The breast develops from the mammary ridge in utero.
1) The breast is composed of adipose tissue, lactiferous ducts and tubules, blood vessels, nerves and lymphatics. It extends from the 2nd to 6th ribs and medially from the lateral border of the sternum to the mid-axillary line.
2) The breast parenchyma contains 15-20 lobes made up of lobules that empty into lactiferous ducts. It also contains stromal connective and fatty tissue.
3) Lymphatic drainage of the breast primarily follows the blood supply to the axillary lymph nodes but may also drain to internal mammary or intercostal nodes. Sentinel lymph node biopsy is used to help determine cancer stage
The mammary gland is modified sweat gland tissue located in the superficial fascia of the anterior chest wall. In females, it is well-developed and plays an important role in reproduction through milk production. The breasts are composed of lobules that drain into lactiferous ducts which open onto the nipple. Lymphatic drainage of the breast is important for staging breast cancer as the disease commonly spreads via lymphatics. The breast receives its blood supply from intercostal and thoracoacromial arteries and drains venously into axillary veins.
Anatomy of Breast in clinical perspective-Dr.GosaiDr.B.B. Gosai
This document provides an anatomical overview of the female breast. It describes the breast's position and structure, including the skin, glandular tissue, stroma, blood and lymphatic supply. Development from the embryonic stage through puberty is addressed. Clinical correlations are discussed, such as breast cancer development and spread, as well as other common breast conditions like mastitis and cysts. Early detection of breast cancer through examination and mammography is emphasized for improved prognosis.
This document provides an overview of the anatomy of the pectoral region. It describes the surface landmarks, superficial fascia containing cutaneous nerves, vessels and the platysma muscle. The breast composition and blood supply are explained. The muscles of the pectoral region including pectoralis major, pectoralis minor, subclavius, and serratus anterior are also detailed. Finally, the clavipectoral fascia enclosing the pectoralis minor is briefly outlined.
The document summarizes fetal development from the 9th week of gestation through birth. It describes how the fetus grows in length and weight each month. It also discusses the development of organs and tissues like the brain, lungs, skin, and muscles. The document then covers the fetal membranes - the amnion, chorion, yolk sac, allantois, and umbilical cord. It explains their roles in protecting the fetus and transporting nutrients. The placenta forms from the chorion and develops branched villi to facilitate nutrient exchange between mother and fetus.
The document summarizes the anatomy and physiology of the breast. It describes the structures of the breast including the lobules, lactiferous ducts, nipple, areola, and supporting stroma. It discusses the blood supply, lymphatic drainage, and nerve innervation of the breast. It also covers the development and changes of the breast during puberty, pregnancy, and lactation. Common anatomical variations are also listed. In summary, the document provides a comprehensive overview of the normal structure and function of the human breast.
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.
It's about the microstructure of breast. Function of the breast and words that will help guide you in anatomy. Having little knowledge about caring for yourself and others make a better nation . Breast cancer is real so let's all be aware . People are somehow careless by taking good care of the breast and also feeding the young ones . With this text made will guide more of the lactating moms to care for the young ones
This document summarizes a lecture on the mammary gland given by Dr. Abdul Waheed Ansari. The lecture covers the gross anatomy, histology, development, and clinical importance of the breast. Specific learning outcomes include identifying the location and structure of the breast, distinguishing normal breast histology, analyzing lymphatic drainage, correlating development, and interpreting mammograms. The lecture discusses the location, blood supply, lymphatic drainage, development, histology of lactating and non-lactating breasts, and clinical significance including metastasis routes. Key clinical points are made about skin dimpling, cancer spread routes, and abnormal mammogram findings.
The document discusses the anatomy and physiology of the Fallopian tubes, fetal development through the three trimesters of gestation, and the three stages of labor and delivery. It describes the layers, cell types and segments of the Fallopian tubes. It outlines the key developments that occur in each trimester of gestation. It then explains the three stages of labor as the dilation stage, expulsion stage, and placental stage. For each stage, it discusses potential complications and common interventions.
The Fallopian tubes extend from the outer edges of the uterus and assist in transporting ova and sperm. They are composed of three layers: mucosa, muscularis, and serosa, each made up of different cell types. Gross anatomy shows they are 10-12 cm long and situated between the ovaries and uterus. Pathophysiological variants include pyosalpinx (pus in the Fallopian tubes) and salpingitis (inflammation of the Fallopian tubes).
Gestation, the development of a fetus, takes 40 weeks and is divided into three trimesters. In the first trimester the embryo develops major organs and limbs. The second trimester sees bone formation and sex appearance.
The placenta develops from the chorionic villi and connects the developing fetus to the uterine wall to allow for nutrient, gas, and waste exchange between mother and fetus. During development, the chorionic villi mature from early mesenchymal villi to immature and mature intermediate villi and finally to terminal villi. By the third trimester, the placenta has highly vascularized and smaller terminal villi. The placenta should be examined at autopsy in cases of fetal or maternal conditions like stillbirth, prematurity, infection, or abnormalities to identify any pathological processes that may have interfered with placental function.
This document provides tips for using a PowerPoint presentation (ppt) on human anatomy. It recommends:
- Freely editing, modifying, and adding your name to the ppt.
- Not worrying about the number of slides, as half are blank except for titles to facilitate discussion.
- Showing blank slides first to elicit what students already know before providing information.
- Rerunning the presentation in an active learning format.
- Using it also for self-study, with bibliography notes provided.
The mammary gland develops through distinct stages in females. During puberty, estrogen and progesterone stimulate ductal growth and lobular development. In pregnancy, placental hormones induce remarkable lobuloalveolar growth. Lactation is stimulated by prolactin and oxytocin to produce milk. Menopause causes glandular tissue shrinkage. Disorders include cancers, cysts, and fibroadenomas. Diagnosis involves exams, imaging, and biopsies. Treatments range from surgery to chemotherapy and reconstruction.
breast is the mammary gland with lobes and ductules with lactiferous ducts.
it extends from 2nd intercostal to 6 intercostal ribs and lies over pectoralis major muscle
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
5. FUNCTIONAL ANATOMY
• At the fifth or sixth
week of fetal
development, two
ventral bands of
thickened ectoderm
(mammary ridges,
milk lines) are evident
in the embryo
6. • The breast or mammary gland (lat. mamma, grc. mastos) is the
largest skin gland.
• That is modified sweat gland.
• It exists in the male as well as in the female, but in the former only in
the rudimentary state.
• At the end of the first month of embryonic development, the
mammary gland begins to develop as a solid bud of epidermis into
the underlying mesenchyme.
• This primary bud occurs from cranial part of the mammary ridges,
thickened strips of ectoderm.
• Each primary bud give rise to several secondary buds that develop
into the lactiferous ducts and their branches that make up the
mammary gland.
• During pregnancy that the breast assumes its complete morphologic
maturation and functional activity.
7. • The breast remains undeveloped in the
female until puberty, when it enlarges in
response to ovarian estrogen and
progesterone, which initiate proliferation of
the epithelial and connective tissue
elements.
• However, the breasts remain incompletely
developed until pregnancy occurs.
8. Developmental anomalies
• Absence of the breast (amastia) is rare and
results from an arrest in mammary ridge
development that occurs during the sixth fetal
week.
• Poland's syndrome consists of hypoplasia or
complete absence of the breast, costal cartilage
and rib defects, hypoplasia of the subcutaneous
tissues of the chest wall, and brachysyndactyly.
• Breast hypoplasia also may be iatrogenically
induced prior to puberty by trauma, infection, or
radiation therapy.
9. • Symmastia is a rare anomaly recognized
as webbing between the breasts across
the midline.
11. • Accessory nipples (polythelia) occur in
less than 1% of infants and may be
associated with abnormalities of the
urinary tract (renal agenesis and cancer),
abnormalities of the cardiovascular system
(conduction disturbances, hypertension,
congenital heart anomalies), and other
conditions (pyloric stenosis, epilepsy, ear
abnormalities, arthrogryposis).
12. Polymastia
• Supernumerary breasts may occur in any
configuration along the mammary milk
line, but most frequently occur between
the normal nipple location and the
symphysis pubis
16. • Turner's syndrome (ovarian agenesis and
dysgenesis) and Fleischer's syndrome
(displacement of the nipples and bilateral
renal hypoplasia) may have polymastia as
a component.
• Accessory axillary breast tissue is
uncommon and usually is bilateral.
17.
18. GYNECOMASTIA
• Gynecomastia refers to an enlarged breast
in the male.
• Physiologic gynecomastia usually occurs
during three phases of life: the neonatal
period, adolescence, and senescence.
• Common to each of these phases is an
excess of circulating estrogens in relation
to circulating testosterone.
19.
20. Classification
• Grade I :Mild breast enlargement without
skin redundancy
• Grade IIa: Moderate breast enlargement
without skin redundancy
• Grade IIb: Moderate breast enlargement
with skin redundancy
• Grade III Marked breast enlargement with
skin redundancy and ptosis, which
simulates a female breast
21. • Estrogen excess states
– A. Gonadal origin
• 1. True hermaphroditism
• 2. Gonadal stromal (nongerminal) neoplasms of the testis
– a. Leydig cell (interstitial)
– b. Sertoli cell
– c. Granulosa-theca
• 3. Germ cell tumors
– a. Choriocarcinoma
– b. Seminoma, teratoma
– c. Embryonal carcinoma
22. • B. Nontesticular tumors
– 1. Adrenal cortical neoplasms
– 2. Lung carcinoma
– 3. Hepatocellular carcinoma
• C. Endocrine disorders
• D. Diseases of the liver—nonalcoholic and
alcoholic cirrhosis
• E. Nutrition alteration states
23. • II. Androgen deficiency states
– A. Senescence
– B. Hypoandrogen states (hypogonadism)
• 1. Primary testicular failure
– a. Klinefelter's syndrome (XXY)
– b. Reifenstein's syndrome
– c. Rosewater, Gwinup, Hamwi familial gynecomastia
– d. Kallmann's syndrome
– e. Kennedy's disease with associated gynecomastia
– f. Eunuchoidal males (congenital anorchia)
– g. Hereditary defects of androgen biosynthesis
– h. ACTH deficiency
• 2. Secondary testicular failure
– a. Trauma
– b. Orchitis
– c. Cryptorchidism
– d. Irradiation
– C. Renal failure III. Drug-related IV. Systemic diseases with
idiopathic mechanisms
24. • The breast is
composed of 15 to 20
lobes, which are each
composed of several
lobules.
• Fibrous bands of
connective tissue travel
through the breast
(suspensory ligaments
of Cooper), insert
perpendicularly into the
dermis, and provide
structural support.
25.
26. • The mature female breast extends from the level
of the second or third rib to the inframammary
fold at the sixth or seventh rib.
• It extends transversely from the lateral border of
the sternum to the anterior axillary line.
• The deep or posterior surface of the breast rests
on the fascia of the pectoralis major, serratus
anterior, and external oblique abdominal
muscles, and the upper extent of the rectus
sheath.
27.
28. Nipple areola complex
• The epidermis of the nipple–areola complex is
pigmented and is variably corrugated.
• During puberty, the pigment becomes darker
and the nipple assumes an elevated
configuration.
• During pregnancy, the areola enlarges and
pigmentation is further enhanced.
• The areola contains sebaceous glands, sweat
glands, and accessory glands, which produce
small elevations on the surface of the areola
(Montgomery tubercles).
29.
30. • Smooth-muscle bundle fibers, which lie circumferentially
in the dense connective tissue and longitudinally along
the major ducts, extend upward into the nipple where
they are responsible for the nipple erection that occurs
with various sensory stimuli.
• The dermal papilla at the tip of the nipple contains
numerous sensory nerve endings and Meissner's
corpuscles.
• This rich sensory innervation is of functional importance
as the sucking infant initiates a chain of neurohumoral
events that results in milk letdown.
31. BLOOD SUPPLY
(1) perforating branches of the internal
mammary artery
(2) lateral branches of the posterior
intercostal arteries
(3) branches from the axillary artery,
including the highest thoracic, lateral
thoracic, and pectoral branches of the
thoracoacromial artery
32. NERVE SUPPLY
• The second, third, and fourth anterior
intercostal perforators and branches of the
internal mammary artery arborize in the
breast as the medial mammary arteries.
33. LYMPHATIC DRAINAGE
• 6 axillary lymph node groups recognized by surgeons
– (1) the axillary vein group (lateral) that consists of 4 to 6 lymph
nodes, which lie medial or posterior to the vein and receive most
of the lymph drainage from the upper extremity
– (2) the external mammary group (anterior or pectoral group) that
consists of 5 or 6 lymph nodes, which lie along the lower border
of the pectoralis minor muscle contiguous with the lateral
thoracic vessels and receive most of the lymph drainage from
the lateral aspect of the breast
– (3) the scapular group (posterior or subscapular) that
consists of 5 to 7 lymph nodes, which lie along the posterior wall
of the axilla at the lateral border of the scapula contiguous with
the subscapular vessels and receive lymph drainage principally
from the lower posterior neck, the posterior trunk, and the
posterior shoulder;
34.
35. • (4) the central group that consists of 3 or 4 sets of
lymph nodes, which are embedded in the fat of the axilla
lying immediately posterior to the pectoralis minor
muscle and receive lymph drainage both from the
axillary vein, external mammary, and scapular groups of
lymph nodes and directly from the breast
• (5) the subclavicular group (apical) that consists of 6 to
12 sets of lymph nodes, which lie posterior and superior
to the upper border of the pectoralis minor muscle and
receive lymph drainage from all of the other groups of
axillary lymph nodes
• (6) the interpectoral group (Rotter's) that consists of 1
to 4 lymph nodes, which are interposed between the
pectoralis major and pectoralis minor muscles and
receive lymph drainage directly from the breast. The
lymph fluid that passes through the interpectoral group of
lymph nodes passes directly into the central and
subclavicular groups.
36.
37. LEVELS OF LN
• Level I - Lateral to pectoralis minor
insertion
• Level II- Behind the insertion
• Level III – Medial / Above the pectoralis
minor insertion
• Supraclavicular nodes
38. Infectious and inflammatory
disorders
• Bacterial infections
– Staphylococcus aureus and Streptococcus
species are the organisms most frequently recovered
from nipple discharge from an infected breast.
– Breast abscesses are typically seen in staphylococcal
infections and present with point tenderness,
erythema, and hyperthermia.
– These abscesses are related to lactation and occur
within the first few weeks of breast-feeding.
39.
40. • They are treated with local wound care,
including warm compresses, and the
administration of intravenous antibiotics
(penicillins or cephalosporins).
• Breast infections may be chronic, possibly with
recurrent abscess formation.
• In this situation, cultures are taken to identify
acid-fast bacilli, anaerobic and aerobic bacteria,
and fungi.
• Uncommon organisms may be encountered and
long-term antibiotic therapy may be required.
41. • Tuberculous infection – anti TB drugs
• Breast pump to drain the breast of milk in
the puerpueral women
42. Mondor’s disease
• This variant of thrombophlebitis involves the
superficial veins of the anterior chest wall and
breast.
• In 1939, Mondor described the condition as
"string phlebitis," a thrombosed vein presenting
as a tender, cord-like structure.
• Frequently involved veins include the lateral
thoracic vein, the thoracoepigastric vein, and,
less frequently, the superficial epigastric vein.
43.
44. • Typically, a woman presents with acute pain in
the lateral aspect of the breast or the anterior
chest wall.
• A tender, firm cord is found to follow the
distribution of one of the major superficial veins.
• Rarely, the presentation is bilateral, and most
women have no evidence of thrombophlebitis in
other anatomic sites.
• This benign, self-limited disorder is not indicative
of a cancer.
45. • When the diagnosis is uncertain, or when a mass is
present near the tender cord, biopsy is indicated.
• Therapy for Mondor's disease includes the liberal use of
anti-inflammatory medications and warm compresses
that are applied along the symptomatic vein.
• Restriction of motion of the ipsilateral extremity and
shoulder as well as brassiere support of the breast are
important.
• The process usually resolves within 4 to 6 weeks.
• When symptoms persist or are refractory to therapy,
excision of the involved vein segment is appropriate.
47. Aberrations of Normal
Development and Involution
• The basic principles underlying the aberrations
of normal development and involution (ANDI)
classification of benign breast conditions are
– (1) benign breast disorders and diseases are related
to the normal processes of reproductive life and to
involution;
– (2) there is a spectrum of breast conditions that
ranges from normal to disorder to disease;
– (3) the ANDI classification encompasses all aspects
of the breast condition, including pathogenesis and
the degree of abnormality.
48. Early reproductive years (age
15–25)
• Normal
– Lobular development
– Stromal development
– Nipple inversion
• Disorder
– Fibroadenoma
– Adolescent hypertrophy
– Nipple inversion
• Disease
– Giant fibroadenoma
– Gigantomastia
– Sub-areolar abscess
– Mammary duct fistula
49. Later reproductive years (age
25–40)
• Normal
– Cyclical changes of menstruation
– Nodularity
– Epithelial hyperplasia of pregnancy
• Disorder
– Cyclical mastalgia
– Bloody nipple discharge
• Disease
– Incapacitating mastalgia
51. Classification of benign breast
disorders according to pathology
• Nonproliferative disorders of the breast
– Cysts and apocrine metaplasia
– Duct ectasia
– Calcifications
– Fibroadenoma and related lesions
• Proliferative breast disorders without atypia
– Sclerosing adenosis
– Radial and complex sclerosing lesions
– Ductal epithelial hyperplasia
– Intraductal papillomas
• Atypical proliferative lesions
– Atypical lobular hyperplasia (ALH)
– Atypical ductal hyperplasia (ADH)
52. Clinical Significance
• Nonproliferative disorders of the breast account
for 70% of benign breast conditions and carry no
increased risk for the development of breast
cancer.
• This category includes
– cysts,
– duct ectasia,
– periductal mastitis,
– calcifications,
– fibroadenomas and related disorders.
56. Fibrocystic disease
• The term fibrocystic disease is nonspecific.
• Too frequently, it is used as a diagnostic term to
describe symptoms, to rationalize the need for
breast biopsy, and to explain biopsy results.
• Synonyms include fibrocystic changes, cystic
mastopathy, chronic cystic disease, chronic cystic
mastitis, Schimmelbusch's disease, mazoplasia,
Cooper's disease, Reclus' disease, and
fibroadenomatosis.
• Fibrocystic disease refers to a spectrum of
histopathologic changes that are best diagnosed
and treated specifically.
57. Fibradenoma
• Fibroadenomas are seen predominantly in
younger women age 15 to 25 years
• Fibroadenomas usually grow to 1 or 2 cm in
diameter and then are stable, but may grow to a
larger size.
• Small fibroadenomas (1 cm in size or less) are
considered normal, while larger fibroadenomas
(up to 3 cm) are disorders and giant
fibroadenomas (larger than 3 cm) are disease.
58.
59. • Similarly, multiple fibroadenomas (more
than five lesions in one breast) are very
uncommon and are considered disease.
61. • The precise etiology of adolescent breast
hypertrophy is unknown.
– A spectrum of changes from limited to massive
stromal hyperplasia (gigantomastia) is seen.
• Nipple inversion is a disorder of development of
the major ducts, which prevents normal
protrusion of the nipple.
• Mammary duct fistulas arise when nipple
inversion predisposes to major duct obstruction,
leading to recurrent subareolar abscess and
mammary duct fistula.
62. Cyclical mastalgia in later
reproductive years
• Cyclical mastalgia and nodularity are usually
associated with premenstrual enlargement of the
breast and are regarded as normal.
• Cyclical pronounced mastalgia and severe
painful nodularity are viewed differently than are
physiologic discomfort and lumpiness.
• Painful nodularity that persists for more than 1
week of the menstrual cycle is considered a
disorder.
• In epithelial hyperplasia of pregnancy, papillary
projections sometimes give rise to bilateral
bloody nipple discharge.
63. II. Pathology of Proliferative
Disorders Without Atypia
• Proliferative breast disorders without
atypia include
– sclerosing adenosis,
– radial scars,
– complex sclerosing lesions,
– ductal epithelial hyperplasia,
– intraductal papillomas.
65. • Sclerosing adenosis is prevalent during the
childbearing and perimenopausal years and has
no malignant potential.
– Histologic changes are both proliferative (ductal
proliferation) and involutional (stromal fibrosis,
epithelial regression) in nature.
– Sclerosing adenosis is characterized by distorted
breast lobules and usually occurs in the context of
multiple microcysts, but occasionally presents as a
palpable mass.
67. • Central sclerosis and varying degrees of
epithelial proliferation, apocrine
metaplasia, and papilloma formation
characterize radial scars and complex
sclerosing lesions of the breast.
• Lesions up to 1 cm in diameter are called
radial scars, while larger lesions are called
complex sclerosing lesions.
68. • Radial scars originate at sites of terminal duct
branching where the characteristic histologic
changes radiate from a central area of fibrosis.
• All of the histologic features of a radial scar are
seen in the larger complex sclerosing lesions,
but there is a greater disturbance of structure
with papilloma formation, apocrine metaplasia,
and, occasionally, sclerosing adenosis
69.
70. III. Pathology of Atypical
Proliferative Diseases
• The atypical proliferative diseases have
some of the features of carcinoma in situ
(CIS) but either lack a major defining
feature of CIS or have the features in less
than fully developed form.
• In 1978, Haagensen and colleagues
described lobular neoplasia, a spectrum of
disorders ranging from atypical lobular
hyperplasia to lobular carcinoma in situ.
71. Cancer Risk Associated with Benign Breast
Disorders and In Situ Carcinoma of the Breast
Abnormality Relative Risk
Nonproliferative lesions of the breast No increased risk
Sclerosing adenosis No increased risk
Intraductal papilloma No increased risk
Florid hyperplasia 1.5 to 2-fold
Atypical lobular hyperplasia 4-fold
Atypical ductal hyperplasia 4-fold
Ductal involvement by cells of
atypical ductal hyperplasia 7-fold
Lobular carcinoma in situ 10-fold
Ductal carcinoma in situ 10-fold
72. Treatment of Selected Benign
Breast Disorders and Diseases
• CYSTS
– Aspiration of the cyst
– Biopsy of aspirate
– The two cardinal rules of
safe cyst aspiration are
– (1) the mass must
disappear completely after
aspiration,
– (2) the fluid must not be
bloodstained.
– If either of these conditions
is not met, then ultrasound,
needle biopsy, and
perhaps excisional biopsy
are recommended.
73. Management of fibroadenomas
• Removal of all fibroadenomas has been advocated
irrespective of patient age or other considerations, and
solitary fibroadenomas in young women are frequently
removed to alleviate patient concern.
• Yet most fibroadenomas are self-limiting and many go
undiagnosed, so a more conservative approach is
reasonable.
• Careful ultrasound examination with core-needle biopsy
will provide for an accurate diagnosis.
• Subsequently, the patient is counseled concerning the
biopsy results, and excision of the fibroadenoma may be
avoided.
74. Management for sclerosing
adenosis
• The clinical significance of sclerosing adenosis lies in its
mimicry of cancer.
• It may be confused with cancer on physical examination,
by mammography, and at gross pathologic examination.
• Excisional biopsy and histologic examination are
frequently necessary to exclude the diagnosis of cancer.
• The diagnostic work-up for radial scars and complex
sclerosing lesions frequently involves stereoscopic
biopsy.
• It is usually not possible to differentiate these lesions
with certainty from cancer by mammography features, so
biopsy is recommended
77. RISK FACTORS
• HORMONE ASSOCIATED RISK FACTORS
– Increased exposure to estrogen is associated with an
increased risk for developing breast cancer, whereas
reducing exposure is thought to be protective.
– Correspondingly, factors that increase the number of
menstrual cycles, such as early menarche, nulliparity,
and late menopause, are associated with increased
risk.
– Moderate levels of exercise and a longer lactation
period, factors that decrease the total number of
menstrual cycles, are protective.
78. – The terminal differentiation of breast epithelium
associated with a full-term pregnancy is also
protective
– older age at first live birth is associated with an
increased risk of breast cancer.
– there is an association between obesity and
increased breast cancer risk.
– Because the major source of estrogen in
postmenopausal women is the conversion of
androstenedione to estrone by adipose tissue, obesity
is associated with a long-term increase in estrogen
exposure
79. • Nonhormonal risk factors
– radiation exposure.
• Young women who receive mantle radiation therapy for
Hodgkin's lymphoma have a breast cancer risk that is 75
times greater than that of age-matched control subjects.
• Survivors of the atomic bomb blasts in Japan during World
War II have a very high incidence of breast cancer, likely
because of somatic mutations induced by the radiation
exposure.
• In both circumstances, radiation exposure during
adolescence, a period of active breast development,
magnifies the deleterious effect.
80. – Studies also suggest that the amount and
duration of alcohol consumption are
associated with an increased breast cancer
risk.
• Alcohol consumption is known to increase serum
levels of estradiol.
– Finally, evidence suggests that chronic
consumption of foods with a high fat content
contributes to an increased risk of breast
cancer by increasing serum estrogen levels
81. 70% – 80% of breast cancer cases have
no identifiable risk factors other than
being a woman and growing older
Majority are sporadic or index cases and
have no family history of breast cancer.
82. Breast cancer risk assessment
model
• Gail Model (see table 16-7 schwartz)
– Age at menarche (years)
– Number of biopsies/history of benign
breast disease, age <50 y
– Number of biopsies/history of benign
breast disease, age 50 y
– Age at first live birth (years)
83. Percent Incidence of Sporadic, Familial, and Hereditary
Breast Cancer
• Sporadic breast cancer 65–75%
• Familial breast cancer 20–30%
• Hereditary breast cancer 5–10%
– BRCA-1 45%
– BRCA-2 35%
– p53 (Li-Fraumeni syndrome) 1%
– STK11/LKB1 (Peutz-Jeghers syndrome) <1%
– PTEN (Cowden disease) <1%
– MSH2/MLH1 (Muir-Torre syndrome) <1%
– ATM (Ataxia-telangiectasia) <1%
– Unknown 20%
• a Affected gene.
• SOURCE: Adapted with permission from Martin AM et al. 47
84. Cancer Prevention for BRCA
Mutation Carriers
• Risk management strategies for BRCA-1 and
BRCA-2 carriers include:
• Prophylactic mastectomy and reconstruction;
• Prophylactic oophorectomy and hormone
replacement therapy;
• Intensive surveillance for breast and ovarian
cancer
• Chemoprevention.- Tamoxifen
85. EPIDEMIOLOGY
Number one cancer in women
Breast cancer is the most common site-
specific cancer in women and is the
leading cause of death from cancer for
women age 40 to 44 years.
It accounts for 33% of all female cancers
and is responsible for 20% of the cancer-
related deaths in women.
86. The incidence of breast cancer is
increasing in many countries at a
mean rate of 1% to 2% annually
and it is estimated that during the
first decade of the third
millennium nearly 1 million women
will develop this disease yearly
throughout the world.
Veronesi U, Sacchini V, Colleoni M, Goldhirsch A. Breast
cancer. In: Pollock RE, ed. Manual of Clinical Oncology, 7th
ed. UICC 1999: 491-514
88. In the Philippines, the
incidence of breast cancer is
30.2/100,000.
It is considered one of the
highest in Asia.
Breast Cancer Working Group. Breast cancer. In: Arcellana-
Nuquid EY, ed. The Handbook of Clinical Oncology, 2nd ed.
2001: 135
89. NATURAL HISTORY
• PRIMARY DISEASE
– Starts from mutation in a single cell
– Doubling time
– More than 80% of breast cancers show
productive fibrosis that involves the epithelial
and stromal tissues. (schirrous type).
90. • With growth of the cancer and
invasion of the surrounding
breast tissues, the
accompanying desmoplastic
response entraps and shortens
the suspensory ligaments of
Cooper to produce a
characteristic skin retraction.
• Localized edema (peau
d'orange) develops when
drainage of lymph fluid from
the skin is disrupted.
91.
92. • With continued
growth, cancer cells
invade the skin and
eventually ulceration
occurs.
• As new areas of skin
are invaded, small
satellite nodules
appear near the
primary ulceration.
93. • The size of the primary breast cancer
correlates with disease-free and overall
survival, but there is a close association
between cancer size and axillary lymph
node involvement.
94. • In general, up to 20% of breast cancer
recurrences are locoregional, more than
60% are distant, and 20% are both
locoregional and distant
96. Axillary Lymph Node Metastases
• As the size of the primary breast cancer
increases, some cancer cells are shed into
cellular spaces and transported via the
lymphatic network of the breast to the regional
lymph nodes, especially the axillary lymph
nodes.
• Lymph nodes that contain metastatic cancer are
at first ill-defined and soft, but become firm or
hard with continued growth of the metastatic
cancer.
97. • Eventually the lymph nodes adhere to each
other and form a conglomerate mass.
• Cancer cells may grow through the lymph node
capsule and fix to contiguous structures in the
axilla including the chest wall.
• Typically, axillary lymph nodes are involved
sequentially from the low (level I) to the central
(level II) to the apical (level III) lymph node
groups.
98. Importance of lymph node status
• While more than 95% of the women who
die of breast cancer have distant
metastases
• the most important prognostic correlate for
disease-free and overall survival is axillary
lymph node status.
• Node-negative women have less than a
30% risk of recurrence, compared to as
much as a 75% risk for node-positive
99. Distant Metastases
• At approximately the twentieth cell doubling,
breast cancers acquire their own blood supply
(neovascularization).
• Thereafter, cancer cells may be shed directly
into the systemic venous blood to seed the
pulmonary circulation via the axillary and
intercostal veins or the vertebral column via
Batson's plexus of veins, which courses the
length of the vertebral column.
• These cells are scavenged by natural killer
lymphocytes and macrophages.
100. • Successful implantation of metastatic foci
from breast cancer predictably occurs after
the primary cancer exceeds 0.5 cm in
diameter, which corresponds to the
twenty-seventh cell doubling.
• For 10 years following initial treatment,
distant metastases are the most common
cause of death in breast cancer patients.
101. • 60% of the women who develop distant
metastases will do so within 24 months of
treatment
• metastases may become evident as late
as 20 to 30 years after treatment of the
primary cancer.
• Common sites of involvement, in order of
frequency, are
– bone, lung, pleura, soft tissues, and liver.
102. PATHOLOGY
• Lobular carcinoma in situ
• Ductal carcinoma in situ
• Invasive breast carcinoma
– Invasive ductal – 70 % of cases
– Invasice lobular carcinoma
– Other special types
104. Histologic classification
I. Paget's disease of the nipple
II. Invasive ductal carcinoma
A. Adenocarcinoma with productive fibrosis (scirrhous,
simplex, NST) 80%
B. Medullary carcinoma 4%
C. Mucinous (colloid) carcinoma 2%
D. Papillary carcinoma 2%
E. Tubular carcinoma (and ICC) 2%
III. Invasive lobular carcinoma 10%
IV. Rare cancers (adenoid cystic, squamous cell,
apocrine)
105. Paget’s disease
• a chronic, eczematous
eruption of the nipple,
which may be subtle, but
may progress to an
ulcerated, weeping
lesion.
• Paget's disease is usually
associated with extensive
DCIS and may be
associated with an
invasive cancer.
• A palpable mass may or
may not be present.
106. • Biopsy of the nipple will
show a population of cells
that are identical to the
underlying DCIS cells
(pagetoid features or
pagetoid change).
• Pathognomonic of this
cancer is the presence of
large, pale, vacuolated
cells (Paget's cells) in the
rete pegs of the
epithelium.
118. Diagnostic Studies for Breast Cancer Patients
History & physical
CBC, platelets
Liver function tests
Chest x-ray
Bilateral mammogram
Hormone-receptor status
HER2/neu expression
Bone scan
Abdominal CT scan or ultrasound or MRI
119. TREATMENT
• SURGERY
1. Mastectomy with axillary lymph node
dissection
1. Sentinel lymph node
2. Breast conservation surgery with radiation
1. Lumpectomy
2. Quadrantectomy (QUART)
3. Simple mastectomy (toilet)
– Consider objective of treatment whether
curative of palliative
120.
121. Adjuvant therapy
• Chemotherapy
– For tumors more than 2 cms
– Positive lymph nodes
• Radiation therapy
– For DCIS
– For breast conservation
– For advance staged disease
122. Hormonal therapy
• SERMS: Selective estrogen modulators
– Tamoxifen – 5 years
– Aromatase inhibitors
• Ablative endocrine therapy
– Oophorectomy
• Given to ER / PR positive tumors
124. Prognosis
• The 5-year survival rate
– stage I patients is 94%
– stage IIa patients, 85%
– stage IIb patients, 70%
– stage IIIa patients, 52%
– stage IIIb patients, 48%
– stage IV patients, 18%.
125. Phylloides tumor
• Phyllodes tumors also known
cystosarcoma phyllodes, cystosarcoma
phylloides and phylloides tumor, are
typically large, fast growing masses that
form from the periductal stromal cells of
the breast.
• They account for less than 1% of all breast
neoplasms.
129. Early Detection Measures
• MONTHLY breast self examination by age
20
• YEARLY health worker breast
examination by age
30
• YEARLY mammogram by age
40