Breast cancer

Risk Factors vs. Protective Factors

Neoplasia and benign Tm

Duct papilloma

•Usually in the main ducts near the nipple.

•Young women.

•Before it become palpable may ulcerate and bloody discharge.

•Block may cause a retention cyst.

Clinic :

1-  bloody discharge (no pain).

2-  small mass fusiform behind areola. Pressur on it bloody discharge.

3-  if no mass the pressure on certain point behind the areola will reveal discharge from one duct

•Investigation:    Ductography

•Treatment: Excision of the affected duct (micro-dochectomy).

fibroadenoma

The commonest breast mass of young women (15-30)

Fibrous +++ and glandular tissues ++

clinical:

Hard mass (20-30) painless , soft mass (30-50) painfull , accident discover

•Usually small, non tender, spherical, firm, well circumscribed, high mobility.

•Investigation: 

Clinical exam enough for diagnosis

Soft tissue == mammography ==reveal a well circumscribed.

May U/S

Treatment: Excision and histological confirmation of diagnosis

CYSTOSACROMA phylloides

-A highly cellular type of fibroadenoma that tend to grow rapidly (brodie). Enlarge slowly and rich a large size (20-30 cm).

-Cystic formation with skin ulceration

-Rarely malignant.

-Phylloides tumour

 -wide local excision to prevent recurrence

-if infiltrate whole breast simple mastectomy.

Carcinoma of breast

•Most common cancer in women

•In USA     9:1

•Breast cancer is second only to lung cancer as a cause of cancer deaths in American women

•The mean age of affection 60 years.

•The commonest malignant neoplasm in Egyptian female 35%.

Histology:

•The carcinoma may arise from the lobule, ducts or nipples

•Arise from the ductal epithelium in the majority of cases.

Carcinoma of ducts:

-ductal carcinoma in situ

-Infiltrating ductal carcinoma

•Carcinoma of the lobules:

-Non infiltrating lobular carcinoma (lobular carcinoma in situ)

-Infiltrating lobular carcinoma. Bilateral in 25%.

        

•Paget’s disease of nipple:

An introduction of carcinoma which begins in the epithelium of a main collecting lactiferous duct and

spreads within epithelium up to the skin of the nipple and down into the breast substance.

A mass may appear after 2 years from the start of the disease.

•Spread:

Local spread: overlying (skin), underlying (pectoralis major,…..., chest wall).

Lymphatic spread: mostly to axillary node, next common is the internal mammary chain.

Blood stream spread: produces metastases in the lungs, bones, brain and liver.

Clinical features

•Symptoms:

1-  accidently notices a painless lump.

2-  mild breast pricking pain , nipple retraction or bloody nipple discharge.

3-  symptomatic metastases.(axillary lump ,pulmonary metastasis)

4-  by routine screening mammography in high risk women.

•Signs:

For breast examination , the top half of trunk exposed, both breast, axillae, arms and supraclavicular.

-Beast asymmetry                  - enlargement

-Skin dimpling                       - skin puckering

-Peau d’orange                       - skin ulceration or nodule

-Mass :   hard  ,  irregular  ,  immobile  ,  fixe  

Nipple : retraction ulce

STAGING OF cancer breast

•Manchester staging:

Stage 1:

Mobile mass ,   no LNs , no attachment of wall.

Stage 2:

Mobile mass , no attachment of wall , mobile ipsilateral axillary LNs.

Stage 3: (wide licale spread) any of theses

1-skin affection (more than tm but at breast)

2-fixed to pectoral muscles

3-ipsilateral axillary LN  matted together

4-ipsilateral supra clavicular  LNs

5-edema of the arm.

Stage 4:

1-skin affection wide of the breast.

2-fixed to chest wall.

3-controlateral axillary LNs.

4-distant metastasis.

v tmn:

self-exam of breast , auto-examination of breast