1. BREAST CANCER

2. Anatomy of the Breast The Breast – Mammary gland Glandular tissue
Duct system
Fat

3. Anatomy of the Breast The nipple – smooth muscle fibers
The areola – contains sebaceous glands
Lactiferous ducts
Lactiferous sinus
Cooper’s ligaments

4. Anatomy of the Breast Arterial supply
Artery thoracic internal , axillary artery, intercostal arteries
Venous drainage
Axillary vein
Lymphatic drainage
Axillary nodes

5. Fibrocystic Disease Fibrosis Cystic disease Sclerosing adenosis
Epithelial hyperplasia

6. Fibrocystic Disease Fibrocystic disease Cancer
Often bilateral Unilateral
Multiple nodules Single
Menstrual variation No variation
Cystic pain No pain
May regress Does not regress

7. Breast Tumors Fibroademona Cystosarcoma phyllodes
Intraductal papilloma
Carcinoma of the breast

8. Breast Cancer Statistics
Lung – 25%
Breast – 11%
Colon and Rectum-11%

9. Breast Cancer Statistics
In the USA:
211,000 new cases of invasive breast cancer will be diagnosed this year
43,300 patients will die

10. Risk Factors of Breast Cancer
1) Fibrocystic disease
2) Menarche disorders
3) Diets high in saturated fat
4) Family history of breast cancer
5) Late or no pregnancies
6) Moderate alcohol intake
7) Estrogen replacement therapy

11. Pathogenesis of Breast Cancer
Genetic (BRCA 1 on 17q and BRCA 2 on 13q)
Viral
Environmental
Hormonal role (“unopposed estrogen”)

12. Breast Cancer Classification
Noninfiltrating intraductal carcinoma
Infiltrating ductal carcinoma
Medullary carcinoma
Colloid (mucinous) carcinoma
Lobular carcinoma
Paget’s disease of the breast
Inflammatory carcinoma

13. Non-infiltrative intraductal carcinoma
“Comedocarcinoma”
Microscopically:
Typical duct epithelial cells proliferate
Ductal dilatation

14. Infiltrative ductal carcinoma
Rock-hard palpable tumors 2-5 cm in diameter
Nipple retraction
Necrosis and calcification
Microscopically:
Anaplastic duct epithelial cells
Fibrous reaction

15. Medullary carcinoma Fleshy masses 5-10 cm in diameter
Little fibrous tissue
Microscopically
Large pleomorphic cells
Lymphocytic infiltrate

16. Colloid (mucinous) carcinoma
Soft, large, gelatinous tumor
Microscopically
Tumor cells and mucin

17. Lobular carcinoma Arises from terminal ductules Multicentric tumors
Rubbery and ill-defined tumors
Microscopically
Small cells arranged in rings
Small cells are confined to lobules

18. Paget’s disease The skin of the nipple and areola are ulcerated
Inflammation
Bacterial infection
Microscopically
Ductal carcinoma
“Paget’s cells”

19. Inflammatory Breast Cancer

20. Breast Cancer TNM-classisfication
TIS = Paget's Disease without a tumor, Carcinoma in-situ T1 = Tumor less than 2 cm. in greatest dimension T2 = Tumor larger than 2 cm. in size but less than 5cm. T3 = Tumor larger than 5 cm. in size T4 = Tumor of any size extending to the chest wall or skin
N1 = Metastasis to moveable axillary nodes N2 = Metastasis to fixed or matted axillary nodes N3 = Metastasis to supraclavicular, infraclavicular or internal mammary nodes
M0 = no distant metastasis M1 = distant metastasis

21. Stages of Breast Cancer
Stage I T1 N0 M0
Stage II T0 N1 M0
T1 N1 M0
T2 N0 N1 M0
Stage IIIA T0 N2 M0
T1 N2 M0
T2 N2 M0
T3 N0, N1, N2 M0
Stage IIIB Any T N3 M0
T4 Any N M0
Stage IV Any T Any N M1

22. Breast Cancer Classification
5-year survival rate
Stage I %
Stage II %
Stage IIIa %
Stage IIIb %
Stage IV %

23. Breast Cancer Treatment Segmental mastectomy Simple mastectomy
Modified radical mastectomy
Radical mastectomy