BREAST CANCER

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

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

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

Fibrocystic Disease Fibrosis Cystic disease Sclerosing adenosis Epithelial hyperplasia

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

Breast Tumors Fibroademona Cystosarcoma phyllodes Intraductal papilloma Carcinoma of the breast

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

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

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

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

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

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

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

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

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

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

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

Inflammatory Breast Cancer

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

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

Breast Cancer Classification 5-year survival rate Stage I 80-95% Stage II 65-85% Stage IIIa 56% Stage IIIb 49% Stage IV 10-19%

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