1. BREAST CANCER Walid Galal El Shazly
Assistant lecturer, General surgical Department
Faculty of medicine, University of Alexandria

2. What is Breast Cancer ?
Abnormal cells develop from normal cells in the breast to form tumors
Tumor cells have genetic defects that allow the cells to grow too rapidly and to invade normal tissues
Malignant cells
Normal cells

3. Breast Cancer: Statistics
Breast cancer is the most common cancer in American women
20% of all cancers in women
Commonest cause of death y
185,000 new cases every year
Lifetime risk for the average woman; approximately one in nine will develop breast cancer

4. Risks Finding of pre-malignant changes in breast tissue
Never having children
Having first child after age 30
Obesity - Alcohol - Estrogen therapy

5. What is the risk for developing breast cancer?
Age years
History of breast cancer in a close relative (mother/sister/daughter)
90% of women with breast cancer have no relatives with the disease

6. Stages of breast cancer
The rate at which a cancer will grow is not predictable - some tumors grow slowly, others rapidly
The earlier a tumor is identified, the better the chance for cure
95% of women with cancers less than 1/2 inch in size are cured
Advanced cases are fare from cure our aim is palliation

7. Spread of Breast Carcinoma:
Lymphatic
Blood
Direct

8. TNM Staging Tumor Tx primary tumor can not be assessed
Tis In situ carcinoma & paget’s disease
T0 no palpable mass
T1 tumor < or = 2 cm
T1a < or = 0.5 cm no deep fixation
T2b – 1 cm + deep fixation
T3c – 2 cm + deep fixation
T2 tumor 2 – 5 cm
T2a no deep fixation
T2b deep fixation
T3 tumor 5 – 10 cm
T3a no deep fixation
T3b deep fixation
T4 tumor of any size
T4a direct chest extension
T4b skin ( Peau d’orange, skin nodule & ulceration)
T4c T 4a + T4b
T4d inflammatory breast cnacer

9. TNM Staging N x can not be assessed N 0 not palpable LN
Nodes
N x can not be assessed
N 0 not palpable LN
N 1 palpable homo-lateral axillary LN and mobile
N 2 palpable homo-lateral axillary LN and fixed
N 3 ipsilateral internal mammary LN
M X can not be assessed
M 0 no known metastases
M 1 distant metastases including supra-clavicular LN
Metastases

10. Stag
Definition
5-year
Surv (%)
7-year I
Tumor 2 cm or less without spread 96 92 II
Tumor 2-5cm with regional lymph node involvement but without distant metastases, OR > 5 cm in diameter without spread 81 71
III
Any size with skin/chest wall fixation, & axillary or internal mammary nodal involvement, without distant metastases 52 39 IV
Tumor of any size with or without regional spread but with evidence of distant metastases 18 11

11. What is the best defense against breast cancer?
EARLY DETECTION
Be aware of personal risk for breast cancer
Practice monthly breast self exam
Have a screening mammogram every year once the female are 40 years old
Have an annual breast exam every year after age 40
See doctor promptly if the patient note a new breast lump or thickening
Enjoy a healthy life: control weight, minimize alcohol, don’t smoke, exercise

12. Breast self examination for early detection
EARLY DETECTION LEADS TO CURE

13. EARLY DETECTION LEADS TO CURE

14. EARLY DETECTION LEADS TO CURE

15. EARLY DETECTION LEADS TO CURE

16. What if a female feel a lump in her breast?
The patient should go to her doctor immediately for a physical examination; and don’t wait for annual examination
The doctor may refer the patient for breast imaging - a mammogram
A biopsy may be recommended, depending on the features of the lump
Many lumps in the breast are NOT cancer; benign fibrocystic disease and benign tumors are common
EARLY DETECTION LEADS TO CURE

17. Mammography Mammograms are sensitive x rays of the breast
Small, safe dose of radiation is used
Minor discomfort due to pressure on the breast is noted by some women
EARLY DETECTION LEADS TO CURE

18. Mammography Mammograms can detect premalignant changes
Mammograms are the best means to find early curable cancers - cancers too small to be detected by touch
85% of cancers will show up on a mammogram - 15% will not
EARLY DETECTION LEADS TO CURE

19. Two Methods of Mammograms
Ordinary film
Xero or zeno mammography
over selinium plates gave different colors blue and white
EARLY DETECTION LEADS TO CURE

20. Abnormal Mammographic findings
Micro calcifications
Speculated
lesion
Satellite
lesion
Circumscribed
lesion
Rounded
punctuate
Linear
branching
Mammographic signs of malignancy
Breast lump
Linear or branching micrcalcification
Skin or nipple thickening
Mammary duct distortion or asymmetry

23. What if abnormal mammogram?
The patient seek medical advice for a breast examination
Special mammogram will be done to confirm if the finding is real
Additional imaging tests - ultrasound - for better definition
Close follow-up imaging may be recommended at 6 months or:

24. What if abnormal mammogram?
Biopsy may be recommended
Needle biopsy - Ultrasound directed
Needle biopsy - mammogram directed
Surgical biopsy
The tissue diagnosis is the most important information in planning treatment
Most mammogram abnormalities are not cancer; most are due to benign changes

25. How is the diagnosis of breast cancer made?
A suspicious sign on a mammogram or a lump in the breast will indicate the need for a tissue biopsy
A biopsy of the abnormal tissue is required to make the diagnosis of breast cancer
A careful physical examination will give signs about the stage of the cancer
size of tumor in breast
lymph node enlargement under arm
status of the opposite breast

26. How is the diagnosis of breast cancer made?
Features of the tumor:
Type of breast cancer - ductal, lobular, etc
Grade of the tumor
Hormone receptor status
Indicators of biologic growth rate potential
c-erb

27. Can breast cancer be prevented?
Recent studies showed that women with an increased risk for breast cancer can have that risk decreased by % by taking the anti-estrogen medication tamoxifen
Tamoxifen benefited women with:
the breast cancer gene
age greater than 55 years
premalignant changes in previous biopsies
Side effects
very small increase in risk of cancer of the uterus
blood clots

28. How is breast cancer treated?
1. SURGERY: to remove all the tumor
Breast preserving surgery - most patients
Removal of the full breast - mastectomy - may be required for some patients
2. DETERMINE THE STAGE OF THE TUMOR: Remove some of the lymph nodes under the arm to look for tumor metastases

30. How is breast cancer treated?
ADJUVANT THERAPY: Medical therapy to decrease the chance of tumor recurrence - to improve the chances for cure
Chemotherapy - many different therapies
Hormonal therapy - tamoxifen, aromatase inhibitors

31. How is breast cancer treated?
4- RADIATION THERAPY - to prevent tumor recurrence in the remaining breast tissue; required for breast preserving therapy

32. Thank you