1. Breast Carcinoma

2. Anatomy

6. Epidemiology: 10% 17.1/10 28/10 46/10 1.2 m world wide 6% develop cancer of the breast in their lifetime. 50,000 to 70,000 new cases USA

7. Risk Factors for Breast Cancer Major Minor Gender(female>male) Early menarche Age Late minopause Family history(mother,sister,or Obesity daughter with premenopausal Low-dose radiation or bilateral cancer) Personal history of contralateral BC Nonivasive carcinoma (ductal or lobular carcinoma in situ) Benign proliferative changes with atypia

8. Pathology of Breast Cancer Noinvasive 1 、 Ductal Carcinoma in situ (DCIS) ， intraductal 2 、 Lobular Carcinoma in situ (LCIS) Invasive 1 、 Infiltrating ductal carcinoma : this is the most common malignant tumor in the breast recognized after biopsy. 2 、 Invasive Lobular carcinoma: Paget’s disease of the nipple

9. Diagnosis of Breast Mass: 1history and physical examination 2Risk factors for breast cancer: 3 fine-needle aspiration 4 breast imaging : 5 ultrasonography, thermography, computed tomography (CT), magnetic resonance imaging (MRI), mammography.

10. Staging Breast Cancer T1 tumor more than 2 cm or less in greatest dimension T2 tumor more than 2 cm, but not more then 5 cm in greatest dimension T3 tumor more than 5 cm in greatest dimension T4 tumor in any size with direct extension to chest wall or skin No no regional lymph node metastasis N1 metastasis to movable ipsilateral axillary lymph node N2 metastasis to ipsilateral axillary lymph nodes that are fixed to one another or to other structures N3 metastasis to ipsilateral internal mammaryl lymph node Mo no distant metastasis M1 distant metastasis (includes metastasis to ipsilateral supraclavicular lymph node)

11. Surgical Procedures Past and Present 1)In 1894, Halsted 2)Radical and Extended Radical mastectomy: 3)Modified radial mastectomy: 4)Patey : 5)Auchincloss :

17. Adjuvant chemotherapy for operable breast cancer: 1) Adjuvant chemotherapy for lymph node-positive patients 2) Adjuvant chemotherapy for lymph node-negative patients Hormonal therapy for breast cancer 1) Steroid hormone receptors 2) Adjuvant hormonal therapy for operable breast cancer

18. Recommendations for Adjuvant Treatment Menopausal Axilliary Tumor Recommended Treatment Starus Nodes Characteristics Premenopausal Positive Favorable or Un Combination chemotherapy Premenopausal Negative Favorable No data to support adjuvant Premenopausal Negative Unfavorable Combination Chemotherapy Postmenopausal Positive Favorable Tamoxifen±Chemotherapy Postmenopausal Positive Unfavorable Chemotherapy ±Tamoxifen Postmenopausal Negative Favorable No data to support adjuvant Postmenopausal Negative Unfavorable No data to support adjuvant Favorable tumor characteristic include size<2 cm, Er or PgR positive,nuclear and histologic grade good(1 or 2)