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    Breast cancer is the most common cancer in women, accounting for 32% of all female cancers. While most cases occur sporadically, around 5-10% of cases have a hereditary component linked to mutations in the BRCA1 and BRCA2 genes. Risk factors include family history, early menarche, late menopause, nulliparity, hormone use, obesity, radiation exposure, and alcohol consumption. Diagnosis involves physical exam, mammography, and biopsy. Treatment depends on cancer stage but commonly involves surgery, radiation, chemotherapy, and hormone therapy. Inflammatory breast cancer is an aggressive subtype characterized by breast erythema and edema without an underlying mass.

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    Breast cancer is the most common cancer in women, accounting for 32% of all female cancers. While most cases occur sporadically, around 5-10% of cases have a hereditary component linked to mutations in the BRCA1 and BRCA2 genes. Risk factors include family history, early menarche, late menopause, nulliparity, hormone use, obesity, radiation exposure, and alcohol consumption. Diagnosis involves physical exam, mammography, and biopsy. Treatment depends on cancer stage but commonly involves surgery, radiation, chemotherapy, and hormone therapy. Inflammatory breast cancer is an aggressive subtype characterized by breast erythema and edema without an underlying mass.

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    Breast cancer is the most common cancer in women, accounting for 32% of all female cancers. While most cases occur sporadically, around 5-10% of cases have a hereditary component linked to mutations in the BRCA1 and BRCA2 genes. Risk factors include family history, early menarche, late menopause, nulliparity, hormone use, obesity, radiation exposure, and alcohol consumption. Diagnosis involves physical exam, mammography, and biopsy. Treatment depends on cancer stage but commonly involves surgery, radiation, chemotherapy, and hormone therapy. Inflammatory breast cancer is an aggressive subtype characterized by breast erythema and edema without an underlying mass.

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    © All Rights Reserved
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    16 views36 pages

    Screenshot 2022-10-26 at 7.27.40 PM

    Uploaded by

    hamdacawad22
    Breast cancer is the most common cancer in women, accounting for 32% of all female cancers. While most cases occur sporadically, around 5-10% of cases have a hereditary component linked to mutations in the BRCA1 and BRCA2 genes. Risk factors include family history, early menarche, late menopause, nulliparity, hormone use, obesity, radiation exposure, and alcohol consumption. Diagnosis involves physical exam, mammography, and biopsy. Treatment depends on cancer stage but commonly involves surgery, radiation, chemotherapy, and hormone therapy. Inflammatory breast cancer is an aggressive subtype characterized by breast erythema and edema without an underlying mass.

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    of 36

    Breast cancer

    Anatomy of the mammary gland


    • Breast cancer is the commonest female cancer
    accounting for 32% .
    • It is a heterogenous disease with multiple
    factors contribute to cancer development.
    • Most of the cases occur sporadically.
    Familial & Hereditary Factors
    • 5% to 10% have a true hereditary
    predisposition to breast cancer.

    • The risk of developing BC is increased 1.5- to


    3 fold if a woman has a mother or sister with
    BC.

    • Depends on the number of relatives with BC,


    the exact relationship, the age at diagnosis, and
    the number of unaffected relatives.
    • Mutations in BRCA1 and BRCA2 are
    associated with a significant increase in BC
    risk.
    • 5-10% of breast cancer cases are related to
    mutations of the BRCA1 and BRCA2 genes.
    • These mutations are inherited in an autosomal
    dominant.
    • The estimated lifetime risk of BC development
    ranges from 26% to 85%.
    Hormonal Factors
    • Early age at menarche, < 13 years
    • Late age at menopause > 60 yrs
    • Nulliparity or late age at first pregnancy.
    • Most hormonal risk factors have a relative risk
    of 2.0 or less for BC development.
    • Oophorectomy before age 50 decreases BC
    risk.
    • Data from women with BRCA1 and BRCA2
    mutations suggest that early oophorectomy has
    a protective effect on BC risk.
    • The use of combined estrogen and progestin
    HRT increases BC risk.
    Dietary and Life style Factors
    • High fat diet intake?
    pooled analysis of seven prospective
    epidemiologic studies failed to identify an
    association between fat intake and BC risk.
    • There may be a moderate protective effect
    from high vegetable consumption.
    • There is a positive association between alcohol
    & BC risk, with risk increasing linearly with
    the amount of alcohol consumed.
    • Obesity is associated with both an increased
    risk of BC development & mortality.
    Benign Breast Disease
    • Nonproliferative disease is not associated with
    an increased risk of BC.
    • Proliferative disease without atypia results in a
    small increase in risk (RR 1.5 – 2)
    • Proliferative disease with atypical hyperplasia
    is associated with a greater risk (RR, 4.0 to
    5.0).
    • Proliferative diseases are more common in
    women with a significant family history of BC
    .
    Environmental Factors
    • Exposure to ionizing radiation increases risk,
    and it is particularly marked for exposure at a
    young age.
    • A markedly increased risk of breast cancer
    development has been reported in women who
    received mantle irradiation for the treatment of
    Hodgkin's lymphoma before age 15 years.
    Management of the High-Risk
    Patient
    • The first step in determining a woman's risk of
    developing BC is to take a thorough history,
    evaluating for the presence of risk factors.
    • Management strategies for risk reduction in the
    high-risk woman include:
    - intensive surveillance
    - chemoprevention with SERMs
    - prophylactic surgery
    HISTOLOGIC
    CLASSIFICATION
    Breast Cancer

    Ductal Lobular

    DCIS IDC LCIS ILC


    (15%) (75%) (5%) (5%)
    Ductal Carcinoma In-situ
    ➢ sed incidence with sed use of
    mammographic screening and
    early cancer detection
    ➢ 50% screen-detected cancers

    ➢ Can also produce palpable mass


    ➢ Different grades i.e. low, intermediate
    and high grade—comedo DCIS is
    classically high grade

    ➢ Often multifocal—malignant
    population can spread widely through
    the duct system
    Lobular Carcinoma In-situ
    ➢ Relatively uncommon lesion

    ➢ Malignant proliferation of small,


    uniform epithelial cells within
    the lobules

    ➢ Also at marked sed relative risk


    for invasive cancer (8 to 10 times)
    in either breast
    Invasive Ductal Carcinoma
    ➢ Commonest form of breast cancer
    especially in poorer populations

    ➢ sing incidence of screen–detected


    cancer in developed countries
    (usually smaller; much better
    prognosis)
    Clinical presentation:
    ➢ Hard, irregular palpable lump

    ➢ Peau d’orange (lymphatic obstruction


    thickening/dimpling of the skin)
    ➢ Paget’s disease of the nipple
    (ulceration/inflammation due to
    intraductal spread to the nipple)
    u Clinical presentation:

    ➢ Tethering of the skin

    ➢ Retraction of the nipple

    ➢ Axillary mass (spread to regional


    lymph nodes)
    ➢ Distant mets (lung, brain, bone)
    ➢ Different histologic types exist
    - The most common is scirrhous
    carcinoma (IDC of no special type)

    - Medullary carcinoma
    - Tubular carcinoma
    - Mucinous/colloid carcinoma
    - Papillary carcinoma
    Invasive Lobular Carcinoma
    ➢ Much less common than IDC

    ➢ Can present with similar features

    ➢ More likely to be bilateral and/or


    multicentric (multiple lesions
    within the same breast)
    * Metastasize more frequently to CSF, serosal
    surfaces and pelvic organs
    Molecular subtypes of BC
    • Luminal A:
    • the most common subtype, representing 50–
    60%.
    • expression of ER and or PGR
    • absence of HER2 expression
    • Low level of Ki67 (<14% ) and a low
    histological grade.
    • Good prognosis, less visceral metastasis
    • all cases of lobular carcinoma in situ are
    luminal A tumors, as are most of the
    Luminal B
    • 10% and 20% of all breast cancers.
    • ER +, HER-2 –ve & high KI67 or, ER+,
    HER2 +ve.
    • 6% of the luminal B tumors are ER – ve &
    HER2.
    • Compared to the luminal A, they have a more
    aggressive phenotype, higher histological
    grade & proliferative index and worse
    prognosis.
    • they respond better to neoadjuvant
    chemotherapy, achieving pCR in 17% of the
    Basal-like
    • 10–20% of all breast carcinomas.
    • High exp cytokeratins CK5 and CK17 &
    EGFR
    • ER, PR & HER2 negative.
    • 70-90% of triple negative cancers are basal-
    like.
    • Clinically they are characterized by early age
    of onset, predominantly in women of African
    origin.
    • large tumor size at diagnosis
    HER2 positive
    • 15-20% of BC.
    • High expression of HER2 gene.
    • Highly proliferative, 75% have a high
    histological grade and more than 40% have
    p53 mutations.
    ➢ Women with DCIS are at risk of:

    ● Recurrent DCIS following Rx

    ● Invasive cancer (rel. risk 8 to 10


    times) especially in the same
    breast
    Diagnosis of Breast Cancer
    • Physical examination
    • palpable mass (ductal)
    • diffuse thickening (lobular)
    • Mammogram (15% FN)
    • microcalcifications in clusters, spiculated lesions
    • architectural distortion
    • reduced mortality on screening age group > 50
    • Biopsy -
    • Stage 0: carcinoma in situ

    • Stage I: tumor < 2 centimeters; no spread


    outside breast.

    • Stage IIA : cancer in axillary lymph nodes; or


    tu< 2 cm with spread to axillary nodes; or
    tumor is 2 - 5 cm and no axillary nodes.

    • Stage IIB: 2 - 5 cm tumor, spread to axillary


    Treatment

    Local-Regional Systemic

    Surgery +/- Radiation Tamoxifen for Chemoteraphy


    ER+
    Inflammatory Breast Cancer
    • Inflammatory breast cancer is a distinct clinical
    subtype of locally advanced breast cancer, with
    a particularly aggressive behavior and poor
    prognosis. Clinically, inflammatory breast
    cancer typically presents with the rapid onset
    of breast erythema, warmth, and edema, often
    without a discrete underlying mass
    • The characteristic pathology is invasion of the
    dermal lymphatic by tumor emboli, which
    results in blockage of the breast lymphatics
    and can lead to breast edema
    Clinical presentation of inflammatory breast cancer.

    Giordano S H The Oncologist 2003;8:521-530

    ©2003 by AlphaMed Press


    • The initial component of treatment should be
    induction chemotherapy with an anthracycline-
    based regimen or an anthracycline and taxane
    combination. Definitive local therapy can then
    be achieved with radiation therapy,
    mastectomy, or both.
    • After local therapy, patients should receive
    further adjuvant chemotherapy, as the risk of
    relapse remains high, followed by adjuvant
    radiotherapy, if not previously given. Patients
    with hormone-receptor-positive tumors should
    be treated with 5 years of adjuvant hormonal
    therapy to minimize the risk of recurrence.

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