Carcinoma of The Breast
Carcinoma of The Breast
Carcinoma of The Breast
• AGE
• GENDER
• GENETICS ( BRCA1/BRCA2)
• DIET ( LOW PHYTO-ESTROGENS, VIT D DEFICIENCY, HIGH ALCOHOLE INTAKE)
• NULLIPAROUS
• LATE MENARCHE
• EARY MENOPAUSE
• LOCAL HAIR-DYE CONTAINING paraphenylenediamine,
• PREVIOUS RADIATIONS
• HRT
CLINICAL PRESENTATION
• IN-SITU CANCER
• LCIS
• DCIS
• INVASIVE CARCINOMA
• DUCTAL
• LOBULAR
• TUBULLAR
• MUCINOUS
• MEDULLARY
• PAPILLARY
• METAPLASTIC
• INFLAMMATORY
• PAGET’S DISEASE
IN-SITU CARCINOMA
• PRE-INVASIVE CANCER
• Not breached the epithelial basement membrane
• Marker for later development of invasive cancer.
• Two types
• Ductal carcinoma in situ (DCIS)
• Lobular carcinoma in situ (LCIS)
DUCTAL
CARCINOMA IN-
SITU
LOBULAR
CARCINOMA IN-SITU
(LCIS)
PAGETS DISEASE OF THE NIPPLE
12% 60%
20%
6% 10%
THE SPREADOF BREAST CANCER
• LOCAL SPREAD
• LYMPHATIC METASTASIS
• SPREAD BY THE BLOODSTREAM
• SKELETAL METASTASIS
TNM CLASSIFICATION FOR BREAST CANCER
• STAGE I
• T1N0M0
• STAGE II A
• T0N1M0
• T1N1M0
• T2N0M0
• STAGE II B
• T2N1M0
• T3N0M0
• STAGE III A
• T0N2M0
• T1-2 N2 M0
• T3 N1-2 M0
• STAGE IIIB
• T4 N0 -2 M0
• STAGE III C
• ANY T N3 M0
• STAGE IV
• ANY T ANY N M1
SPECIAL CONDITIONS
• AIMS;
• CURE
• CONTROL
• CONSERVATION
• PREVENTION OR DELAY
THE MULTIDISCIPLINARY TEAM APPROACH
BREAST COUNSELLOR
BREAST SURGEON
MEDICAL ONCOLOGIST
RADIOTHERAPIST
CLINICAL NURSE SPECIALIST
PSYCHOLOGICAL SUPPORT
PHYSIOTHERAPIST
SURGERY
• AUSCHINCLOSS PROCEDURE
• REMOVES ALL BREAST TISSUES, NIPPLE-AREOLA COMPLEX, SKIN
AND LEVEL 1-2 AXILLARY LNs.
• PATEY’S PROCEDURE
• PECTORALIS MINOR IS REMOVED TO ALLOW COMPLETE
DISSECTION OF LEVEL III AXILLARY LNs.
• SCANLON’S MODIFICATION OF PATEY’S PROCEDURE
• PECTORALIS MINOR IS DIVIDED INSTEAD OF REMOVING
CONSERVATIVE BREAST CANCER SURGERY
• 6 MONTH CYCLE OF
• CYCLOPHOSPHAMIDE
• METHOTRIXATE
• 5-FLUOROURACIL
• ANTHRACYCLINE
• TAXANES
NEW BIOLOGICAL AGENTS
• TRANSTUZAMAB (HERCEPTIN)
• growth factor receptor c-erbB2
• BEVACIZUMA
• vascular growth factor receptor inhibitor
• LAPATINAB
• oral combined growth factor receptor inhibitor
FOLLOW UP
• RADIOTHERAPY AVOIDED
• CHEMOTHERAPY AVAODED IN 1ST TRIMESTER
• NO HORMONE THERAPY
• MASTECTOMY PREFERRED