Breast Lump

Breast Lump

1. Anatomy of the breast

   • functional unit
     • duct-lobular unit
   • lies on
     • serratis anterior
     • pectoralis major
     • external oblique

2. Development of the breast

   • prenatal
     • starts at day 35 gestation
       • formation of mammary line
     • 6 months
       • breast framework
   • infant
     • areola pigmented
     • nipple projects from growth of underlying mesoderm
   • puberty till adulthood
     • TANNER STAGES

3. Breast Cancer

   • Genetics
     • Subtypes
       • Luminal A
         • ER+
           • SERMs
       • Luminal B
         • ER+ Her2+
       • Her 2+
         • ER -ve, Her 2+
           • trastuzumab
       • Basal like
         • ER-, HER2-
           • chemotherapy
   • Risk factors
     • BRCA-1 and BRCA-2
     • increased oestrogen exposure
     • age at first birth
     • early menarche, late menopause
     • obesity
   • non-invasive
     • ductal carcinoma in situ
       • malignant proliferation of ductal cells
       • doesn't cross BM
     • comedocarcinoma
       • central necrosis and calcification
     • paget disease
       • intraepithelial adenocarcinoma
       • eczematous lesion on nipple
   • invasive
     • ductal carcinoma
       • DCIS crosses BM
       • nipple retraction
       • skin dimpling
     • lobular carcinoma
       • single sheet of cells
       • decreased E-cadherin expression
     • medullary carcinoma
       • fleshy, cellular,lymphocytic infiltrate
     • inflammatory
       • lymphatic invasion and blockage
         • p'eau d'orange
   • screening
     • mammogram

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