Breast Lump

Breast Lump

1. Normal structure and function of breast

   • Pair of modified sweat glands
     • Location
       • Superficial fascia of pectoral region
     • Functional parts
       • Epithelial part
         • Milk production
       • Connective tissue part
         • Make up and support
         • Coopers Ligament
   • Lymph drainage
   • Hormones
     • Estrogen
       • Ductal development
     • Progesterone
       • Lobular development and differentiation of epithelium
     • Prolactin
       • Lactogenesis
   • Tanner stages

2. Cancer

   • Epidemiology
     • Estimated Mortality rate worldwide (All ages)
     • UAE
   • Classification
     • Ductal
       • In situ (DCIS)
         • Malignant proliferation of the cell in ducts
         • No invasion
         • Mammography > calcification > biopsy
         • Paget's disease
           • DCIS involve the nipple
       • Invasive
         • Duct-like structure and desmoplastic stroma
         • Present as a mass
         • 4 subtypes
           • Tubular
             • Tubule lacks myoepithelial cells
             • Good prognosis
           • Medullary
             • High-grade cells / Lymphocytes / Plasma cells
             • Good prognosis
             • BRCA 1
           • Mucinous
             • Tubule in mucus pools
             • Good prognosis
             • Older women
           • Inflammatory
             • In dermal lymphatics
             • Inflamed swollen breast
             • Poor prognosis
     • Tubular / Lobular
       • In situ (LCIS)
         • Malignant proliferation of the cell in lobule
         • No invasion
         • No mass or calcification
         • Dyscohesive cells
         • Multifocal and bilateral
         • Responsd to tamoxifen
       • Invasive
         • Single file pattern
         • Signet cell morphology
         • No duct formation
           • Lack E-cadherin
   • Staining
     • Estrogen and progesterone receptor
       • Designed antibodies against them
       • Inside the nucleus
     • HER2/neu amplification
       • A growth factor receptor
       • Designed antibodies against HER2 receptor
       • On the cell surface
   • Genetic mutations
     • Repair DNA damage
       • BRCA1 and BRCA2
       • ATM
         • Ataxia-telangiectasia
       • BRIP1
       • BARD1
         • Works with BRCA1
       • MRE11A
         • Ataxia-telangiectasia-like disorder
       • NBN
         • Nijmegen breakage syndrome
       • RAD50
       • MSH6 and PMS2
         • Mismatch repair genes
         • Lynch syndrome
       • PALB2
         • Partner and localizer of BRCA 2
         • Breast cancer
       • RAD51C
         • Breast and ovarian cancer
     • Tumor suppressor gene
       • TP53
         • Li-Fraumeni syndrome
       • CHEK2
         • Cancer: breast / colon / prostate
       • PTEN
         • Cowden syndrome
       • STK11
         • Peutz Jegher syndrome
     • Helps cells to bind together
       • CDH1
         • Stomach cancer / Invasive lobular breast cancer
     • Screening
       • DNA Microarrays Technology
         • Show the expression of the genes
   • Grading
     • Grade 1
       • Well differentiated
         • Most like normal breast cells and usually slow-growing
     • Grade 2
       • Moderately differentiated
         • Less like normal cells and is growing faster
     • Grade 3
       • Poorly differentiated
         • Different to normal breast cells and is usually fast-growing
   • Staging
     • TNM staging system
       • 5 stages
       • T: Tumor
       • N: Lymph node
       • M: Metastasis
   • Molecular classification
     • Luminal A
       • Hormone-receptor positive (ER and/or PR positive)
       • HER2 negative
     • Luminal B
       • Hormone-receptor positive (ER and/or PR positive)
       • Faster than luminal A
       • HER2 either positive or negative
     • Triple-negative/basal-like
       • Hormone-receptor negative (ER and PR negative)
       • Common in BRCA 1mutation
       • HER2 negative
     • HER2-enriched
       • Hormone-receptor negative (ER and PR negative)
       • HER2 positive
     • Normal-like
       • Similar to luminal A
       • Worse prognosis than luminal A
   • Factors
     • Risk
       • Female gender
       • Advancing age
       • Family history
       • Ethnicity
       • Early menstrual period
     • Protective
       • Healthy weight
       • Breastfeeding
       • Limiting alcohol intake
       • Exercise
       • Multiple pregnancy
   • Diagnosis
     • Examinations
       • Physical
       • Self
     • Investigations
       • Mammogram
         • Types
           • Screening
           • Diagnostic
         • Disadvantages
           • False-positive results
           • Overdiagnosis and overtreatment
           • False-negative results
       • Ultrasound
         • Detect abnormality type
       • MRI
         • Screening high-risk women
         • Monitoring treatment
       • Biopsy
         • Fine needle aspiration biopsy
         • Core needle biopsy
         • Vacuum-assisted breast biopsy (guided)
         • Surgical Biopsy
       • Blood tests
         • Markers
           • CA 15.3 / TRU-QUANT/ CA 27.29 / CA125
           • Progression / Recurrence / Expensive
   • Management
     • Local
       • Surgery
         • Lumpectomy
         • Mastectomy
           • Subtypes
             • Radical mastectomy
             • Modified radical mastectomy
             • Simple mastectomy
             • Skin-sparing mastectomy
           • Pre-operative management
             • Discontinuation of Aspirin
             • Echocardiogram
             • Chest X-ray
         • To remove lymph nodes
           • Sentinel lymph node biopsy (SLNB)
           • Axillary lymph node dissection (ALND)
           • Surgery for advanced breast cancer
         • Breast reconstruction
           • Implant reconstruction
           • Autologous or "flap" reconstruction
           • Tissue expansion
       • Radiation Therapy
     • Systemic
       • Chemotherapy
         • Neoadjuvant
         • Adjuvant
       • Hormonal therapy
         • ER or PR positive breast cancer
       • Targeted therapy
         • HER2-positive breast cancer
     • Post-operative pain
       • Short-acting anesthetic bupivacaine
       • Psychoeducation
     • Follow up
       • Doctor visits
       • Mammograms
       • Pelvic exams
       • Bone density tests
       • Other tests
   • Prognosis
     • Depends on many factors
     • 5-year survival rate
       • Average is 90%
       • Located only in breast is 99%
       • In regional lymph nodes is 85%
       • In metastasis is 27%
     • 10-year survival rate is 83%

Bilder und Dateien der Mindmap