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A 36 year old woman with breast lump

hamda ali English

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Physiology of breast
- Tanner Stages
- Estrogen
  - involves in ductal development.
  - Development of the stromal tissues of the breast.
  - Deposition of fat in the breast.
- Progesterone
  - Responsible for lobular development and differentiation of epithelium
    - enlargement of alveolar cells which become secretory in nature
- Prolactin
  - is the most important hormone for lactogenesis in late pregnancy and postpartum period
    - Lactation
      - Mammogenesis
        Process of growth and development of mammary gland
      - lactogenesis
        Initiation of milk secretion
      - galactopoiesis
        Maintenance of milk secretion.
      - Milk let-down reflex
        oxytocin
        contraction of myoepithelial cells
Went for routine health check
- mammogram performed
  - lesions identified
    - History was taken
      - Family history of breast cancer
        Risk factor of breast cancer
        Female gender
        Advancing Age
        Ethnicity
        White women
        Radiation to Chest or Face Before Age 30
        Overweight and obese women
        first child after age 30
        Hormone Replacement Therapy)
        Alcohol \ smoking
        Early period and late menopause
    - Physcial examination was performed
      - Breast examination
        No palpable breast mass
        Wide local excision of breast lump performed
        Releaved infiltrating ductal breast carcinoma
        Breast carcinoma
        Epidemiology
        Genetic Mutations
        Screening ?
        DNA Microarrays Technology
        hybridization between two DNA strands, the property of complementary nucleic acid sequences to specifically pair with each other by forming hydrogen bonds between complementary nucleotide base pairs.
        Staging and grading
        Investigations
        Mammogram
        MRI
        Screening high-risk women
        Gathering more information about an area of suspicion
        Monitoring treatment
        Ultrasound
        Usually after mammogram
        Detect abnormality type
        Before mammogram to evaluate lump
        Biopsy
        Fine needle aspiration biopsy
        Core needle biopsy
        Vacuum-assisted breast biopsy (guided)
        Surgical Biopsy
        Blood tests
        Tumor markers
        Useful in
        Detecting the recurrence
        Monitoring the response to the treatment
        Serum Tumor Markers
        Cancer antigen 15-3 (CA 15-3)
        Cancer antigen 27.29 (CA 27.29)
        Carcinoembryonic antigen (CEA)
        Tissue Tumor Markers
        Estrogen and Progesterone Receptors
        Human Epidermal Growth Factor Receptor 2 (HER2)
        Management
        Local
        Surgery
        Pre-op preparation
        Discontinuation of Aspirin.
        CXR
        Echocardiogram
        Management of post-op pain
        Short-acting anesthetic bupivacaine.
        Psychoeducation
        Breast Reconstruction
        Implant reconstruction
        Associated with Anaplastic Large Cell Lymphom
        Autologous or "flap" reconstruction
        Indications
        previous radiotherapy, radical mastectomy with removal of the chest muscle and having a tight mastectomy scar
        Tissue expansion
        Lumpectomy
        Indications
        small, early stage breast cancers.
        Contraindications
        Previous radiation\ Multiple masses\ Large tumor\ Diffuse malignant microcalcifications
        Advantages
        preserve the appearance\ less invasive surgery\ short recovery time
        Disadvantages
        Radiotherapy is needed after the surgery\ local recurrence\ additional surgeries may be needed
        Mastectomy
        subtypes
        Radical mastectomy\ Modified radical mastectomy\ Simple mastectomy\ Skin-sparing mastectomy
        extensive, long recovery time and additional surgeries to reconstruct the breast are needed.
        less likely to need radiation
        Indications
        Previous radiation\ Multiple masses\ Large tumor\ Diffuse malignant microcalcifications
        Surgery to remove lymph nodes
        Sentinel lymph node biopsy
        Axillary lymph node dissection
        Radiation Therapy
        Systemic
        Chemotherapy
        Cyclophosphamide\ Doxorubicin\ Epirubicin\ Methotrexate\ Fluorouracil\ Paclitaxel\ Docetaxel
        Hormonal therapy
        ER (estrogen)-positive or PR (progesterone)-positive breast cancer.
        Targeted therapy
        HER2-targeted therapies
        Follow up
        Doctor visits
        Mammograms
        Pelvic exams
        imaging tests
        x-ray, CT scan, PET scan, MRI scan, bone scan
        measure levels of blood tumor markers
        Prognosis
        The average 5-year survival rate for people with breast cancer is 90%. The average 10-year survival rate is 83%.
        spread to the regional lymph nodes, the 5-year survival rate is 85%
        spread to a distant part of the body, the 5-year survival rate is 27%
        Classification
        Ductal
        Ductal carcinoma in situ
        Releaved infiltrating ductal breast carcinoma
        Malignant proliferation of the cell in ducts.
        No invasion to the basement membrane
        It doesn’t produce a mass
        Detected as calcification
        Paget disease
        DCIS that extends up the ducts to involve the skin of the nipple
        Nipple ulceration and erythema
        Invasive Ductal carcinoma
        Duct-like structure + desmoplastic stroma
        Present as a mass
        has four subtypes
        Tubular
        Tubule lacks myoepithelial cells
        Good prognosis
        Medullary
        High-grade cells + lymphocytes and plasma cells
        Good prognosis
        increase with BRCA 1
        Mucinous
        Tubule in mucus pools
        Good prognosis
        older women
        Inflammatory
        In dermal lymphatics
        Inflamed swollen breast
        Poor prognosis
        Tubular
        Lobular carcinoma in situ
        Malignant proliferation of the cell in lobule.
        No invasion
        No mass or calcification
        incidentally discovered
        Dyscohesive cells
        Multifocal and bilateral
        Invasive Lobular carcinoma
        Single file pattern
        Signet cell morphology.
        No duct formation
        lacks E-cadherin
        Molecular classification
        Luminal A
        ER+
        Luminal B
        ER+ , HER2+
        Her2 +ve
        ER-
        Basal like
        ER-,PR-,HER2-
        No nipple changes
        No axillary lymphadenoapthy
  - Types of mammogram
    - Screening mammography
    - Diagnostic mammography
  - Disadvantages
    - False-positive results
    - False-negative results
    - Overdiagnosis and overtreatment
  - screening guidelines
Anatomy of breast
- Lymphnodes

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Description: Mind Map on A 36 year old woman with breast lump, created by hamda ali on 24/02/2019.
Created by: hamda ali
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A 36 year old woman with breast lump

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