Breast cancer

Breast cancer

1. Anatomy of the breast

   • Blood supply
   • Lymphatic drainage

2. Risk factors

   • Early menarche
   • Not breastfeeding
   • Using hormone replacement therapy
   • Obesity

3. Signs and symptoms

   • Change in breast size or shape
   • Nipple discharge
   • Lump in the breast
   • Redness, dimpling of the skin

4. Tumors of the breast

   • Benign
     • Fibroadenoma
       • Small, well-defined, mobile mass, increased size and tenderness with high estrogen, women < 35 years old
     • Intraductal papilloma
       • Small fibroepithelial tumor within lactiferous ducts, typically beneath areola, most common cause of nipple discharge
     • Phyllodes tumor
       • Large mass of connective tissue and cysts with “leaf-like” lobulations, most common in 5th decade
   • Malignant
     • Non-invasive
       • DCIS
         • Fills ductal lumen (neoplastic cells in duct; engorged blood vessel). Arises from ductal atypia. Often seen early as microcalcifications on mammography
           • Cribriform type
           • Comedo type
             • Central necrosis
       • LCIS
         • Proliferation of cells in lobules, Discohesive growth, round cells clumped together
       • Paget's disease
         • Results from underlying DCIS or invasive breast cancer. Eczematous patches on nipple . Paget cells = intraepithelial adenocarcinoma cells.
     • Invasive
       • Invasive ductal carcinoma
         • Firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct-like cells. Tumor can deform suspensory ligaments. Classic morphology: “stellate” infiltration
       • Invasive lobular carcinoma
         • Orderly row of cells (“single file”), due to loss of E-cadherin expression. Often bilateral with multiple lesions in the same location.
       • Medullary carcinoma
         • Fleshy, cellular, lymphocytic infiltrate, good prognosis
       • Inflammatory breast cancer
         • Dermal lymphatic invasion by breast carcinoma. Peau d’orange (skin texture resembles orange peel due to edema leading to tightening of Cooper’s suspensory ligament)

5. Physical examination

   • Look for symmetry, irregular lumps, change in shape and size, tenderness, discharge

6. Investigations

   • FNA biopsy
     • very thin, hollow needle attached to a syringe used to aspirate tissue from suspicious area
     • Contraindications
       • coagulopathy or platelet disorder

7. Treatment and management

   • Surgery
   • chemotherapy
   • Radiation

Images and files in the map