A 36 year old woman with breast lump

hamda ali
Mind Map by hamda ali, updated more than 1 year ago
hamda ali
Created by hamda ali almost 3 years ago
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Mind Map on A 36 year old woman with breast lump, created by hamda ali on 02/24/2019.

Resource summary

A 36 year old woman with breast lump
  1. Physiology of breast
    1. Tanner Stages
      1. Estrogen
        1. involves in ductal development.
          1. Development of the stromal tissues of the breast.
            1. Deposition of fat in the breast.
            2. Progesterone
              1. Responsible for lobular development and differentiation of epithelium
                1. enlargement of alveolar cells which become secretory in nature
              2. Prolactin
                1. is the most important hormone for lactogenesis in late pregnancy and postpartum period
                  1. Lactation
                    1. Mammogenesis
                      1. Process of growth and development of mammary gland
                      2. lactogenesis
                        1. Initiation of milk secretion
                        2. galactopoiesis
                          1. Maintenance of milk secretion.
                          2. Milk let-down reflex
                            1. oxytocin
                              1. contraction of myoepithelial cells
                    2. Went for routine health check
                      1. mammogram performed
                        1. lesions identified
                          1. History was taken
                            1. Family history of breast cancer
                              1. Risk factor of breast cancer
                                1. Female gender
                                  1. Advancing Age
                                    1. Ethnicity
                                      1. White women
                                      2. Radiation to Chest or Face Before Age 30
                                        1. Overweight and obese women
                                          1. first child after age 30
                                            1. Hormone Replacement Therapy)
                                              1. Alcohol \ smoking
                                                1. Early period and late menopause
                                            2. Physcial examination was performed
                                              1. Breast examination
                                                1. No palpable breast mass
                                                  1. Wide local excision of breast lump performed
                                                    1. Releaved infiltrating ductal breast carcinoma
                                                      1. Breast carcinoma
                                                        1. Epidemiology
                                                          1. Genetic Mutations
                                                                1. Screening ?
                                                                  1. DNA Microarrays Technology
                                                                    1. 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.
                                                                2. Staging and grading
                                                                    1. Investigations
                                                                      1. Mammogram
                                                                        1. MRI
                                                                          1. Screening high-risk women
                                                                            1. Gathering more information about an area of suspicion
                                                                              1. Monitoring treatment
                                                                              2. Ultrasound
                                                                                1. Usually after mammogram
                                                                                  1. Detect abnormality type
                                                                                    1. Before mammogram to evaluate lump
                                                                                    2. Biopsy
                                                                                      1. Fine needle aspiration biopsy
                                                                                        1. Core needle biopsy
                                                                                          1. Vacuum-assisted breast biopsy (guided)
                                                                                            1. Surgical Biopsy
                                                                                            2. Blood tests
                                                                                              1. Tumor markers
                                                                                                1. Useful in
                                                                                                  1. Detecting the recurrence
                                                                                                    1. Monitoring the response to the treatment
                                                                                                    2. Serum Tumor Markers
                                                                                                      1. Cancer antigen 15-3 (CA 15-3)
                                                                                                        1. Cancer antigen 27.29 (CA 27.29)
                                                                                                          1. Carcinoembryonic antigen (CEA)
                                                                                                          2. Tissue Tumor Markers
                                                                                                            1. Estrogen and Progesterone Receptors
                                                                                                              1. Human Epidermal Growth Factor Receptor 2 (HER2)
                                                                                                        2. Management
                                                                                                          1. Local
                                                                                                            1. Surgery
                                                                                                              1. Pre-op preparation
                                                                                                                1. Discontinuation of Aspirin.
                                                                                                                  1. CXR
                                                                                                                    1. Echocardiogram
                                                                                                                    2. Management of post-op pain
                                                                                                                      1. Short-acting anesthetic bupivacaine.
                                                                                                                        1. Psychoeducation
                                                                                                                        2. Breast Reconstruction
                                                                                                                          1. Implant reconstruction
                                                                                                                            1. Associated with Anaplastic Large Cell Lymphom
                                                                                                                            2. Autologous or "flap" reconstruction
                                                                                                                              1. Indications
                                                                                                                                1. previous radiotherapy, radical mastectomy with removal of the chest muscle and having a tight mastectomy scar
                                                                                                                              2. Tissue expansion
                                                                                                                              3. Lumpectomy
                                                                                                                                1. Indications
                                                                                                                                  1. small, early stage breast cancers.
                                                                                                                                  2. Contraindications
                                                                                                                                    1. Previous radiation\ Multiple masses\ Large tumor\ Diffuse malignant microcalcifications
                                                                                                                                    2. Advantages
                                                                                                                                      1. preserve the appearance\ less invasive surgery\ short recovery time
                                                                                                                                      2. Disadvantages
                                                                                                                                        1. Radiotherapy is needed after the surgery\ local recurrence\ additional surgeries may be needed
                                                                                                                                      3. Mastectomy
                                                                                                                                        1. subtypes
                                                                                                                                          1. Radical mastectomy\ Modified radical mastectomy\ Simple mastectomy\ Skin-sparing mastectomy
                                                                                                                                          2. extensive, long recovery time and additional surgeries to reconstruct the breast are needed.
                                                                                                                                            1. less likely to need radiation
                                                                                                                                              1. Indications
                                                                                                                                                1. Previous radiation\ Multiple masses\ Large tumor\ Diffuse malignant microcalcifications
                                                                                                                                              2. Surgery to remove lymph nodes
                                                                                                                                                1. Sentinel lymph node biopsy
                                                                                                                                                  1. Axillary lymph node dissection
                                                                                                                                                2. Radiation Therapy
                                                                                                                                                3. Systemic
                                                                                                                                                  1. Chemotherapy
                                                                                                                                                    1. Cyclophosphamide\ Doxorubicin\ Epirubicin\ Methotrexate\ Fluorouracil\ Paclitaxel\ Docetaxel
                                                                                                                                                    2. Hormonal therapy
                                                                                                                                                      1. ER (estrogen)-positive or PR (progesterone)-positive breast cancer.
                                                                                                                                                      2. Targeted therapy
                                                                                                                                                        1. HER2-targeted therapies
                                                                                                                                                    3. Follow up
                                                                                                                                                      1. Doctor visits
                                                                                                                                                        1. Mammograms
                                                                                                                                                          1. Pelvic exams
                                                                                                                                                            1. imaging tests
                                                                                                                                                              1. x-ray, CT scan, PET scan, MRI scan, bone scan
                                                                                                                                                              2. measure levels of blood tumor markers
                                                                                                                                                              3. Prognosis
                                                                                                                                                                1. The average 5-year survival rate for people with breast cancer is 90%. The average 10-year survival rate is 83%.
                                                                                                                                                                  1. spread to the regional lymph nodes, the 5-year survival rate is 85%
                                                                                                                                                                    1. spread to a distant part of the body, the 5-year survival rate is 27%
                                                                                                                                                                2. Classification
                                                                                                                                                                  1. Ductal
                                                                                                                                                                    1. Ductal carcinoma in situ
                                                                                                                                                                      1. Releaved infiltrating ductal breast carcinoma
                                                                                                                                                                        1. Malignant proliferation of the cell in ducts.
                                                                                                                                                                          1. No invasion to the basement membrane
                                                                                                                                                                            1. It doesn’t produce a mass
                                                                                                                                                                              1. Detected as calcification
                                                                                                                                                                                1. Paget disease
                                                                                                                                                                                  1. DCIS that extends up the ducts to involve the skin of the nipple
                                                                                                                                                                                    1. Nipple ulceration and erythema
                                                                                                                                                                                2. Invasive Ductal carcinoma
                                                                                                                                                                                  1. Duct-like structure + desmoplastic stroma
                                                                                                                                                                                    1. Present as a mass
                                                                                                                                                                                      1. has four subtypes
                                                                                                                                                                                        1. Tubular
                                                                                                                                                                                          1. Tubule lacks myoepithelial cells
                                                                                                                                                                                            1. Good prognosis
                                                                                                                                                                                            2. Medullary
                                                                                                                                                                                              1. High-grade cells + lymphocytes and plasma cells
                                                                                                                                                                                                1. Good prognosis
                                                                                                                                                                                                  1. increase with BRCA 1
                                                                                                                                                                                                  2. Mucinous
                                                                                                                                                                                                    1. Tubule in mucus pools
                                                                                                                                                                                                      1. Good prognosis
                                                                                                                                                                                                        1. older women
                                                                                                                                                                                                        2. Inflammatory
                                                                                                                                                                                                          1. In dermal lymphatics
                                                                                                                                                                                                            1. Inflamed swollen breast
                                                                                                                                                                                                              1. Poor prognosis
                                                                                                                                                                                                        3. Tubular
                                                                                                                                                                                                          1. Lobular carcinoma in situ
                                                                                                                                                                                                            1. Malignant proliferation of the cell in lobule.
                                                                                                                                                                                                              1. No invasion
                                                                                                                                                                                                                1. No mass or calcification
                                                                                                                                                                                                                  1. incidentally discovered
                                                                                                                                                                                                                  2. Dyscohesive cells
                                                                                                                                                                                                                    1. Multifocal and bilateral
                                                                                                                                                                                                                    2. Invasive Lobular carcinoma
                                                                                                                                                                                                                      1. Single file pattern
                                                                                                                                                                                                                        1. Signet cell morphology.
                                                                                                                                                                                                                          1. No duct formation
                                                                                                                                                                                                                            1. lacks E-cadherin
                                                                                                                                                                                                                      2. Molecular classification
                                                                                                                                                                                                                        1. Luminal A
                                                                                                                                                                                                                          1. ER+
                                                                                                                                                                                                                          2. Luminal B
                                                                                                                                                                                                                            1. ER+ , HER2+
                                                                                                                                                                                                                            2. Her2 +ve
                                                                                                                                                                                                                              1. ER-
                                                                                                                                                                                                                              2. Basal like
                                                                                                                                                                                                                                1. ER-,PR-,HER2-
                                                                                                                                                                                                                      3. No nipple changes
                                                                                                                                                                                                                        1. No axillary lymphadenoapthy
                                                                                                                                                                                                                      4. Types of mammogram
                                                                                                                                                                                                                        1. Screening mammography
                                                                                                                                                                                                                          1. Diagnostic mammography
                                                                                                                                                                                                                          2. Disadvantages
                                                                                                                                                                                                                            1. False-positive results
                                                                                                                                                                                                                              1. False-negative results
                                                                                                                                                                                                                                1. Overdiagnosis and overtreatment
                                                                                                                                                                                                                                  1. screening guidelines
                                                                                                                                                                                                                                2. Anatomy of breast
                                                                                                                                                                                                                                    1. Lymphnodes
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