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Breast Lump

Description

Mind Map on Breast Lump, created by Moza Almualla on 25/02/2019.
Moza Almualla
Mind Map by Moza Almualla, updated more than 1 year ago
Moza Almualla
Created by Moza Almualla about 7 years ago
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Resource summary

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

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