Mind map

Breast Lump

Moza Almualla English

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Breast Lump

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
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%