Breast

Description

Mind Map on Breast, created by Jodie Nadal on 12/21/2013.
Jodie Nadal
Mind Map by Jodie Nadal, updated more than 1 year ago
Jodie Nadal
Created by Jodie Nadal about 11 years ago
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Resource summary

Breast
  1. Presentation
    1. Breast lump
      1. most common
        1. single or multiple
          1. 2 layers of cells
            1. outer
              1. myoepitheliae
              2. inner
                1. epithelial
            2. Nipple discharge
              1. milk/blood
              2. Nipple inversion
                1. exsema
                2. Erosion
                  1. Pain, skin changes
                    1. most common presentation
                      1. good prognosis
                      2. cosmotic
                      3. Benign
                        1. Duct ectasia
                          1. dilated ducts
                            1. secretions & cellular debris
                              1. presentation of nipple discharge/mass
                              2. parous perimenopausal women
                                1. fibrosis
                                  1. nipple retraction
                                  2. symptoms may mimic cancer
                                    1. calcification on mammography
                                    2. smoking
                                    3. Fat necrosis
                                      1. trauma (~40%)
                                        1. surgery
                                          1. RT
                                          2. hard irregular painless mass
                                            1. mimics cancer
                                              1. clinically and mammography
                                              2. obese
                                                1. after menopausal
                                                2. Inflammatory
                                                  1. Acute pyogenic mastitis
                                                    1. 1st few weeks of lactation
                                                      1. bacteria infection
                                                        1. S. aureus
                                                        2. abscess
                                                        3. Tuberculous mastitis
                                                          1. rare in western countries
                                                            1. firm fibrocaseous mass
                                                              1. mimicry
                                                            2. Actinomyces
                                                              1. rare, primary infection
                                                                1. abscess beneath nipple
                                                              2. Lymphocytic mastitis
                                                                1. occurs in diabetic women
                                                                  1. autoimmune diseases
                                                                    1. predispose to lymphoma
                                                                    2. Granulomatous mastitis
                                                                      1. granulomatous inflammatory infiltrate around lobules
                                                                        1. aetiology unknown
                                                                          1. TB has to be excluded
                                                                          2. Screening
                                                                            1. 50-70yrs
                                                                              1. GP/surgeon
                                                                                1. biopsy immediately
                                                                            2. Malignant
                                                                              1. risk factors
                                                                                1. >99% of BC occur in females
                                                                                  1. genetic predispostion
                                                                                    1. rare under 25yrs
                                                                                      1. overexpression of oestrogen
                                                                                        1. underexpression of progesterone
                                                                                        2. prolonged breast feeding decreases risk
                                                                                          1. high alcohol intake, smoking
                                                                                            1. increased incidence in developed countries
                                                                                            2. most common female cancer
                                                                                              1. 2nd most common death
                                                                                                1. 35-55yrs
                                                                                                  1. average 62yrs
                                                                                                  2. increased with age
                                                                                                  3. Ductal carcinoma in situ
                                                                                                    1. 40-60yrs
                                                                                                      1. 2-100mm in size
                                                                                                        1. 90% of DCIS by mammogram
                                                                                                          1. calcifications
                                                                                                            1. necrosis
                                                                                                              1. increased Ca2+
                                                                                                          2. 5% as a palpable lump
                                                                                                            1. relationship to invasive carcinoma
                                                                                                              1. morphological & molecular similarities to invasive
                                                                                                                1. high freq. of progression to invasive carcinoma if incompletely excised
                                                                                                                2. classification
                                                                                                                  1. grade
                                                                                                                    1. low/intermediate/high/mixed nuclear
                                                                                                                    2. pattern
                                                                                                                      1. cribriform/micropapillary/solid
                                                                                                                      2. presence of necrosis
                                                                                                                        1. increased chance of cancer
                                                                                                                    3. Lobular carcinoma in situ
                                                                                                                      1. Premenopausal women
                                                                                                                        1. no palpable lump
                                                                                                                          1. ~20% of patients with LCIS with develop
                                                                                                                            1. risk is less than ADH
                                                                                                                            2. Invasive Carcinoma of Breast
                                                                                                                              1. local control
                                                                                                                                1. surgery
                                                                                                                                  1. +/- radio
                                                                                                                                    1. ability to metastasis
                                                                                                                                    2. systematic theraoy
                                                                                                                                      1. homone
                                                                                                                                        1. chemo
                                                                                                                                          1. targeted
                                                                                                                                          2. data set
                                                                                                                                            1. tumour size
                                                                                                                                              1. lymph node stage
                                                                                                                                                1. vascular invasion
                                                                                                                                                  1. hormone receptor & HER2 status
                                                                                                                                                2. histologic types & prognosis
                                                                                                                                                  1. Additional Prognostic and Predictive factors
                                                                                                                                                    1. vascular invasion
                                                                                                                                                      1. angiogenesis
                                                                                                                                                        1. tumour necrosis, fibrosis & central scar
                                                                                                                                                          1. age, menopausal status
                                                                                                                                                            1. HER2
                                                                                                                                                              1. cell death markers
                                                                                                                                                                1. adhesion markers
                                                                                                                                                                  1. tumour suppression
                                                                                                                                                                  2. excellent
                                                                                                                                                                    1. tubular
                                                                                                                                                                      1. cribriform
                                                                                                                                                                        1. low grade mucinous
                                                                                                                                                                        2. moderate
                                                                                                                                                                          1. lobular
                                                                                                                                                                            1. medulaary
                                                                                                                                                                              1. neuroendocrine
                                                                                                                                                                              2. poor
                                                                                                                                                                                1. ductal NST
                                                                                                                                                                                  1. metaplastic
                                                                                                                                                                                2. Miscellaneous tumours
                                                                                                                                                                                  1. malignant phyllodes
                                                                                                                                                                                    1. lymphoma
                                                                                                                                                                                      1. metastasis
                                                                                                                                                                                        1. angiosarcoma
                                                                                                                                                                                          1. young women
                                                                                                                                                                                            1. very rare
                                                                                                                                                                                          2. staging
                                                                                                                                                                                            1. TNM
                                                                                                                                                                                              1. Tx,Tis,T0-4
                                                                                                                                                                                                1. N0-3
                                                                                                                                                                                                  1. M0-3
                                                                                                                                                                                                  2. NPI
                                                                                                                                                                                                    1. size
                                                                                                                                                                                                      1. grade
                                                                                                                                                                                                        1. spread to lymph nodes
                                                                                                                                                                                                          1. <4
                                                                                                                                                                                                            1. good outcome
                                                                                                                                                                                                            2. 4.01-5.4
                                                                                                                                                                                                              1. intermideate
                                                                                                                                                                                                              2. >5.4
                                                                                                                                                                                                                1. poor
                                                                                                                                                                                                              3. stage I-IV
                                                                                                                                                                                                            3. Lymph Node stage
                                                                                                                                                                                                              1. examined histologically
                                                                                                                                                                                                                1. reports
                                                                                                                                                                                                                  1. total no. of nodes
                                                                                                                                                                                                                    1. no involved
                                                                                                                                                                                                                      1. therapy type & dose determined
                                                                                                                                                                                                                        1. presence of extracapsular
                                                                                                                                                                                                                          1. higher nodes=poor
                                                                                                                                                                                                                        2. metastasis
                                                                                                                                                                                                                          1. isolated tumour cells
                                                                                                                                                                                                                            1. micrometastasis
                                                                                                                                                                                                                              1. 0.2-2mm
                                                                                                                                                                                                                              2. macrometastasis
                                                                                                                                                                                                                                1. >2mm
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