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Ch 35 BREAST CANCER

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Ch 35 BREAST CANCER R1 1/3 of all cancers in women 2nd only to lung cancer as the leading cause of cancer deaths in women ... – PowerPoint PPT presentation

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Title: Ch 35 BREAST CANCER


1
Ch 35 BREAST CANCER
  • ????? ????
  • R1 ? ? ?

2
  • 1/3 of all cancers in women
  • 2nd only to lung cancer as the leading cause of
  • cancer deaths in women
  • Incidence increased significantly
  • one in every eight women in
    U.S.A
  • But, mortality rate actually declined
  • -increased success in earlier diagnosis
    treatment

3
PREDISPOSING FACTOR
  • 25? ?? less than 1
  • 30? ?? a sharp increase
  • 45?-50? short plateau
  • ?? increases steadily with age

4
PREDISPOSING FACTOR
  • Family hystory
  • -only 20 family hystory
  • -mother sister breast cancer after
    menopause
  • -gt risk is not
    increased
  • bilateral
    premenopausally
  • -gt at least
    4050
  • unilateral
    premenopausally
  • -gt 30
  • -inherited oncogenes BRCA 1 (chromosome 17q
    21)
  • BRCA 2
    (chromosome 13q 12-13)

5
PREDISPOSING FACTOR
  • Diet, obesity, and alcohol
  • - high-fat diet, obesity, alcohol risk factor
  • - but, not clear

6
PREDISPOSING FACTOR
  • Reproductive and hormonal factors
  • - the risk of breast ca increases with the
    length of a
  • womens reproductive phase
  • - menarche is lower
  • early menopause
  • artificial menopause (oophorectomy)
  • -gt the risk is decreased
  • -gt but, no clear association with
    irregularity

  • duration of menses

7
  • -lactation does not affect the breast cancer
  • -gtbut, risk is high never pregnant gt
    multiparous
  • -primigravida older gt younger (high
    incidence)
  • -although short-term estrogen treatment for
  • menopausal symptoms prebably does not
    increase
  • the risk of breast ca, prolonged use or
    higher dosages
  • of estrogen may increase the risk
  • -gt low dose or combination with
    progestin
  • -gt but, benbefits in preventing
    osteoporosis and
  • heart problem

8
HISTORY OF CANCER
  • Endometrial carcinoma, ovarian carcinoma, or
    colon
  • cancer has also been associated with an
    increased
  • risk of breast cancer

9
DIAGNOSIS
  • most commonly in the upper outer quadrant
  • (there is
    more beast tissue)
  • mammography and physical examination, the
    standard
  • screening modalities, are complementary
  • -10 to 50 of cancers detectred
    mammographically
  • are not palpable, physocal exam detects
    10 to 20
  • of cancers not seen on mammography
  • All women unfergo screening mammography starting
    at
  • age 40, along with clinical or self breast
    examination

10
DIAGNOSIS
  • USG, MRI, CT, PET, sestamibiscans, serum blood
  • marker be used only when indicated
  • palpation easy- older, more fatty
  • Malignancy thickening area amid normal nodulaity
  • skin dimpling
  • nipple retraction
  • skin erosion
  • clinically malignancy 3040 benign on histology
  • clinically benign 2025 malignant by biopsy

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12
Biopsy techniques
  • Fine-needle aspiration cytology (FNA)
  • - 20- or 22- gauge needle
  • - a high level of diagnostic accuracy
  • 10-15 false negative
  • rare false positive
  • -negative FNA cytology results do not exclude
  • malignancy and usually are followes by
    excisional
  • biopsy or careful observation

13
  • Open biopsy
  • -FNA cytology has not been performed
  • the results are negative
    or eqivocal
  • 1. the location of the mass confirmed
  • 2. local anesthesia skin, suncutaneous around
    mass
  • 3. incision directly over the mass
    (ellise-cosmetically)
  • paraareolar(near the
    nipple-areolar complex)
  • 4. mass gently grasped with Allis forcep or
    stay suture
  • 5. the mass should be excised completely

14
  • 6. adequate hemostasis
  • breast parenchyma not reapproximated
    deeply
  • subcutaneous fat with fine absorbable
    suture
  • skin subcuticular suture and adhesive
    strips
  • usually a drain is not necessary

15
  • Mammographic localization biopsy
  • - biopsy of nonpalpable lesion
  • - mammographer localization a biologic dye
  • surgeon review excised
  • Stereotactic core biopsy
  • - localize abnormalities and perform needle
    biopsy
  • without surgery

16
PATHOLOGY AND NATURAL HISTORY
  • Breast ca in the intermediate-sized ducts or
    terminal
  • ducts and lobules
  • -the diagnosis of lobular and intraductal
    carcinoma is
  • based on histological appearance than site
    of origin
  • infiltrating ductal carcinoma 60-70
  • -mammographically, stellate density
  • -macroscopically, gritty and chalky
  • Medullary carcinoma
  • -a dence lymphocytic infiltration
  • -sloe growing, less aggressive malignancy

17
  • Mucinous (colloid) carcinoma 5 of breast ca
  • -glossly, mucinous, gelatinous
  • Papillary carcinoma
  • -noninvasive ductal carcinoma
  • Tubualr carcinoma 1 of breast ca
  • -better prognosis than infiltrating ductal
    carcinoma
  • rarely metastasize to axillary LN

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