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    The Breast: Kristoff Armand E. Tan Hannah Lois Kangleon-Tan

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    Kenneth Nuñez
    The document provides an overview of breast anatomy, physiology, benign and malignant breast conditions. It discusses risk factors for breast cancer including genetics, hormones, lifestyle factors. It then covers breast cancer screening tools like mammography and ultrasound. Key aspects of breast cancer diagnosis using imaging, biopsy and tumor biomarkers are presented. The stages of breast cancer from Stage I to IV are defined based on tumor size, lymph node involvement and metastasis. Treatment approaches are outlined depending on the stage, including neoadjuvant therapy for locally advanced cancers and surgery with adjuvant therapy for early invasive cancers.

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    The Breast: Kristoff Armand E. Tan Hannah Lois Kangleon-Tan

    Uploaded by

    Kenneth Nuñez
    186 views30 pages
    The document provides an overview of breast anatomy, physiology, benign and malignant breast conditions. It discusses risk factors for breast cancer including genetics, hormones, lifestyle factors. It then covers breast cancer screening tools like mammography and ultrasound. Key aspects of breast cancer diagnosis using imaging, biopsy and tumor biomarkers are presented. The stages of breast cancer from Stage I to IV are defined based on tumor size, lymph node involvement and metastasis. Treatment approaches are outlined depending on the stage, including neoadjuvant therapy for locally advanced cancers and surgery with adjuvant therapy for early invasive cancers.

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    Breast 2

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    The document provides an overview of breast anatomy, physiology, benign and malignant breast conditions. It discusses risk factors for breast cancer including genetics, hormones, lifestyle factors. It then covers breast cancer screening tools like mammography and ultrasound. Key aspects of breast cancer diagnosis using imaging, biopsy and tumor biomarkers are presented. The stages of breast cancer from Stage I to IV are defined based on tumor size, lymph node involvement and metastasis. Treatment approaches are outlined depending on the stage, including neoadjuvant therapy for locally advanced cancers and surgery with adjuvant therapy for early invasive cancers.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    186 views30 pages

    The Breast: Kristoff Armand E. Tan Hannah Lois Kangleon-Tan

    Uploaded by

    Kenneth Nuñez
    The document provides an overview of breast anatomy, physiology, benign and malignant breast conditions. It discusses risk factors for breast cancer including genetics, hormones, lifestyle factors. It then covers breast cancer screening tools like mammography and ultrasound. Key aspects of breast cancer diagnosis using imaging, biopsy and tumor biomarkers are presented. The stages of breast cancer from Stage I to IV are defined based on tumor size, lymph node involvement and metastasis. Treatment approaches are outlined depending on the stage, including neoadjuvant therapy for locally advanced cancers and surgery with adjuvant therapy for early invasive cancers.

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    of 30

    The Breast

    KRISTOFF ARMAND E. TAN


    HANNAH LOIS KANGLEON-TAN
    tobytanmd

    Part 1

    Embryology and Anatomy


    Physiology
    Course Benign Breast Conditions

    Outline Part 2

    Breast Cancer
    Screening and Staging
    Diagnosis and Treatment

    www.yourwebsite.com
    tobytanmd

    RISK FACTORS
    For Developing Breast Cancer

    Genetics
    Hormonal Non-Hormonal
    • Sporadic 65-75%
    • Increased estrogen exposure • Radiation
    • Familial 20-30%
    - Early menarche • Alcohol consumption
    • Hereditary 5-10%
    - Late menopause • High fat intake
    - Nulliparity
    - Obesity
    tobytanmd

    GAIL MODEL
    Risk Assessment
    Models
    Average Risk = 12%

    • Gail Model
    • Claus Model
    • BRCAPRO Model
    tobytanmd

    RISK MANAGEMENT
    For High Risk Patients

    Active Surveillance and


    Screening Lifestyle Modification
    About Me

    Chemoprevention Risk Reducing Surgery


    tobytanmd

    BRCA1 vs BRCA2
    COMPARISON

    BRCA1 BRCA2
    GERMLINE located on located on
    MUTATIONS chromosome arm 17q chromosome arm 13q

    Breast cancer risk: 85% Breast cancer risk: 85%

    Ovarian cancer risk: 40% Ovarian cancer risk: 20%

    Likely hormone negative Likely hormone negative


    tobytanmd

    DISTANT METASTASIS
    PRIMARY BREAST CANCER

    NATURAL
    HISTORY

    AXILLARY NODE METASTASIS


    tobytanmd

    DISTANT METASTASIS
    PRIMARY BREAST CANCER

    NATURAL
    HISTORY

    AXILLARY NODE METASTASIS


    tobytanmd

    DISTANT METASTASIS
    PRIMARY BREAST CANCER

    NATURAL
    HISTORY

    AXILLARY NODE METASTASIS


    tobytanmd

    Carcinoma In Situ

    Cancer cells are in situ or invasive depending


    on whether or not they invade through the
    basement membrane.
    tobytanmd

    LOBULAR CARCINOMA IN SITU

    • Originates from the terminal duct lobular units


    • Develops only in the female breast
    • Cytoplasmic mucoid globules are a distinctive
    cellular feature
    • Usually an incidental finding
    • A marker of increased risk for invasive breast
    cancer
    • NOT an anatomic precursor
    tobytanmd

    DUCTAL CARCINOMA IN SITU


    • Predominantly seen in female breast
    - 5% in male breast
    • papillary growths within the duct lumina
    • Classified based on nuclear grade and
    necrosis
    • Risk for invasive cancer - fivefold
    • Anatomic precursor of IDC
    tobytanmd

    INVASIVE BREAST CARCINOMA

    1. Paget’s disease of the nipple


    2. Invasive ductal carcinoma (AdenoCa), 80%
    3. Medullary carcinoma, 4%
    4. Mucinous (colloid) carcinoma, 2%
    5. Papillary carcinoma, 2%
    6. Tubular carcinoma, 2%
    7. Invasive lobular carcinoma, 10%
    8. Rare cancers (adenoid cystic, squamous, apocrine)
    DIAGNOSIS OF BREAST CANCER Inspection
    • Symmetry
    Examination • Size
    • Shape
    • Skin and nipple changes

    Palpation

    • All quadrants up to boundaries


    • Axillary lymph node assessment
    DIAGNOSIS OF BREAST CANCER Mammography
    • Supplements history and PE
    Imaging • Radiation to low to cause cancer
    • MLO view – greater volume
    • CC view – better compression and medial aspect
    DIAGNOSIS OF BREAST CANCER Mammography
    • Supplements history and PE
    Imaging • Radiation to low to cause cancer
    • MLO view – greater volume
    • CC view – better compression and medial aspect

    Ultrasonography
    • Determine echogenic qualities
    • Lymph node assessment
    • Used along with biopsy techniques
    DIAGNOSIS OF BREAST CANCER Mammography
    • Supplements history and PE
    Imaging • Radiation to low to cause cancer
    • MLO view – greater volume
    • CC view – better compression and medial aspect

    Ultrasonography
    • Determine echogenic qualities
    • Lymph node assessment
    • Used along with biopsy techniques

    Magnetic Resonance Imaging


    • BRCA patients
    • Unknown primary
    • Assess neoadjuvant therapy and recurrence
    DIAGNOSIS OF BREAST CANCER

    Non-Palpable Lesions
    Biopsy • Stereotactic techniques

    Palpable Lesions
    • Fine Needle Aspiration
    • Core Needle Biopsy
    • Open Biopsy (Excision or Incision)

    An open and core needle biopsy specimen


    can be checked for tumor biomarkers
    TUMOR
    BIOMARKERS
    Hormone Receptors ER and PR

    Growth Factor Receptors HER-2/neu

    Indices of Apoptosis P53, Bcl-2

    Indices of Proliferation Ki-67

    Indices of Angiogenesis VEGF


    tobytanmd

    Clinical Staging
    of Breast Cancer

    Tumor Size

    T1 T2 T3 T4
    T <2 cm 2 – 5 cm >5 cm
    skin or chest
    wall involved

    Lymph Nodes
    NO N1 N2
    N No lymph node
    involvement
    Solitary lymph
    node
    Matted lymph
    nodes

    Metastasis M0
    Without M1
    M distant
    metastasis
    With distant
    metastasis
    tobytanmd

    Clinical Staging
    of Breast Cancer

    Easy way to remember staging


    • Stage IV – M1

    • Stage IIIB – T4

    • Stage IIIA – N2

    • Stage IIB – T + N = 3 Exception to the rule!


    T3 N1 M0 = Stage IIIA
    • Stage IIA – T + N = 2

    • Stage I – T1
    tobytanmd

    Clinical Staging
    of Breast Cancer

    Easy way to remember staging


    • Stage IV – M1

    • Stage IIIb – T4 Locally advanced


    (Inoperable)
    • Stage IIIa – N2

    • Stage IIb – T + N = 3
    Early Invasive
    • Stage IIa – T + N = 2 (Operable)

    • Stage I – T1
    tobytanmd

    Clinical Staging
    of Breast Cancer

    Easy way to remember staging


    • Stage IV – M1

    • Stage IIIb – T4 Locally advanced


    Neoadjuvant Surgery
    (Inoperable)
    • Stage IIIa – N2

    • Stage IIb – T + N = 3
    Early Invasive
    Surgery Adjuvant
    • Stage IIa – T + N = 2 (Operable)

    • Stage I – T1
    How is Breast Cancer
    Treated?

    • Treated by Stage

    • Early Invasive – Surgery + adjuvant

    • Locally advanced – Neoadjuvant +


    surgery

    • Local AND systemic treatment


    tobytanmd

    • Surgery for breast


    Course of Mastectomy vs BCS
    Treatment • Surgery for axilla
    ALND vs SLNB
    Locoregional • Radiotherapy
    If with positive LN or margins
    Or if BCS was done
    tobytanmd

    • Chemotherapy
    Course of Almost all cases, OncotypeDX
    Treatment • Hormonal Therapy (Tamoxifen/AI)
    If ER or PR positive
    Systemic • Anti Her2 Therapy (Trastuzumab)
    If HER2 positive
    tobytanmd

    Other Considerations

    Breast Cancer in Pregnancy


    • 1 in every 3000 pregnant women

    • No radiotherapy until delivery

    • MRM at 1st and 2nd trimester

    • BCS at 3rd trimester

    • Risk of abortion and birth defects


    from chemotherapy
    tobytanmd

    Other Considerations

    Phyllodes Tumor
    • Benign, Borderline or Malignant

    • Difficult to diagnose with imaging and


    FNA

    • Excision with 1cm margins


    tobytanmd

    Other Considerations

    Male Breast Cancer


    • Benign, Borderline or Malignant

    • Difficult to diagnose with imaging and


    FNA

    • Excision with 1cm margins


    tobytanmd

    RISK FACTORS AND ASSESSMENT


    MODELS

    THERAPEUTIC MANAGEMENT

    Infographic
    The Breast
    Part 2
    slide

    DIAGNOSTIC MANAGEMENT

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