Breast Cancer

67 %
33 %
Information about Breast Cancer
Entertainment

Published on April 20, 2009

Author: chrismdez

Source: authorstream.com

Breast Cancer : Breast Cancer April 20, 2009 Introduction : Introduction Most common female cancer Accounts for 32% of all female cancer 211,300 new cases yearly and rising 40,000 deaths yearly Gross Anatomy : Gross Anatomy Sappy’s plexus – lymphatics under areolar complex 75% of lymphatics flow to axilla Microscopic Anatomy : Microscopic Anatomy Stromal tissue Connective tissue, capillaries, lymphocytes, etc. Adipose tissue Ductal tissue Squamous epithelium Columnar or cuboidal epithelium Lobular tissue Presentation : Presentation Breast lump Abnormal mammogram Axillary lympadenopathy Metastatic disease Familial Breast Cancer : Familial Breast Cancer Cause 5-10% of all cancer and 25% in women <30 y/o BRCA2 Causes 40% of familial breast CA 50-70% - breast 15-45% - ovarian Increased risk for prostate, colon BRCA1 50-70% - breast 20-30% - ovarian Increased risk for prostate, pancreatic, laryngeal, Screening Mammography : Screening Mammography Recommendations Biannually or annually in 40-49 y/o Annually in >50 y/o 15% relative risk reduction Birads 0 - Incomplete assessment; need additional imaging evaluation 1 - Negative; routine mammogram in 1 year recommended 2 - Benign finding; routine mammogram in 1 year recommended 3 - Probably benign finding; short-term follow-up suggested (3%) 4 - Suspicious abnormality; biopsy should be considered (30%) 5 - Highly suggestive of malignancy; appropriate action should be taken (94%) Biopsy techniques : Biopsy techniques FNA Diagnostic and therapeutic in cystic lesions Core needle U/S guided or sterotatic 90% effective in establishing diagnosis Atypia – need excision Sterotatic Needle localization Excision biopsy Risk of Future Invasive Breast Carcinoma Based on Histologic Diagnosis from Breast Biopsies : Risk of Future Invasive Breast Carcinoma Based on Histologic Diagnosis from Breast Biopsies No Increase AdenosisApocrine metaplasiaCysts, small or largeMild hyperplasia (>2 but <5 cells deep)Duct ectasiaFibroadenomaFibrosisMastitis, inflammatoryPeriductal mastitisSquamous metaplasia Slightly Increased (relative risk, 1.5–2) Moderate or florid hyperplasia, solid or papillaryDuct papilloma with fibrovascular coreSclerosing adenosis, well-developed Moderately Increased (relative risk, 4–5) Atypical hyperplasia, ductal or lobular Benign Breast Masses : Benign Breast Masses Cysts Fibroadenoma Hamartoma/Adenoma Abscess Papillomas Sclerosing adenosis Radial scar Fat necrosis Papilloma Maligant Breast Masses : Maligant Breast Masses Ductal carcinoma DCIS Invasive Lobular carcinoma LCIS Invasive Inflammatory carcinoma Paget’s disease Phyllodes tumor Angiosarcoma Ductal carcinoma : Ductal carcinoma DCIS : DCIS Ductal carcinoma in situ (DCIS) 1. Solid type* 2. Cribiform type 3. Papillary type 4. Comedo type* Lobular carcinoma : Lobular carcinoma Invasive Histology : Invasive Histology Ductal NOS Lobular Mucinous Tubular Medullary Staging : Staging Tumor Tis: in situ T1: <2cm T2: 2-5cm T3: >5cm T4: invasion of skin or chest wall Node N1: 1-3 axillary nodes or int mam node N2: 4-9 axillary nodes or palpalbe int mam node N3: >10 nodes or combo of axillary and int mam nodes {mic micoroscopic posivitiy, mol molecular posiivity Metastasis Staging : Staging Modified Radical Mastectomy : Modified Radical Mastectomy Entire breast tissue and Level I & II nodes Survival at 10 yrs Negative nodes – 82% (5% local recurrence) Positive nodes – 48% (5% local recurrence) Simple mastectomy Modified radical Breast Treatment Trials : Breast Treatment Trials NSABP (1971 with B-04 update in 2002) Compared radical, vs modified radical +/- radiation No survival diff for node neg or pos between three arms 75% of recurrences occur in 5 years Tumor location not important Breast Treatment Trials : Breast Treatment Trials Ontario study All pts got lumpectomy, randomized to radiation or no radiation 25% failure rate without radiation, 5% with NSABP B-06 Mastecomy vs lumpectomy vs lumpectomy with radiation No difference in survival 39% recur with lumpectomy, reduced to 14% with radiation, 3-4% with mastectomy 0.5-1% per year recurrence rate for life with BCT and radiation 2-5% complication rate with radiation (rib fx, pericarditis, cosmesis) Radiation after mastectomy? : Radiation after mastectomy? 2 Danish studies and one Britsh study Recommend in: >3 nodes positive, aggressive/large tumors or extranodal invasion Decreased local or regional recurrence +/- survival benefit Sentinel node biopsy : Sentinel node biopsy Contraindications: Clinically positive nodes, pregnant or nursing, prior axillary surgery, locally advanced disease False negative rate 3.1% Macrometases (>0.2cm) so recommended pathology cuts are 0.2 cm Micrometases (IHC staining) 37% death rate vs 50% of those with macrometases If sentinel node positive 43% will have other nodes positive and 24% will have >4 nodes positive NSABP (B-32) in progress Treatment of DCIS : Treatment of DCIS 600% increase after mammography Options Mastectomy – 1% breast ca mortality Large tumors, multicentric, positive margins after reexcision, Lumpectomy and radiation Radiation decreases local recurrence by 50% Of those that recur 50/50 DCIS vs Invasive 0-3% chance of dying of maligant breast ca for all DCIS Treatment of DCIS : Treatment of DCIS Nodal involvement 3.6% of DCIS pts have positive nodes in mastectomy specimins By definition DCIS has no access to lymphatics Size may matter (111 DCIS tumors evaluated) <45mm – 0% microinvasion 45-55mm – 17% microinvasion >55mm – 48% microinvasion Tamoxifen in DCIS : Tamoxifen in DCIS NSABP (B-24) Determine benefit of tamoxifen in lumpectomy plus radiation pts 31% decrease in ipsilateral, 47% in contralateral, 31% decrease all together Retrospectively looked at ER status 75% of DCIS is ER+ 59% reduction in ER+ pts No significant reduction in ER- Treatment for invasive breast ca : Treatment for invasive breast ca Locally advanced is likely already metastatic in most Surgery and radiation alone make no difference on survival Chemotherapy & +/- Tamoxifen Neoadjuvant chemotherapy 7 randomized trials No survival benefit 50-80% response May allow for BCT in large tumors Sentinel node before chemo Tamoxifen : Tamoxifen Indications ER + breast ca LCIS BRCA1/2 Increased overall risk Benefits Decreases risk of ca in other breast by 47-80% Draw backs Increases endometrial ca risk by 2.5, PE 3.0, DVT 1.7 Source: NSABP P-1 trial Chemotherapy : Chemotherapy Early Breast Cancer Trialists’ Collaborative Group Decreases recurrence (12%) and death (11%) regardless of nodal status Indications All patients except node negative, <10mm tumors Regimens Multidrug combination chemotherapy Tamoxifen or aromatse inhibitor - ER positive tumors Herceptin (trastuzumab) – HER2/neu positive tumors NSABP B-31 – 33% reduction in risk of death Other breast cancers : Other breast cancers Inflammatory ca Carcinoma invading lymphatic ducts Chemotherapy, mastectomy, radiation 50% survival at 5 years Other breast cancers : Other breast cancers Paget’s disease Intraepithelial extesion of ductal ca Excision with nipple-areolar complex Sentinel node if invasive ca Mastectomy Other breast cancers : Other breast cancers Phyllodes tumor <1% of breast tumors Age 30-45 Similar in appearance to fibroadenoma 4% recurrence after excision 0.9% axillary spread Radiation, chemotherapy, tamoxifen ?? Phyllodes tumor Fibroadenoma Angiosarcoma : Angiosarcoma Risk factors Radiation Lymphedema Treatment Excision, radiation Male breast cancer : Male breast cancer 90% are invasive at time of diagnosis 80% ER+, 75% PR+, 30% HER2/neu More invade into pectoralis Treatment same as for female ca

Add a comment

Related presentations

Related pages

Breast cancer - Wikipedia, the free encyclopedia

Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of ...
Read more

Breastcancer.org - Breast Cancer Information and Awareness ...

Breastcancer.org is a nonprofit organization dedicated to providing the most reliable, complete, and up-to-date information about breast cancer.
Read more

Breast Cancer Causes, Symptoms, Stages, Treatment & Signs

Get the facts on breast cancer awareness, signs, symptoms, stages, types, treatment, and survival rates. Statistics show that 40,000 women in the U.S. die ...
Read more

WebMD - Breast Cancer Health Center

The five year survival rate of breast cancer is over 90% when caught early. Get in-depth breast cancer information here including symptoms
Read more

Your Breast Cancer Diagnosis | Breastcancer.org

Just as no two people are exactly alike, no two breast cancers' diagnoses are exactly the same, either. Learn more about breast cancer diagnosis today.
Read more

Breast Cancer | Cancer.Net

This is Cancer.Net’s Guide to Breast Cancer. Use the menu below to choose the Overview/Introduction section to get started. Or, you can choose another ...
Read more

Breast Cancer: MedlinePlus

Breast cancer affects 1 in 8 women during their lives. Here's what you need to know about risk factors, symptoms, diagnosis, and treatment.
Read more

National Breast Cancer Foundation, Inc.

The National Breast Cancer Foundation's mission is to help women now by providing help and inspiring hope to those affected by breast cancer through early ...
Read more

Breast cancer: MedlinePlus Medical Encyclopedia

Breast cancer risk factors are things that increase the chance that you could develop breast cancer: Some risk factors you can control, such as drinking ...
Read more

Breast Cancer Care | The breast cancer support charity

The breast cancer support charity ... £23 can pay for a call to our Support Line so anyone affected by breast cancer can talk to someone who understands ...
Read more