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1

Cancer

Cancer Carcinoma • Lobular carcinoma • Ductal carcinoma • In situ • invasive / infiltrating Sarcoma

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2

Carcinoma Risk factors : • familial history • fibrocystic disease • early menarche / late menopause • late birth of first child • nulliparous

• exogenous hormone

Carcinoma in situ Ductal carcinoma in situ (Intraductal carcinoma) Lobular carcinoma in situ • nonpalpable lesion : mammography, incidental finding • mass : periductal fibrosis, FCD • nipple discharge

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3

Ductal carcinoma in situ

Invasive carcinoma • Invasive ductal carcinoma (Infiltrating duct carcinoma) • Invasive lobular carcinoma

• Tubular carcinoma • Colloid carcinoma • Medullary carcinoma

• Metaplastic carcinoma

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4

Invasive ductal carcinoma

Colloid carcinoma

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5

Invasive lobular carcinoma

Carcinoma behavior : • direct invasion skin, chest wall • lymphatic spread axillary lymph nodes internal mammary chain • hematogenus spread bone, lung, liver, ovary

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6

Carcinoma

Invasive ductal carcinoma

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7

Invasive ductal carcinoma

Invasive ductal carcinoma

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8

Invasive ductal carcinoma

Lymphatic drainage

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9

Paget’s disease • epidermal invasion by ductal

cancer cells of the nipple • nipple lesion : chronic eczema • underlying ductal carcinoma

Paget’s disease

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10

Investigations • physical examination • mammography • fine needle aspiration • core needle biopsy • excisional biopsy • incisional biopsy

mammography

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11

+

abnormal mammography

FNA : normal ductal epithelium

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12

FNA : Invasive ductal carcinoma

Treatment • surgery : modified radical mastectomy : conservative operation • radiotherapy • chemotherapy • hormonal therapy

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13

Estrogen receptor : Immunohistochemical study

Response to hormonal therapy

0

10

20

30

40

50

60

70

80

ER+, PR+ : 77% ER-, PR+ : 46% ER-, PR- : 11%

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14

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