BREAST CANCER

Anatomy of the Breast

The Breast – Mammary gland

a) Glandular tissue

b) Duct system

c) Fat

Anatomy of the Breast

• The nipple – smooth muscle fibers• The areola – contains sebaceous glands• Lactiferous ducts • Lactiferous sinus• Cooper’s ligaments

Anatomy of the Breast

Arterial supply

Artery thoracic internal , axillary artery, intercostal arteries

Venous drainage

Axillary vein

Lymphatic drainage

Axillary nodes

Fibrocystic Disease

a) Fibrosis

b) Cystic disease

c) Sclerosing adenosis

d) Epithelial hyperplasia

Fibrocystic Disease

Fibrocystic disease Cancer

Often bilateral Unilateral

Multiple nodules Single

Menstrual variation No variation

Cystic pain No pain

May regress Does not regress

Breast Tumors

1. Fibroademona

2. Cystosarcoma phyllodes

3. Intraductal papilloma

4. Carcinoma of the breast

Breast Cancer Statistics

Lung – 25%

Breast – 11%

Colon and Rectum-11%

Breast Cancer Statistics

In the USA:

211,000 new cases of invasive breast cancer will be diagnosed this year

43,300 patients will die

Risk Factors of Breast Cancer

1) Fibrocystic disease

2) Menarche disorders

3) Diets high in saturated fat

4) Family history of breast cancer

5) Late or no pregnancies

6) Moderate alcohol intake

7) Estrogen replacement therapy

Pathogenesis of Breast Cancer

a) Genetic (BRCA 1 on 17q and BRCA 2 on 13q)

b) Viral

c) Environmental

d) Hormonal role (“unopposed estrogen”)

Breast Cancer Classification

a) Noninfiltrating intraductal carcinoma

b) Infiltrating ductal carcinoma

c) Medullary carcinoma

d) Colloid (mucinous) carcinoma

e) Lobular carcinoma

f) Paget’s disease of the breast

g) Inflammatory carcinoma

Non-infiltrative intraductal carcinoma

“Comedocarcinoma”

Microscopically:

Typical duct epithelial cells proliferate

Ductal dilatation

Infiltrative ductal carcinoma

Rock-hard palpable tumors 2-5 cm in diameter

Nipple retraction

Necrosis and calcification

Microscopically:

Anaplastic duct epithelial cells

Fibrous reaction

Medullary carcinoma

Fleshy masses 5-10 cm in diameter

Little fibrous tissue

Microscopically

Large pleomorphic cells

Lymphocytic infiltrate

Colloid (mucinous) carcinoma

Soft, large, gelatinous tumor

Microscopically

Tumor cells and mucin

Lobular carcinoma

Arises from terminal ductules

Multicentric tumors

Rubbery and ill-defined tumors

Microscopically

Small cells arranged in rings

Small cells are confined to lobules

Paget’s disease

The skin of the nipple and areola are ulcerated

Inflammation

Bacterial infection

Microscopically

Ductal carcinoma

“Paget’s cells”

Inflammatory Breast Cancer

Breast Cancer TNM-classisfication

TIS = Paget's Disease without a tumor, Carcinoma in-situT1 = Tumor less than 2 cm. in greatest dimensionT2 = Tumor larger than 2 cm. in size but less than 5cm.T3 = Tumor larger than 5 cm. in sizeT4 = Tumor of any size extending to the chest wall or skin

N1 = Metastasis to moveable axillary nodesN2 = Metastasis to fixed or matted axillary nodesN3 = Metastasis to supraclavicular, infraclavicular or internal mammary nodes

M0 = no distant metastasisM1 = distant metastasis

Stages of Breast Cancer Stage I T1 N0 M0 Stage II T0 N1 M0

T1 N1 M0

T2 N0 N1 M0 Stage IIIA T0 N2 M0

T1 N2 M0

T2 N2 M0

T3 N0, N1, N2 M0 Stage IIIB Any T N3 M0

T4 Any N M0 Stage IV Any T Any N M1

Breast Cancer Classification

5-year survival rate

Stage I 80-95%

Stage II 65-85%

Stage IIIa 56%

Stage IIIb 49%

Stage IV 10-19%

Breast Cancer

Treatment

Segmental mastectomy

Simple mastectomy

Modified radical mastectomy

Radical mastectomy