Management of breast lump with awareness to breast carcinoma

Presented by:Yusor JaafarMariam TalalSherin Raad

Management of breast lump with awareness to breast carcinom

Introduction.Evaluation of breast lump.

By: Yusor Jaafar

IntroductionThe complaining of breast lump ranging frm 40_70%

Evaluation of breast lump

Diagnosis

History and examination

imaging

Cytology and

histology

History taking

Physical examinationGeneral examinationPosition

Inspection

Palpation

Primary analysisPainless lump:CarcinomaCystFibroadenomaArea of fibroadenosis

Painful lump:An area of fibroadenosisCystPeriductal mastitisAbscessCarcenoma

Nipple changesDestructionDepressionDiscolourationDisplacementDeviationDischargeDuplication

Nipple dischargeRed (blood)Pink (serum+blood)Clear pale yellowBrownGreenBlackCreamy white or yellowThin white

Nipple dischargeDuct ectasia

Intraduct papilloma

Ductal carcinoma in-situ

Associated with cyst

Imagimg

MammograpgyUsed for screening in women >40 years of age

Computer aided detection and diagnosis(CAD)

Use computer for better visualization of lump

3D mamographyThe machine move in an arc around the breast to give 3

dimention picture

BI-RADS system categories:

MRIcan diffrentiate between scar tissue and recurrent lesioncan be used in women with implant know used for screnning

Ultrasound Can diffrentiate between solid and cystic lesions Used for guided aspiration

DuctoscopyTo visulization of duct and take biopsy from abnormal areas DuctogramInject a contrast material through the tube inserted in the duct and

see the lining of the ductDiffuse optical tomographyDetect the percentage of HB saturation during take full inspirationPositron emission mammographyUse sugar attach to radioactive materials to detect malignant calls

Nuclear medicine studyScintimammography Use radioactive tracer which is accumulate in the tissue and emmit gamma rays

which is detected by gamma camera ThermpgraphyHave high failure rate .. Detect 1 from 4 malignant masses

Other experimental imigingOptical imigingPass light through breat tissue and measure the light which is pass or return

through the tissueMolecular breast imagingNew nuclear medicine imaging technique

Cytology and histology

Core needle biopsy

To diffrentiate between ca in situ and invasive ca Fine needle diopsy

Less invasive but have high failure rateVacuum biopsy

For removal of microcalcifications

Pathological classification of breast lumps

Epithelial: Duct papilloma

Connective tissue:Neurofibroma

Lipoma

Mixed:

Fibroadenoma

Phyllodes tumor

Benign Invasive duct

carcinoma

Inflammatory carcinoma

Malignant

Benign breast lumps

•Others •Inflammation•Infection

•Pregnency related

• Injury

Hematoma

Fat necrosis Galactocele

Puerperal abscess

Breast cyst

Fibroadenoma of breast

Acute bacterial mastitis

Duct ectasia

tuberculosis

http://www.healthplus24.com/womens-health/breast-cancer/breast-lump.aspx

Breast CystSmooth, unilateral

massFeels like a cystInfrequently

associated with malignancy

AspirateWatch for reforming of

cystRecurring cysts are

more worrisome.

Galactocele

Milk-filled cyst

Usually follows lactation

Firm, tender mass

Usually in upper quadrants

Diagnostic aspiration often curative

Galactocele

Galactocele

Fibroadenomas

CausesTypesTreatment

Fat Necrosis

SymptomsCauses Treatment

Lipoma

Fibrocystic breastsAberrations of normal development and

involution (ANDI)

SymptomsCausesComplicationsTreatment

Fibrocystic breastsAberrations of normal development and

involution (ANDI)Clinical features: It most commonly affect women between

(30-50) years of age. The symptoms of ANDI include an area of

lumpiness and/or breast pain (mastalgia). The changes may be cyclical, with an

increase in both lumpiness, and often tenderness, before a menstrual period.

No consistent association between fibrocystic complex and breast cancer.

Fibrocystic breastsAberrations of normal development and

involution (ANDI)

Mastitis

TypesSymptomsBreast abscess

CausesTreatmentRisk factorsWeaning

Tuberculosis of the breast

Tuberculosis of the breast with secondary suppurating axillary

lymph nodes

Breast CancerEpidemology

Risk factors

Age Previous history of

breast disease

Previous history of

breast cancer

Family history of

breast cancer

lifestyle genetics

http://www.medscape.com/viewarticle/443381_13

Signs and symptoms

Clinical presentationbreast cancer commences most

frequently in the upper, outer quadrant

Classification

HistopathologyGradeStage

Stage 1A

Stage 1B

Stage 2A

Stage 2B

Stage 3A

Stage 3B

Stage 4

Treatment Medication

Hormone therapy

ChemotherapyCMFCAF (or FAC)TACAC → TFEC → TTCTCH

Monoclonal antibodiesNaked monoclonal antibodiesConjugated monoclonal antibodies

Radiation

surgery

Screening Average-risk womenAbove-average risk women

Self examination

Clinical Breast ExaminationMammographyMRI