Diseases of Breast (New)
Diseases of Breast (New)
Diseases of Breast (New)
clinics
assessment
1. Solid or cystic
2. Echogenecity
4. Axillary LN
5. Guide biobsy
E- MRI
disease
equivocal
nonpalpable lesions .
BENIGN BREST DISEASES
A - Infectious & inflammatory breast disease
1. Cellulitis (Mastitis )
- Common during lactation, bacteria enter through the
nipple (staph Or strept)
4. Mondor’s disease
1. fibrocystic breasts
epithelial component .
4- Sclerosing adenosis
2. Galactorrhea
an intraductal papilloma*
2. culture sensitivity
4. Duct excision
D - Mastalgia refers to breast pain.
1- cyclic pain
THE BREAST
A - Epidemiology of breast cancer :
(60%).
2. BRCA-2 Increases risk of ca. breast 60% &ovary 40%
2- Hormonal factors
- O.C.P ( high estrogen pills, use before age of 20y, use for
late1st pregnancy).
breast is 60y .
1. lumps
2. pain
breast tumor .
Peau d’orange of the Breast
Slit-like retraction of duct- Circumferential retraction of
ectasia Ca. Breast
- Distant organs - brain, lungs, liver & musculoskeletal
good prognosis
Ca. breast )
3- Paget’s disease
the nipple .
c. Papillary carcinoma .
2. Less favorable lesions
infiltration
- Localized warmth
- Swelling
- Pain
Inflammatory Ca. of Rt breast
Screening
- Performed by mammography.
node negative
2 - Capsular invasion .
5 - Hard matted.
3. Metastasis (M)
or synchronous disease.
or bone metastasis
3. USS Abdomen – detects liver mets
7. PET scan
worse prognosis .
6. proliferative ability
Ki-67, Cathepsin,p53
Table- 1 T N M staging .
T Primary Tu size
Tx A primary Tu Can't be assessed
T0 No evidence of primary Tu
Tis Intraductal Ca or lobular Ca in situ, paget’s disease of
nipple with no Tu
T1 Tu 2cm or less in greatest dimension
T1mic - Microinvasion 0.1cm or less in g.d .
T1a > 0.1 and < 0.5cm in g.d
T1b > 0.5cm and < 1cm .. ..
T1c > 1cm and < 2cm .. ..
T2 Tu > 2cm and < 5cm .. ..
T3 Tu > 5cm in g.d .
T4 Tu Of any size with distant extension to
chest wall or skin
T4a - extension to chest wall.
T4b - edema (peau d’orange) or skin
ulceration or satellite skin nodules
T4c - both 4a &4b
T4d - inflammatory Ca
N regional L.N
M distant metastasis
Mx D.M can’t be assessed
M0 No D.M
M1 D.M
Table-2 Breast cancer prognosis based on stage
Stage 2a T1 N1 M0 72%
T2 N0 M0
Stage 2b T2 N1 M0
T1 N2 M0
Stage 3a T2 N2 M0
T3 N1 M0
T3 N2 M0
Stage 3b T4 Any N M0 41%
cancer
I - Surgery (local treatment )
stage 1&2
V- Hormonal therapy
1- Tamoxifen (antiestrogen ) 20 mg /day for 5yrs and
Aromatase inhibitors
2 - As effective as chemotherapy in postmenopausal
pts.
3- Excellent choice in elderly pts who can’t tolerate
chemotherapy
4- Based on ER status of the Tu ( ER+ 65% respond,
ER-ve 5% respond )
5- Decrease the size of the Tu. in ER+ pts. with
recurrent disease
VI – Targeted therapy
A B