BREAST CARSINOMA

by:-
Dr.RAJESH KAKKERI
Anatomy of breast
 Introduction

• The term “breast Caner” refers to a malignant tumor that has

developed from cell in the breast . Breast cancer occure anywhere
in the breast, but most are found in the Upper outer quadrant,where
most breast tissue is located. Usually breast cancer either begins in
the cells of the lobules, which are the milk- producing glands, or the
ductsz the passages that Drain milk from the lobules to the
nipple.less commonly, breast cancer can begin in the stromal
tissues, which include the fatty and fibrous connective tissue of the
breast.
 Definition

• Breast cancer is a malignant tumor that starts in the cells on the

breast.
 Forms of breast cancer
1. Invasive ductal carcinoma- This type of breast cancer develops in the milk
ducts and account for about 79% of cases. It can break through the duct wall and
invade the breasts fatty tissue, then metastasize(spread) to other part of the body
through the bloodstream or lymphatic system.
 2. Invasive lobular carcinoma
• This type of breast cancer accounts for about 10% of cases and originates in
the breasts milk- producing lobules. It also can spread to the breasts fatty tissue
and other place in the body.

3. Medullary, mucinous and tubular

carcinomas
• These are three slow- growing types of breast cancer. Together they
represent about 10% of all breast cancer.
4. Pagets Diseases
• This type accounts for about 1 % of all cases. Of all breast cancers,
inflammatory carcinoma is the most aggressive and difficult to treat,
because it spread so quickly.

5. Inflammatory carcinoma
• This type represents about 1% of breast cancers. It starts in the milk ducs of
the nipple and can spread to the areola (dark circles around the nipple). Women
who get pagets Diseases usually have a history of nipple crusting, scaling,
itching or inflammation.
 Ductal carcinoma in situ ( DCIS)

• DCIS occurs when cancer cells fill the ducts but haven’t yet spread
through the walls into fatty tissue. Nearly all women diagnosed at
this early stage can be cured. Without treatment, about 25% of
DCIS case will lead to invasive breast cancer within 10 years.
 Lobular carcinoma in situ ( LCIS)

• LCIS is less common and less of a treat than DCIS. It develops in

the breasts milk- producing lobules. LCIS doesn’t require
treatment, but it does increase a women’s risk of developing
breast cancer.
 Risk factors
No one know the exact cause of breast cancer. A “risk factor” is anything
that in creases your risk of developing breast cancer. Studies have found
the following risk factors for breast cancer.

• Age • Reproductive and menstrual history

• Gender
• Personal history of breast cancer
• Family history
• Certain breast changes
• Gene change
• Overweight or obese after
• Radiation therapy to the chest
• Breast density
• Atypical hyperplasia
• Hormone replacement therapy
• Oral contraceptive use
• Lack of physical activity
• Drinking alcohol
 Stages of breast cancer

Stage Definition

Stage-0 Carsinoma in situ .

Cancer cell remain inside the brest ducts, without invasion into normal adjacent breast
tissue.

Stage-I Cancer is 2 cm or less and is confined to the breast .

Cancer cells have not spread beyond the breast.

Stage-II The tumor is larger than 2 but no larger than 5cm and has not spread to the axillary
lymph nodes.
 Contt…
.
Stage-II Locally advanced cancer. It is decided into stage IIIA, IIIB, and IIIC .

No tumor is found in the brest. Cancer is found in axillary lymph nodes

that are sticking together or to other structures, or cancer
Stage-III A maybe found in lymph nodes near the breastbone or the
tumor is any size. Cancer has
spread to the axillary lymph nodes, which are sticking
together or to other structures,
or cancer may be found in lymph nodes near the
breastbone.

The tumor may be any size and has spread to the chest wall and /or skin of the breast and may have
spread to
Stage-III B axillary lymph nodes that are clumped together or sticking to other structures or cancer may
have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at
least stage IIIB.
 Contt…
.
There may either be no sign of cancer in the breast or a tumor
may be any size and may have spread to the chest wall and/or
Stage-III C the skin of the breast and the cancer has spread to lymph nodes
either above or below the collarbone and the cancer may have
spread to axillary lymph nodes or to lymph nodes near the
breastbone.

Stage-IV The cancer has spread or metastasized to other parts of the body.
 Clinical manifestation
According to American Cancer Society, any of the following unusual changes in the
breast can be a symptom of breast cancer:

• A lump or thickening in or near the breast or in the

underarm area
• A change in the size or shape of the breast
• The skin of the breast, areola, or nipple may be scaly,red, or swollen.
• Skin irritation or dimpling
• Breast pain
• Nipple pain or tenderness
• A nipple turned inward into the breast
• Unilateral nipple discharge other than breast milk
• Enlarged axillary or supraclavicular lymph nodes
Diagnostic evaluations

• Diagnostic mammogram
• Ultrasound
• Magnetic resonance imaging
• Biopsy
• Hormone receptor test
• CT- scan
• Bone scan
 Screening and early detection
• Screening for breast cancer before there are symptoms can be important.
Screening can help doctors find and treat cancer early. Doctor may suggest
the following screening test for breast cancer.
• Yearly mammograms are recommended starting at age 40 and continuing for
as long as a women is in good health. A mammograms can often show a breast
lump before it can be felt.
• Clinical breast exam ( CBE) about every 3 years for women in their 20s
and 30s and every year for women 40 and over. A through clinical breast exam
may take about 10 min . During ba clinical breast exam, your health care
provider checks your breasts . Health care provider looks for differences in size
or shape between your breasts. The skin of your breasts is checked for a rash,
dimpling, or other abnormal signs.Your nipples may be squeezed to check for
fluid.
 Management
• Women with breast cancer have many treatment options. These include
surgery, radiation therapy, chemotherapy, hormone therapy, and biological
therapy. Many women receive more then one type of treatment. Cancer
treatment is either local therapy or systemic therapy:
• Local therapy: Surgery and radiation therapy are local treatment.
They remove or destroy cancer in the breast . When breast cancer is spread to
other parts of the body, local therapy may be use to control the Diseases
in thode specific areas.
• Systemic therapy: Rest of the therapies are systemic treatment. They
enter the bloodstream and destroy or control cancer throughout the body.
Some women with breast cancer have systemic therapy to shrink the tumor
before surgery or radiation. Others have systemic therapy after surgery
and /or radiation to prevent the Cancer from coming back . Systemic
treatments also are used for cancer that has spread.
 A. Surgery
Surgery is the most common treatment for breast cancer.
There are several type of surgery.
1. Mastectomy: an operation to remove the breast ( or as much of
the breast tissue as possible) is a mastectomy. This procedure is
generally done for carcinoma in situ. In the most caaes, the
surgeon also removes lymph nodes under the arm.
Some women have radiation therapy after surgery. It can be
done in several forms:
• Total mastectomy
• Redical mastectomy
• Modified redical mastectomy
 2. Lymph node Dissection
• The surgeon often Removes the underarm lymph nodes as well. A separate
incisions is made. This procedure is called an axillary lymph node Dissection.
It shows whether cancer cells have enter the lymphatic system.

3 Breast sparing surgery

• An operation to remove the cancer but not thebreast is breast sparing surgery. It is
also called breast conserving surgery, lumpectomy, segmental mastectomy, parital
mastectomy and removal of axillary lymph nodes. Sometime an excisional
biopsy serves as a lumpectomy because the surgeon removes the whole lump.
After breast- sparing surgery, most women receive radiation therapy to the
breast . This treatment destroys cancer cells that may remain in the breast.
4. Prophylactic ovary removal
• It is a preventive Surgery that lowers the amount of estrogen in the
body, making it harder for estrogen to stimulate the development of
breast cancer.

5. Cryotherapy
• Cryotherapy, is also called cryosurgery, uses extreme cold to freeze
and kill cancer cells . It also use to control pain and control
bleeding . Right now , cryotherapy is an experimental treatment for
breast cancer. All cells, including cancer cells, contain water. When
cryotherapy freeze the cells, the water turns to ice crystal. These ice
crystals, along with the cold it self, destroy the cancer cells.
6. Breast reconstructive surgery

• Breast reconstruction is the rebuilding of the breast after

mastectomy and sometimes lumpectomy. Reconstruction can take
place at the same time as cancer removing surgery, or months to
year later. It is done to hence body image to provide symmetry of
breast.
B. Radiation therapy
 External radiation
 Internal radiation

C. Chemotherapy
D. Hormon therapy
E. Biological therapy
Post- operative
Mastectomy
exercises
 Evaluation

1. What is breast cancer?

2. Enlist the types of breast cancer?
3. What are the risk factor of breast cancer?
4. What are the diagnostic evaluation done to detect
breast cancer?