THE BREAST Dr.JAMIL SAWAKED BREAST TAIL LATISSIMUS DORSI

THE BREAST Dr.JAMIL SAWAKED

BREAST TAIL LATISSIMUS DORSI TERES MAJOR SERRATUS ANTER ANATOMY

RIBS &intercost.m PECTORALIS MAJOR FAT LOBE AMPULLA 20 MAJOR LACT.ORIFICES LACTOCYTE MAJOR LACT.DUCT IS THE SITE OF DUCTAL CA.

THEIR CONTRACTION CAUSES SKIN DIMPLING PEAU d`ORANGE IS DUE TO OEDEMA OF SKIN LYMPHATIC

DUCT SYSTEM MAJOR DUCT Is the site of ductal Ca

[MINOR] OR [ TERMINAL] MINOR DUCT IS THE SITE OF LOBULAR CARCINOMA

INTERNAL MAMMARY L.N. SENTINEL L.N PECTORAL LAT.THOR.V RPOSTERIO LATERAL APICAL 85% OF THE BREAST DRAIN INTO THE AXILLA CENTRAL LONG THORACIC N SUPERIOR THORACIC V. SUBSCAP.V

IF IT IS FILLED WITH MILK IT IS GALACTOCELE

MASTITIS;PLUGGED DUCT OR CRACKED NIPPLE,[STAPHYLLOCOCCI] ABSCESS

60% OF MASTITIS IS IN LACTATIG WOMEN

TYPES OF MASTITIS MASTITIS NEONATORUM MASTITIS OF PUBERTY LACTATING MASTITIS SPECIFIC MASTITIS; 1-T.B MASTITIS 2-SYPHILITIC MASTITIS 3-ACTINMYCOSIS

BENIGN BREAST DISEASE FIBROADENOMA FIBROCYSTIC DIS DUCTECTASIA BENIGN CYSTS LIPOMA:VERY RARE [DANGEROUS TO DIAGNOSE LIPOMA]

FIBROADENOMA BREAST MOUSE SMALL ONES COULD BE LEFT ALONE

Giant fibroadenoma> 5 CM CAN BECOME MALIGNANT

DUCTECTASIA with milk fistula Treatment; like fistula in ano

WHEN A BENIGN BREAST DISEASE BECOMES WORRYING? WHEN A PATHOLOGY SPECIMEN SHOWS ATYPICAL HYPERPLASIA FLORID HYREPLASIA CARRIES AMILD RISK NB;METAPLASIA AND MILD HYPERPLASIA CARRY NO RISK

CYSTS BENIGN MALIGNANT MANAGEMENT OF A CYST ASPIRATE & OPERATE OR CORE BIOPSY IF; 1-BLOODY ASPIRATE 2-DID NOT DISAPPEAR COMPLETELY AFTER ASPIRATION 3-RECURES IN 6 WEEKS 4-US SHOWS SOFT TISSUE INSIDE

NIPPLE DISCHARGE I=NONBLOODY; 1-FIBROCYSTIC DISEASE 2-DUCTECTASIA II=BLOODY; 1-DUCT PAPILLOMA; MOST COMMON 2-DUCT ECTASIA; VERY COMMON 3-DUCT CARCINOMA;VERY RARE

BLOODY NIPPLE DISCHARGE

NORMAL DUCT DUCT PAPILLOMA

MICRODOCHECTOMY FOR BLEEDING NIPPLE BLEEDING SEGMENT IS REMOVED AND SUBMITTED TO HISTOPATHOLOGY PROBE DETERMINE FIRST WHICH ORIFICE OR SEGMENT IS BLEEDING BY PRESSING AROUND THE AREOLA

BREAST CANCER DUCTAL CARCINOMA [90%] LOBULAR CARCINOMA[<10%] PAGET`S DISEASE INTRACYSTIC PAPILLIFEROUS CA SARCOMA

What Are the Risk Factors for Breast Cancer? 1-Age; INCREASING AGE 2-Race;WHITE++.RARE IN JAPAN, 3-Individual or family history of breast cancer 4-A history of ovarian cancer 5-A genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers) 6-Estrogen exposure;MENARHE,MENOPAUSE 7-Atypical hyperplasia of the breast 8-Lobular carcinoma in situ (LCIS) 9-Lifestyle factors (obesity, lack of exercise, alcohol use) 10-Radiation 1-Age; INCREASING AGE 25:1/20,000. 45:1/100. 50:1/50. 55:1/33. 60:1/24. 80:1/10. 2-Race;WHITE++.RARE IN JAPAN, 3-Individual or family history of breast cancer 4-A history of ovarian cancer 5-A genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers) 6-Estrogen exposure;MENARHE,MENOPAUSE 7-Atypical hyperplasia of the breast 8-Lobular carcinoma in situ (LCIS) 9-Lifestyle factors (obesity, lack of exercise, alcohol use ) 10-Radiation

About 15%?[3-15]of breast cancers are inherited Approximately 80% of hereditary breast cancer is caused by mutations in the BRCA1 or BRCA2 genes.P53 has a role too Women who inherit a BRCA mutation have a 50% to 85% chance of developing breast cancer in their lifetime Women with especially strong family history may consider preventive surgery to remove breast tissue and/or chemoprevention Several other genetic syndromes can increase breast cancer risk

What Are the Symptoms of Breast Cancer? New lumps or a thickening in the breast or under the arm Nipple tenderness, discharge, or physical changes Skin irritation or changes, such as puckers, dimples, scaliness, or new creases Warm, red, swollen breasts with a rash resembling the skin of an orange Pain in the breast (usually not a symptom of breast cancer, but should be reported to a doctor) No visible or obvious symptoms (asymptomatic)

SITES LT.BREAST 60% 12% 10% 6% 12% RT. LT. 60 6 60 6

MODE OF SPREAD OF DUCTAL CARCINOMA LOCAL LYMPHATIC BLOOD; BONE SOFT TISSUE 1-LUMBER V. 1-LIVER 2-FEMUR 2-LUNG 3-THORAC V. 3-BRAIN 4-RIBS 4-KIDNEY 5-SKULL 5-ADRENALS

DIAGNOSIS TRIPLE ASSESSMENT 1-CLINICAL: A-AGE . B-EXAMINATION 2-IMAGING : A-US . B-MAMMOGRAM 3-PATHOLOGY: A-FNA. B-CORECUT

FNA & CORECUT FNA [CYTOLOGY EXAMINATION] HAS 5% FALSE –VE MOSTLY DUE TO SAMPLING ERROR CORECUT [TRUCUT] IS A TISSUE HISTOPATHOLOGY THAT IS MORE ACCURATE AND TELLS YOU ABOUT THE GRADE & INVASIVENESS; IN-SITU OR INVASIVE

MAMMOGRAM MALIGNANT 1-CALCIFICATION; CLUSTER[5-6] OF BRANCHED FINE MICROCALCIFICATION 2-ARCHITECTURAL CHANGES; SPIKY DENSE IRREGULAR MASS BENIGN WELL DEFINED ROUNDED MASS WITH HALO SIGN; CYST,FIBROADENOMA

MAMMOGRAM CONVENTIONAL & DIGITAL IT IS NON USED FOR YOUNGER WOMEN<35 YEARS, BECAUSE THEIR DENSE BREAST TISSUE GIVES FALSE POSITIVE RESULTS BUT IT IS GOOD FOR THE SOFT BREASTS; BECAUSE THE GLANDULAR TISSUE IS SEPERATED BY FAT PLANES

Ca.breast with peau d`orange

CA BREAST;MAMMOGRAM

FIBROADENOMA ON MAMMOGRAM

MRI IS THE MOST SENSITIVE 1- CAN PICK UP CARCINOMA IN-SITU 2- DIFFERENTIATES BETWEEN LOCAL RECURRENCE AND FIBROSIS

MRI NO RADIATION BUT MAGNETIC FIELD 1-CAN VISUALIZE A PALPAPABLE MASS WHICH IS NOT Seen ON US OR MAMMOGRAM 2-CAN BE USEFUL IN YOUNG WOMEN 3-CAN LOCATE BREAST CANCER WITH AXILLARY L.N. METS BUT BREAST FREE ON US OR MAMMOGRAM 4-CAN DETECT MULTICENTRIC LESION 5-CAN DIFFERENTIATE BETWEEN RECURRENCE AND FIBROUS TISSUE 6-CAN DETECT SILICON LEAK DISADVANTAGES 1-CANNOT DETECT CALCIFICATIONS UBOS:UNIDETIFIED BRIGHT OBJECTS DISLODGE CERTAIN METALS;PACEMAKER EXPENSIVE

POSITRON EMISSION MAMMOGRAM SHOWS [MULTIFOCAL LESION]

RETRACTED BREAST

SWOLLEN BREAST WITH NIPPLE RETRACTION

CANCER EN-CUIRASSE درع المحارب MULTIPLE LOCAL RECURRENCE

LYMPHOEDEMA CAN BE COMPLICATED BY LYMPHANGIOSARCOMA COMBINATION OF SURGERY &RADIOTHERAPY ON THE AXILLA CAN CAUSE THIS

Axillary venous thrombosis in ca. breast

DIFF.DIAGNOSIS OF MASTITIS & MASTITIS CARCINOMATOSA MASTITIS CARCINOMATOSA [INFLAMMATORY CARCINOMA] IS THE MOST MALIGNANT OF ALL BR. CA. MASTECTOMY IS RARELY INDICATED BECAUSE IT IS LATE NO CONSTITUTIONAL SYMPTOMS NO FEVER NO LEUCOCYTOSIS SKIN OEDEMA > 1/3 OF THE BREAST IN BOTH ;THE BREAST IS WARM,TENDER BOTH OCCUR IN CHILD BEARING PERIOD DIFFICULT TO DISTINGUISH SOMETIMES EXCEPT BY CORECUT BIOPSY. US & MAMMOGRAM ARE USELESS BECAUSE THERE IS NO MASS

DIFF.DIAGNOSIS OF PAGET`S DISEASE &ECZEMA OF THE NIPPLE PAGET`S DISEASE THERE IS AN UNDERLYING BREAST CANCER UNILATERAL NIPPLE DESTRUCTION BOUNDRIES OF THE LESION IS WELL DEMARKATED DOES NOT RESPOND TO STEROID LOCAL THERAPY

PAGET`S DISEASE OF THE BREAST

PAGET`S DISEASE OF THE BREAST

LOBULAR CARCINOMA ARISE FROM THE TERMINAL DUCTS COULD BE MULTIFOCAL & BILATERAL IN 20% OF CASES IN UNILATERAL CASES ALWAYS WATCH THE OTHER BREAST LCIS DOES NOT NEED FURTHER ACTION EXCEPT CAREFUL F.U

Carcinoma in pregnancy THEY ARE DIAGNOSED LATE THEY BEHAVE THE SAME AS NON-PREGN. THEY ARE TREATED THE SAME NO BREAST CONSERVING SURGERY NO RADIOTHERAPY;TERATOGENIC NO CHEMOTHERAPY IN THE FIRST TRIMESTER NO HORMONAL THERAPY;BECAUSE THEY ARE HORMONE RECEPT.-VE

STAGES OF CA. BREAST MASS<2CM . NO L.N. MASS2-5CM.MOB.L.N MASS5-10CM.FIX.L.N OR MASS FIXED TO CHEST WALL SUPRACLAV.L.N.OR DISTANT METS CIS STAGE 0 CARCINOMA IN SITU CONFINED TO BASEMENT MEMBRANE. NON INVASIVE. CLINICALLY; IMPALPABLE I I II III IV

INVESTIGATIONS FOR DISTANT METASTASIS BLOOD S.ALK.PHOSPHATASE GGT[Gamma Glutamin Transferase] RADIOLOGY CXR US;Liver NUCLEAR ISOTOPE BONE SCAN

WHAT DOES STAGING MEAN STAGE I & II :EARLY BREAST CANCER [POTENTIALLY CURABLE DISEASE] STAGE III & IV : ADVANCED CANCER [INCURABLE DISEASE]

WHAT IS THE MOST SIGNIFICANT PROGNOSTIC FACTOR ? AXILLARY LYMPH NODES INVOLVEMENT & NUMBER;IS THE MOST NO L.N; 85% 5-YEAR SURVIVAL 3 L.N. ; 50% >3L.N. : 25-40% OTHER FACTORS GRADE,-VE HORMONE RECEPTORS,SIZE, VASCULAR&LYMPH.INVASION,HER2;EPIDERMAL GROWTH FACTOR RECEPTOR

MANAGEMENT OF EARLY BREAST CANCER BREAST CONSERVING SURGERY: WIDE LOCAL EXCISION + AXILLARY CLEARANCE+ LOCAL BREAST RADIOTHERAPY PROVIDED MASS BREAST RELATION IS ACCEPTABLE

INDICATIONS OF MODIFIED RADICAL MASTECTOMY 1. BIG SIZE TUMOUR IN REALATION TO THE BREAST 2.CENTRAL TUMOUR;UNDER THE NIPPLE 3.MULTIFOCAL TUMOUR 4. RECURRENCE AFTER LUMPECTOMY 5 IN PREGNANCY 6. PATIENT`S PREFERENCE

WHAT IS MODIFIED RADICAL MASTECTOMY ? : simple mastectomy + axillary clearance Ax.VEIN Apical Lateral INTERPECTORAL POSTERIOR CENTRAL LONG THORACIC N. SHOULD BE PRESERVED INTERCOSTO-BRACHIAL N. CAN BE SACRIFIED

Modified radical mastectomy Axillary clearance of l. nodes Breast conserving surgery

WHAT IS THE DIFFERENCE BETWEEN THE 2 NO DIFFERENCE IN 5-YEAR SURVIVAL THERE IS A DIFFERENCE IN LOCAL RECURRENCE RECURRENCE AFTER LUMPECTOMY IS MORE .TREATED BY MASTECTOMY AND THEY DO BETTER

THE OTHER MODALITIES CHEMOTHERAPY;== CMF == 1-ADJUVANT & 2-NEOADJUVANT HORMONAL THERAPY; TAMOXIFEN: OESTROGEN BLOCKER LHRH : OVARIAN ABLATION IN the young ANASTROZOLE: AROMATASE INHIBITOR INHIBIT CONVERSION OF ANROGENS TO OESTROGEN In the postmenopausal women IMMUNE THERAPY; HERCEPTIN [monoclonal antibody ;Anti HER2,Human Epidermal Growth Factor Receptor ] RADIOTHERAPY; LOCAL ACTION

Port-a-cath for systemic chemotherapy Chemotherapy kills all dividing cells [malignant or not malignant].so bone marrow GIT and skin are affected.

HOW TO EXAMINE YOUR OWN BREASTS TEACH PATIENT LOOK AT THE MIRROR NOTE ANY ABNORMALITY IN YOUR BREASTS OR AXILLAE AT EVERY SHOWER

USE PALMER ASPECTS OF USE PALMER ASPECTS OF YOUR FINGERS

gynecomastia

MALE BREAST CANCER