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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
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
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
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”
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%