Hasan Radi Al-Shabaan214010094

Group: 3Serial number: 31

Tutor: Dr. Ahmed Ramadan

King Faisal UniversityCollege of MedicineBlock 1.1

Learning Objectives Definition and epidemiology of breast cancer.

Anatomy of the breast.

Signs and symptoms of breast cancer.

Types of breast cancer.

Stages of breast cancer.

Grades of breast cancer.

Methods of spread.

Causes of breast cancer.

Methods of examination.

Methods of screening.

Prevention & treatment.

Anatomy of the breast

conical in shape

It extends from the sternum

margin to the midaxillary line

at the level of 4th rib.

Vertically, it extends from

the 2nd rib to the 6th rib

along the midclavicular line.

Shape and position:

Anatomy of the breast Parts of the breasts:

1- The nipple and areola

• The nipple is a conical

or cylindrical prominent.

• It lies below the center

of the breast and opposite

of the 4th intercostal space.

The areola:

Areola is a circular patch of pigmented skin surrounding the nipple.

The areola contains many sebaceous glands.

During pregnancy, the areola undergo some changes.

2-The breast.

It consists of the parenchyma,

stroma and the overlying skin.

The Parenchyma:

The parenchyma is the mammary

glands and the lactiferous ducts.

The mammary glands:

It is a modified sweat gland.

It consists of 15-20 lobes.

lobe lobules ductule Lactiferous ducts

The lactiferous ducts:

converge toward the nipple.

Each duct dilates under the

areola to form lactiferous sinus.

Lactiferous sinus narrows

again and open separately

on the summit of the nipple.

2- The stroma:

It is the superficial fascia

of the pectoral region.

It consists of fat and fibrous strands.

The fat surrounding the parenchyma

- smooth rounded contour of the breast.

Fibrous strands known as

cooper’s ligaments - suspend

the breast on the chest wall.

The coopers ligaments extends from the skin to the deep membranous layer of the superficial fascia.

These ligaments maintain the protuberance of the breast.

In cancer breast

It becomes like an orange

“peau d'orange”

Anatomy of the breast

Lymph nodes

1- The anterior (pectoral) group

2- the posterior (subscapular) group

3 – The apical group

4- central basal group

5- lateral (brachial) group

Lymphatic drainage of the breast:

1- A superficial plexus ( subareolar lymphatic plexus )

* Under the areola

2- A deep lymphatic plexus on deep fascia of the pectoralismajor underlying the breast.

• Located within the retromammary space.

These two plexuses communicate freely.

1-subareolar lymphatic plexus

2-deep lymphatic plexus

1- The central and the lateral part of the gland drain into the anterior group.

2- The tail of the breast drain into the posterior group.

3- the upper part of the gland drain into the apical group of the axillary lymph nodes and the lower deep cervical lymph nodes.

4- The medial part of the

gland drains into

the parasternal lymph nodes

Lymphatic drainage of the breast:

Signs and symptoms

A lump in the breast

Swelling in or around the

breast, collarbone, or armpit

Skin thickening or redness

Nipple changes

Nipple discharge

Pain

Signs and symptoms

Types of breast cancer A- Non-invasive:

1- Ductal Carcinoma In Situ, where abnormal cells have been contained in the lining of the breast milk duct.

2- Lobular Carcinoma In Situ, abnormal cells form in the lobules or milk glands in the breast

Types of breast cancer B- Invasive:

1- Invasive Ductal Carcinoma, abnormal cells that originated in the lining of the milk ducts have invaded surrounding tissue.

Types of breast cancer 2- Invasive Lobular Carcinoma, the cancer began in the

lobules and has spread into the surrounding breast tissue.

Types of breast cancer 3-Medullary carcinoma, a rare subtype of invasive ductal

carcinoma.

Medullary tumors are often “triple-negative”, which means that they test negative for estrogen and progesterone receptors, as well as for the HER2/neu protein.

Types of breast cancer 4- Colloid (mucinous) Carcinoma, the tumor cells produce

abundant amounts of extracellular mucin

Types of breast cancer 5- Tubular Carcinoma, usually small (about 1 cm or less)

and made up of tube-shaped structures called "tubules”

It is usually found through a mammogram

Stages of breast cancer

Stage I

Stage IIA

Stage IIB

Stage IIIA

Stage IIIB

Stage IIIC

Stage IV

grades of breast cancerGrade 1 (low-grade) – The cancer cells look similar to normal cells and grow very slowly.

Grade 2 (moderate- or intermediate-grade)– The cancer cells look more abnormal and are slightly faster growing.

Grade 3 (high-grade) – The cancer cells look very different from normal cells and tend to grow quickly.

Methods of spread There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

Tissue. The cancer spreads from where it began by growing into nearby areas.

Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.

Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Causes of breast cancer Three sets of influences: genetic changes, hormonal

influences and environmental variables.

1- Genetic Changes:

Overexpression of the HER2/NEU proto-oncogene

BRCA1 and BRCA2 are tumor suppressor genes. When one of these genes are mutated, it no longer suppresses abnormal growth, and cancer is more likely to develop.

Causes of breast cancer 2- Hormonal Influences:

Endogenous estrogen excess (long duration of reproductive life, late age at birth of the first child)

Hormone replacement therapy

3-Environmental variables:

Radiation.

Diagnosis of breast cancer 1- Asking about history

Family history

Personal history

Having a previous cancer in breast, uterine, ovarian, or colon increase the chance of having breast cancer.

Clinical breast exam:

- Breasts, armpits, and the neck and chest area should be examined.

- These sites should be examined twice, when the patient is sitting up and when she is lying down.

- The physician should examine the axillary lymph nodes

2- Physical Examination

* The clinical breast exam is done annually by the family physician or gynecologist

Breast self-examination

breast self-exam is done

once at month at home

3- Investigation:

Mammography, to screen

for breast cancer or help

identify the breast lump.

Breast MRI, to help better

identify the breast lump

Methods of screening Mammogram: every two years for women 50-74 years.

Clinical Breast Exam: every year for women 40 years or older.

Breast self-exam: every month for women starting in their 20s

Breast ultrasound, to show whether

the lump is solid or fluid-filled

Breast biopsy, to determine whether

or not a lump is cancer and,

if it is cancer, what type it is.

Prevention Physical exercise.

Limit hormone therapy.

Breast cancer screening .

Breastfeeding.

Alcohol consumption .

Treatment 1- Surgery:

breast-conserving surgery:

Surgery to remove just the cancerous lump (tumor).

it includes:

Lumpectomy:

Partial mastectomy (segmental mastectomy)

Mastectomy:

Surgery to remove the whole breast.

All of the breast tissue is removed,

sometimes along with other nearby tissues.

It includes:

Total (Simple) mastectomy

Modified radical mastectomy

Radical mastectomy

Lymph node surgery:

To find out if the breast cancer has spread to axillary lymph nodes, one or more of these lymph nodes may be removed and looked at under the microscope.

Ways to check these lymph nodes:

Axillary lymph node dissection

Sentinel lymph node biopsy

2. Chemotherapy:

Chemotherapy is usually used after surgery,It uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

Types of chemotherapy:

Systemic chemotherapy

Regional chemotherapy

3. Radiotherapy:

Radiotherapy is generally given after surgery and chemotherapy, it uses high-energy x-rays or other types of radiation, to kill remaining cancer cells or keep them from growing.

Types of radiotherapy:

External radiation

Internal radiation

4. Hormone therapy:

It is usually given before surgery and chemotherapy, but sometimes it is given before surgery to shrik a tumor, making it easier to remove.

Some hormones (estrogen or progesterone)

can cause certain cancers to grow, hormone therapy lowers the levels of hormones or blocks their action and stops cancer cells from growing.

5. Targeted Therapy (Biological Therapy):

A certain protein called human epidermal growth factor receptor 2 (HER2) makes cancer cells grow and spread faster. Biological therapy works by stopping the effects of HER2 and by helping the immune system fight off cancer cells.

References Robbins Basic Pathology, 9th edition

http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page2

http://www.cdc.gov/cancer/breast/basic_info/screening.htm

http://www.nationalbreastcancer.org/types-of-breast-cancer