2. Carcinoma of the female breast.(Spread and grading) Flashcards

1
Q

Spread of breast cancer

A

l- Direct (Local) spread

ll- Lymphatic Spread

III- Blood spread

lV - Transcoelomic spread

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2
Q

Direct (Local) spread of breast carcinoma

A
  • 1st within the breast tissue itself,
  • then to the skin, pectoral muscle and fascia,
  • then to serratus anterior muscle and chest wall.
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3
Q

Lymphatic Spread of breast carcinoma

A

Pathogenesis

Bailey & love note on Lymphatic Spread

Routes

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4
Q

Pathogenesis of Lymphatic Spread of breast carcinoma

A

By both embolization & Permeation

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5
Q

Bailey & love note on Lymphatic Spread of breast carcinoma

A

The site of the tumour within the breast does not dictate which nodes will be involved:

Axillary L.N: 75-80%

Internal mammary L.N: 20-25%

Posterior intercostal L.N, subscapular L.N, Intercostal L.N: 3%

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6
Q

Routes of Lymphatic Spread of breast carcinoma

A

according to the site of the tumour within the breast:

Lateral quadrants

Upper quadrants

medial quadrants

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7
Q

Lateral quadrants Routes of Lymphatic Spread of breast carcinoma

A

drains into pectoral L.N then to central L.N then to apical L.N

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8
Q

Upper quadrants Routes of Lymphatic Spread of breast carcinoma

A

Pierce pectoralis major muscle & clavipectoral fascia directly to the apical L.N

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9
Q

medial quadrants Routes of Lymphatic Spread of breast carcinoma

A

drain into internal mammary L.N of both sides then to mediastinal L.N

or Reach the lymphatics of rectus sheath and then:

1) to the porta hepatis and liver through lymphatics in the falciform ligament
2) To umbilicus (sister Joseph nodules of mayo-clinic)

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10
Q

Blood spread of breast carcinoma

A
  1. Common sites
  2. Bone secondaries
  3. The order of frequency of bony metastases
  4. Blood micro-metastases
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11
Q

Common sites of Blood spread of breast carcinoma

A
  1. Bone
  2. Lung
  3. Liver
  4. Brain
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12
Q

Bone secondaries in Blood spread of breast carcinoma

A

Bone secondaries are very common and are osteolytic, very rarely osteosclerotic

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13
Q

The order of frequency of bony metastases in Blood spread of breast carcinoma

A

1- Lumber vertebrae

2- femur

3- thoracic vertebrae

4- Ribs

5- Skull

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14
Q

Blood micro-metastases in Blood spread of breast carcinoma

A

The carcinoma of the breast considered a systemic disease from the start as it spreads by blood micro-metastases very early

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15
Q

explain the frequent Bone dissemination in the absence of lung metastases

A

It has been suggested that tumour cells may spread via the paravertebral venous plexus, which has direct connections with the breast through the posterior intercostal veins

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16
Q

why is the carcinoma of the breast considered a systemic disease from the start

A

as it spreads by blood micro-metastases very early

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17
Q

Trans-coelomic spread of breast carcinoma

A
  1. Pathogenesis

2. Common sites

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18
Q

Pathogenesis of Trans-coelomic spread of breast carcinoma

A

It’s now proved to be due to retrograde lymphatic permeation

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19
Q

Common sites of Trans-coelomic spread of breast carcinoma

A

a) Ovaries: krukenburg’s tumour.

b) Nodules in Douglas pouch : Blumer’s shelf nodules.

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20
Q

what is the krukenburg’s tumour

A

any secondaries affecting the ovaries

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21
Q

Blumer’s shelf nodules

A

Nodules in Douglas pouch (Transcoelomic spread of cancer breast)

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22
Q

Staging of cancer breast by

A

TNM classification

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23
Q

TNM classification in staging of cancer breast

A
  1. Primary tumour (T)
  2. Regional lymph nodes (N)
  3. Metastasis (M)
24
Q

Primary tumour (T) in TNM classification in staging of cancer breast

A

Tx

T0

Tis

T1

T2

T3

T4a

T4b

T4c

25
Meaning of Tx in Primary tumour (T) in TNM classification in staging of cancer breast
can't be assessed
26
Meaning of T0 in Primary tumour (T) in TNM classification in staging of cancer breast
No evidence of primary tumour.
27
Meaning of Tis in Primary tumour (T) in TNM classification in staging of cancer breast
Carcinoma in situ ( DCIS, LCIS or Paget's disease with no mass )
28
Meaning of T1 in Primary tumour (T) in TNM classification in staging of cancer breast
Tumour less than 2 cm greatest diameter.
29
Meaning of T2 in Primary tumour (T) in TNM classification in staging of cancer breast
Tumour 2-5 cm.
30
Meaning of T3 in Primary tumour (T) in TNM classification in staging of cancer breast
Tumour > 5 cm or fixation to pectoral muscle.
31
Meaning of T4a in Primary tumour (T) in TNM classification in staging of cancer breast
Tumour of any size with direct extension to chest wall
32
Meaning of T4b in Primary tumour (T) in TNM classification in staging of cancer breast
Tumour of any size with skin fixation
33
Meaning of T4c in Primary tumour (T) in TNM classification in staging of cancer breast
Inflammatory carcinoma
34
chest wall includes all of the following except: * ribs * intercostal muscle * serratous anterior muscle * pectoral muscle and fascia
pectoral muscle and fascia
35
Regional lymph nodes (N) in TNM classification in staging of cancer breast
N0 N1 N2 N3
36
Meaning of N0 in Regional lymph nodes (N) in TNM classification in staging of cancer breast
No L.N metastasis.
37
Meaning of N1 in Regional lymph nodes (N) in TNM classification in staging of cancer breast
Mobile ipsilateral axillary L.N
38
Meaning of N2 in Regional lymph nodes (N) in TNM classification in staging of cancer breast
Fixed ipsilateral axillary L.N
39
Meaning of N3 in Regional lymph nodes (N) in TNM classification in staging of cancer breast
Ipsilateral supraclavicular L.N other textbooks consider: N3:palpable ipsilateral internal mammary L.N M1: palpable ipsilateral supraclavicular L.N
40
Metastasis (M) in TNM classification in staging of cancer breast
M0 M1
41
Meaning of M0 in Metastasis (M) in TNM classification in staging of cancer breast
No distant metastasis
42
Meaning of M1 in Metastasis (M) in TNM classification in staging of cancer breast
Distant metastasis including contralateral Axillary L.N and breast (or palpable ipsilateral supraclavicular L.N)
43
Interpretation of TNM classification in staging of cancer breast
Clinical Significance of stages Interpretation of stages
44
Clinical Significance of stages in Interpretation of TNM classification in staging of cancer breast
Clinical Significance of stage one and two Clinical Significance of stage three Clinical Significance of stage four
45
Clinical Significance of stage one and two in Interpretation of TNM classification in staging of cancer breast
Curable breast cancer
46
Clinical Significance of stage three in Interpretation of TNM classification in staging of cancer breast
Locally advanced breast cancer
47
Clinical Significance of stage four in Interpretation of TNM classification in staging of cancer breast
metastatic breast cancer
48
Interpretation of stages of TNM classification in staging of cancer breast
Stage 0 Stage I Stage IIA Stage IIB Stage IIIA Stage IIIB Stage IIIC Stage IV
49
Interpretation of Stage 0 of TNM classification in staging of cancer breast
Tis N0 M0
50
Interpretation of Stage I of TNM classification in staging of cancer breast
T1 N0 M0
51
Interpretation of Stage IIA of TNM classification in staging of cancer breast
T2 N0 M0 T1 N1 M0 T0 N1 M0
52
Interpretation of Stage IIB of TNM classification in staging of cancer breast
T3 N0 M0 T2 N1 M0
53
Interpretation of Stage IIIA of TNM classification in staging of cancer breast
T0-3 N2 M0 T3 N1-2 M0
54
Interpretation of Stage IIIB of TNM classification in staging of cancer breast
T4 N0-2 M0
55
Interpretation of Stage IIIC of TNM classification in staging of cancer breast
any T N3 M0
56
Interpretation of Stage IV of TNM classification in staging of cancer breast
any T any N M1