breast cancer Flashcards
what’re the most common symptoms of the breast cancer ?
its asymptomatic.
pain or discomfort isn’t usually a symptoms of the breast cancer
how to general approach to pt with breast cancer ?
by the triple assessment
- clinical presentation (history)
- clinical examination
- imaging
whats the triple assessment ?
@history
- pt with breast cancer is usually with breast cancer is asymptomatic .largrer cancer may don’t have any pain > because the pain and discomfort is not the symptoms of the breast cancer .only 5%-10% of pt with cancer have pain
- but mainly we search for the the family history of the breast cancer in the 1st degree relative
examine the pt first in siting position and the arm is relax and then exam them in laying position when their arms are raised :
- check any change in the size and shape
- any skin changes as tethering or laceration or lesion
- any nipple inversion , change in the skin changes
- any nipple discharge
- any axillary LN changes
after that to complete the examination we should examine the chest , abdomen and the neurology
chest —
a) breathing abnormality
b) bone pain
c) hypercalciemia
abdomen —
a) abdominal pain
b) jaundice
neurology —-
a) headache
b) neurological sign
c) altered cognitive function
the concerning findings are : 1- lump or change in the shape , the size and the counter 2-skin tethering 3- laceration 4-dilated vein 5-nipple inversion 6- mammy Paget disease 7-edema or peau d'Orange
usually mammography, ultrasound and needle biopsy
what’re the clinical presentation of the breast cancer ?
1- painless lump
2- painful lump
3-skin ulceration and fungation
4-nipple discharge
5- axillary lymph nod enlargement
6- secondaries to the liver overies
7- chest pain and heamoptsis
8- bone pain and pathological fracture
9- plural effusion , ascites
what’re the cutaneous manifestation of the breast cancer
1- skin ulceration and fungation 2-ulceration and nipple discharge 3- nipple retraction -------------------------- 4-tethering of the skin 5- dimpling of the skin 6- peau d' orange --------------------------- 7- cancer en cuirasse
what’re the concerning findings in the physical examination ?
the concerning findings are : 1- lump or change in the shape , the size and the counter 2-skin tethering 3- laceration 4-dilated vein 5-nipple inversion 6- mammy Paget disease 7-edema or peau d'Orange
whats the cause of the peau d’ orange ?
the dermal lymphatic is obstructed and so the sebaceous gland and the hair follicle is buried تدفن giving raise as orange
whats the cause of the skin dimpling ?
cancer vinlterate into the cooper ligament
whats the cause of the nipple retraction as circumferential ?
infiltration to the lacterferious duct
whats the cancer en cuirasse ?
its that the breast cancer metastasis to the skin and appear nodular as armor coat
what dose the local spread of the tumer means ?
its spread to the skin ,pectorals muscle and the chest
what dose the lymphatic spread means ?
spread to the internal mammary gland & axilla
in advance stage its spread to the supraclavicaular LN or contalateral side
for where the tumer goes ?
it metastasis to the lumber vertebrae ribs and skull
and liver lung and ovary arenal gland
whats non invasive breast carcinoma?
ductal carcinoma in situ
lobular carcinoma in situ
paget’s disease
the non invasive only 10%
how the ductal carcinoma is seen in mammogram ? and whats the chance of recurrence ?
its seen in the mammogram as microcalcification
after 5 years reccurance (25-50%)
whats the TRT of ductal carcinoma in situ ?
1- wide local excision with radiation decrease the recurrence to 2%
2- mastectomy if rise or local and regional recurrence
how to detect the lobular carcinoma in situ ? how much the risk to be invasive ?
lobular can’t detect in the mammogram but found incidentally
after 20 year of in situ there is 15%-20% to become invasive and it becomes BILATERALLY
whats the TRT of pt with lobular carcinoma in situ ?
- flow up
- bilateral mastectomy if there is family history or pervious breast cancer
list the invasive breast cancer by percentage ?
1- infiltrating ductal carcinoma 75% of all breast cancer
2- infiltrating lobular carcinoma
3 - medullary %5 younger
4- mucinous less than 5%
5- tubular 1-2 %
6- papillary 1-2% elderly more than 60 yrs
7-metablastic 1% in the 6ht decade
8- mammary paget disease 1-4% 6th decade
favorable breast carcinoma ?
Temon & Pompa
1- tubular
2- medullary —– ocurrance only 2-3%
3- papillary
-survival is 73% and 59%
less favorable breast carcinoma ?
invasive ductal carcinoma 78%
survival is 38% -54%
least favorable breast carcinoma?
inflmmatory carcinoma is only 1.5 -3%
breast staging ?
N—- for lymph node involvement (1-3)
TNM #T --- for tumer size from (1-4)
Tx --- tumer size can't assess
T0 --- tumer isn't significance
Tis ---- ductal carcinoma in situ
lobular carcinoma in situ
paget disease
T1—— tumer size equal and less than 2 cm
T2 ——— tumer size is greater than 2cm
T3———-tumer size more than 5cm
T4 —- tumer at any size
if tumer extend to the chest or skin
or it was inflammatory breast cancer
Nx —- not assessed
N0— no
N1—- ipsi axillary LN
N2——ipsi axillary LN fixed or matted
ipsi internal mammary LN without axalliary
N3 - ipsi supra or infraclavicular
ipsi internal mammary LN with axillary
Mx – can’t assess
M0 —- no
M1— no metastasis
where the breast metastasis ?
1- under the breast is muscle and bone
bone 70%
soft tissue 5-15%
2- deep to the Brest to lung and Pleura
is 20%-30%
3- most important organ is liver and the brain
liver 10-12%
brain 2-5%
4- adrenal gland 2-5%
what’re the investigations of the breast cancer ?
1-mammogram 2- breast u/s 3-FNAC 4-sensual LN biopsy recessional biopsy
4-CT for chest 6- CT for the abdomen and the brain 7- chest X ray 8- x-ray spine 9- MRI
10- estrogen and progesterone and her2 receptos
11- tumer marker
12-ductography
