Carcinoma Breast
When cancer occurs in the breast of women under forty,it is more rapid in its progress than when the patient is elder and also more extensive. - John Hunter
👉 Aetiology of Carcinoma Breast
- Carcinoma Breast is more common in developed countries.
- In African-american,it is more aggressive.
- Carcinoma in one breast increase the risk of developing carcinoma on second/opposite breast by 3-4 times. Incidence of bilateral carcinoma is 2-3%.
- More commonly seen in middle age ( can occur at any age )
- It can be familial in 2-5% cases.
- "Gene mutation” - mutation of tumour suppressor genes BRCA1/BRCA2 is thought of involved with high risk of breast carcinoma.BRCA1 mutation is having more risk than BRCA2 mutation.
- High alcohol intake have also high risk of carcinoma Breast.
- Attaining early menarche and late menopause have high-risk of breast carcinoma.
- Early child bearing and breastfeeding reduce s chances of malignancy.
- In male occasionally gynaecomastia turns into carcinoma. But this theory is not proved yet.
- Oral contraceptives (not proved) and hormone replacement therapy for more than 5 year also risk factors for carcinoma Breast.
👉 Pathology of Breast Carcinoma
- Breast Carcinoma arising from lactiferous ducts is called as ductal carcinoma.
- Breast Carcinoma arising from lobules is called as lobular Carcinoma.
- In situ carcinoma : it is preinvasive carcinoma which is not breached the epithelial basement membrane.
- Invasive carcinoma can occur eventually.
👉 Classification of Breast Carcinoma
(1) Ductal carcinoma
Lobular Carcinoma
(2) A. In situ carcinoma
- Ductal in situ carcinoma
- Lobular in situ carcinoma
B.Invasive
- Invasivs ductal carcinoma
- Invasive lobuler carcinoma
C. Unilateral
Bilateral.
D. Unifocal
Multifocal - tumour tissue within the same quadrant at multiple foci.
Multicentric - tumour tissue within same breast but in different quadrant.
👉Types of Carcinoma Breast
(1) Scirrhous carcinoma
It is 50-60% common.It is hard,whitish or whitish yellow,noncapsulated, irregular,with cartilaginous consistensy. It contains malignant cells with fibrous stroma.
(2) Medullary Carcinoma of Breast (5%)
It has brain like consistency. It contains malignant cells with dispersed lymphocytes.
It is uniformly high grade aggressive tumour cells.
(3) Inflammatory carcinoma/lactating carcinoma/mastitis carcinoma
- Most aggressive type
- 2% common
- Common in lactating amor pregnant women
- Some features is short duration,pain, warmth, tenderness.
- More than 1/3 skin involve
- *mammography may not show any finding except skin thickening.
(4) Colloid Carcinoma
It produced abundant mucin,both intra and extracellularly carrying better prognosis.
(5) Paget's disease of the nipple
(6) Tubular carcinoma, papillary carcinoma of breast,cribriform is other types
It is most common type of carcinoma Breast.if u want details and other type pls comment.
👉 Grading of Breast Cancer
It is based on nuclear pleomorphism,tubule formation, mitotic rate.
- Grade 1 : well differentiated
- Grade 2 : moderately differentiated
- Grade 3 : poorly differentiated
👉 Biological changes and clinical features of breast cancer/carcinoma Breast
- Most common site is upper quadrant
- Lump in breast, painless, tenderness and at least size of 1mm
- Nipple discharge
- Ulceration
- Fungation
- Axillary lymphnode enlargements
- Subclavicular lymphnode enlargements
- Chest pain
- Haemoptysis
- Bone pain
- Pleural infusion
- Ascites
- Pain in lump in some of case like 8-10%
- Peau d'orange due to obstruction of dermal lymphatic, opening of sebaceous gland and hair follicles get buried into oedema.
- Dimpling of skin
- Retraction of nipple
- Discharge from nipple and areola
- Tethering of skin
- If spread into deeper plane like pectoralis muscle is confirmed by restrictions of mobility of swelling while contracting pectoralis major muscle.
- Into lattismus dorsi muscle by extending the shoulder against resistance and try to move swelling
- Into serratus anterior by pushing hand against wall without flexible elbow
- Into chest wall by raising arm upward. When hand rise upward breat will not move upward due to fixed..
- Lymphatic drainage of the breast is predominantly through axillary and internal mammary lymphnodes, through lymphatic penetrations.
Breast Self Examination
Breast self examination plays major role in early detection and intervention of breast carcinoma.
Ideally done once a month after the menstruation,as during this time breast are less engorged.In post menopause age group it is done at monthly regular intervals.
Examine Both Breast
remind the patient that 90% of breast lumps are not cancer
Better way is in lying down position with arm raised with mattress support behind.
Palpate with fingers over all quadrant and if any abnormal swelling found,consult doctor.
American cancer society recommend monthly BSE after 20 years of age.
Nursing mother should perform BSE just after feeding the baby.
👉 Investigation of breast cancer/carcinoma of breast
Bilateral mammography is done to indentify multicentricity,to have guideline for assessing eventual chemotherapy or RT in LABC.
FINDING OF MAMMOGRAPHY ;
Size and location of mass
Microcalcification signify malignancy
Soft tissue shadow is irregular
Speculation
To find out whether the lesion is solid or cystic, margin of lesion,internal echeos,retro-tumour acoustic shadowing, compressibility, dimensions.
FNAC
Ii is useful in diagnosing of carcinoma of breast.
And biopsy also useful for investigation of breast carcinoma.
Some study like oestrogen receptor study and progesterone receptor study also useful
Senitinel lymphnode biopsy (SLNB)
The first axillary node draining the breast is designed as the sentinel lymphnode.
MRI of breast
To differentiate scar from recurrence
To imagine breast of women with implant
It is useful in screening females with high risk group and young women and in pregnancy.
Tumour markers
CA 15/3 are used mainly during follow up period. CEA ,CA,15-3,CA,27-29 may be useful.
PET scan
It may be effective single scan for bone,soft tissue or visceral metastases in patients with symptoms or signs of metastatic disease.
CT scan of chest, abdomen and brain whenever needed.
Chest X-ray
To look for pleural effusion,cannon ball secondaries in lungs, mediastinal lymph nodes, secondary in rib.
Note : Other investigation is also available. Here only described mostly used Investigation.
👉 TREATMENT
SURGERIES FOR CARCINOMA BREAST/BREAST CANCER
- Modified redical mastectomy (MRM)
- Total mastectomy
- Conservative breast surgery
- Skin sparing mastectomy
- Other procedure
- Toilet mastectomy
- Extended radial mastectomies
- Halsted redial mastectomy
HORMONE THERAPY ALSO USEFUL IN BREAST CANCER.
NOTE : Given information is just for knowledge. If any abnormalities seen pls consult with your doctor.
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