1 of 29

MALIGNANT BREAST DISEASES

​

​

​

  • Primary
  • Secondary

2 of 29

CLASSIFICATION

  • Epithelial origin
  • Carcinoma-ductal,lobular(in-situ/invasive)

-mucinous/colloid,papillary,tubular,medullary

  • Connective tissue origin/non-epithelial
  • Sarcoma-1%,angio..,fibro..,unclass
  • lymphoma-burkitt’s,Hodgkin’s,Non-Hodgkin’s

3 of 29

Clinical features

  • lumps/masses
  • abn. of the breast/nipple
  • nipple discharge
  • axillary lumps
  • features of metastasis to GIT,MSS,CNS,RS

4 of 29

Tripple assessment

  • Clinical assessment
  • Radiological assessment
  • Pathological assessment

5 of 29

Clinical assessment.. history

  • Biodata
    • Age
    • Sex
  • Presenting complain (include duration)
    • Mammographic /screen detected
    • Painless breast lump
    • Skin changes
    • Nipple areolar changes
    • Axillary/ Other swellings swellings
    • Metastasis

6 of 29

Clinical assessment.. history

  • Past medical history: previous breast diseases, previous breast cancer, previous breast radiation, comorbidities

​

  • Family and social history: family history of breast or ovarian cancer, alcohol consumption, smoking

​

  • Summary

7 of 29

Clinical assessment.. history

  • Metastasis: chest (cough, dyspnoea, chest pain), bone (bone pains, bone swellings, fracture, weakness of lower limb), abdomen (jaundice, ascites, pelvic mass), brain (headaches, convulsion)

​

  • Risk factors: gynaecologic/obstetric history

8 of 29

Signs and Symptoms

8

Most common: lump in the breast. Often painless

Change in color or appearance of areola

Redness or pitting of skin over the breast, like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

9 of 29

Clinical assessment.. examination

  • General examination: wasting, palor, anaemia
  • Examine normal breast first
  • Positioning
  • Inspection
    • Symmetry
    • Size
    • Shape
    • Skin of the breast: puckering, nodules, peau d’ orange, ulcer
    • Nipple areola
    • Axilla

​

​

10 of 29

11 of 29

12 of 29

Locoregional Spread

12

13 of 29

13

14 of 29

14

15 of 29

Metastasis

  • Lungs+++
  • Brain+
  • Liver++
  • Bones++
  • Skin+
  • Adrenal+
  • Ovaries+
  • Intra.abd.lymph nodes+
  • Peritoneum,etc

​

15

16 of 29

Radiological assessment

  • Ultrasonography

​

  • Mammography

​

  • MRI

16

17 of 29

Pathological assessment

Non palpable mass

  • USS localisation

​

  • Wire localisation

​

  • Stereotactic

​

Palpable mass

  • FNAB

​

  • Trucut

​

  • Incisional

​

  • Excisional

​

17

18 of 29

Pathological assessment

  • Histological type
  • Histological grade
  • Estrogen receptor status
  • Progesterone receptor status
  • Her 2/neu status
  • Lymphovascular invasion
  • In situ component
  • Size of specimen
  • Size of tumour
  • Presence or absence of tumour at the excision margins

18

19 of 29

Staging investigation

  • Screening Mammography/ Breast Ultrasound
  • Chest radiograph
  • Abdpelvic Uss
  • Skeletal survey
  • Skeletal scintigraphy
  • Liver function test
  • Brain CT Scan
  • PET/CT Scan

​

19

20 of 29

Others..

  • Full blood count
  • Stool microscopy
  • Electrocardiography
  • Echocardiography
  • Pregnancy test,group and cross match

20

21 of 29

22 of 29

Differential diagnosis

  • Tuberculosis of the breast
  • Chronic breast abscess
  • Breast lymphoma
  • Phylloides tumor
  • Traumatic fat necrosis
  • Chronic fungal infection
  • Duct ectasia
  • BMD

22

23 of 29

Treatments

Usually through a combined approuch

  • Surgery
  • Chemotherapy,NEO-ADJ/ADJ
  • Hormonetherapy
  • Radiotherapy
  • Immunotherapy/Targeted Therapy

​

24 of 29

24

25 of 29

26 of 29

27 of 29

LOCALLY ADVANCED

28 of 29

29 of 29

BREAST CANCER

  • Aetiology
  • Risk factors
  • Clinical features
  • Staging---Manchester, TNM
  • Investigations-diagnosis
  • Treatment-aim,modalities.