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BREAST CANCER
Anatomy of the Breast
The Breast – Mammary gland
a) Glandular tissue
b) Duct system
c) Fat
Anatomy of the Breast
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The nipple – smooth muscle fibers
The areola – contains sebaceous glands
Lactiferous ducts
Lactiferous sinus
Cooper’s ligaments
Anatomy of the Breast
Arterial supply
Artery thoracic internal , axillary artery,
intercostal arteries
Venous drainage
Axillary vein
Lymphatic drainage
Axillary nodes
Fibrocystic Disease
a)
b)
c)
d)
Fibrosis
Cystic disease
Sclerosing adenosis
Epithelial hyperplasia
Fibrocystic Disease
Fibrocystic disease
Often bilateral
Multiple nodules
Menstrual variation
Cystic pain
May regress
Cancer
Unilateral
Single
No variation
No pain
Does not regress
Breast Tumors
1.
2.
3.
4.
Fibroademona
Cystosarcoma phyllodes
Intraductal papilloma
Carcinoma of the breast
Breast Cancer Statistics
Lung – 25%
Breast – 11%
Colon and Rectum-11%
Breast Cancer Statistics
In the USA:
211,000 new cases of invasive breast cancer
will be diagnosed this year
43,300 patients will die
Risk Factors of Breast Cancer
1) Fibrocystic disease
2) Menarche disorders
3) Diets high in saturated fat
4) Family history of breast cancer
5) Late or no pregnancies
6) Moderate alcohol intake
7) Estrogen replacement therapy
Pathogenesis of Breast Cancer
a)
b)
c)
d)
Genetic (BRCA 1 on 17q and BRCA 2 on
13q)
Viral
Environmental
Hormonal role (“unopposed estrogen”)
Breast Cancer Classification
a)
b)
c)
d)
e)
f)
g)
Noninfiltrating intraductal carcinoma
Infiltrating ductal carcinoma
Medullary carcinoma
Colloid (mucinous) carcinoma
Lobular carcinoma
Paget’s disease of the breast
Inflammatory carcinoma
Non-infiltrative intraductal
carcinoma
“Comedocarcinoma”
Microscopically:
Typical duct epithelial cells proliferate
Ductal dilatation
Infiltrative ductal carcinoma
Rock-hard palpable tumors 2-5 cm in diameter
Nipple retraction
Necrosis and calcification
Microscopically:
Anaplastic duct epithelial cells
Fibrous reaction
Medullary carcinoma
Fleshy masses 5-10 cm in diameter
Little fibrous tissue
Microscopically
Large pleomorphic cells
Lymphocytic infiltrate
Colloid (mucinous) carcinoma
Soft, large, gelatinous tumor
Microscopically
Tumor cells and mucin
Lobular carcinoma
Arises from terminal ductules
Multicentric tumors
Rubbery and ill-defined tumors
Microscopically
Small cells arranged in rings
Small cells are confined to lobules
Paget’s disease
The skin of the nipple and areola are ulcerated
Inflammation
Bacterial infection
Microscopically
Ductal carcinoma
“Paget’s cells”
Inflammatory Breast Cancer
Breast Cancer
TNM-classisfication


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TIS = Paget's Disease without a tumor, Carcinoma insitu
T1 = Tumor less than 2 cm. in greatest dimension
T2 = Tumor larger than 2 cm. in size but less than 5cm.
T3 = Tumor larger than 5 cm. in size
T4 = Tumor of any size extending to the chest wall or
skin
N1 = Metastasis to moveable axillary nodes
N2 = Metastasis to fixed or matted axillary nodes
N3 = Metastasis to supraclavicular, infraclavicular or
internal mammary nodes
M0 = no distant metastasis
M1 = distant metastasis
Stages of Breast Cancer

Stage I
Stage II

Stage IIIA

Stage IIIB
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Stage IV

T1 N0 M0
T0 N1 M0
T1 N1 M0
T2 N0 N1 M0
T0 N2 M0
T1 N2 M0
T2 N2 M0
T3 N0, N1, N2 M0
Any T N3 M0
T4 Any N M0
Any T Any N M1
Breast Cancer Classification
Stage I
Stage II
Stage IIIa
Stage IIIb
Stage IV
5-year survival rate
80-95%
65-85%
56%
49%
10-19%
Breast Cancer
Treatment
Segmental mastectomy
Simple mastectomy
Modified radical mastectomy
Radical mastectomy