Download Ch 35 BREAST CANCER

Ch 35 BREAST CANCER
부산백병원 산부인과
R1 서 영 진
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1/3 of all cancers in women
2nd only to lung cancer as the leading cause of
cancer deaths in women
Incidence: increased significantly
one in every eight women in U.S.A
But, mortality rate actually declined
-increased success in earlier diagnosis & treatment
PREDISPOSING FACTOR
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25세 미만: less than 1%
30세 이후: a sharp increase
45세-50세: short plateau
이후: increases steadily with age
PREDISPOSING FACTOR
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Family hystory
-only 20%: family hystory
-mother & sister : breast cancer after menopause
-> risk is not increased
bilateral premenopausally
-> at least 40%~50%
unilateral premenopausally
-> 30%
-inherited oncogenes: BRCA 1 (chromosome 17q 21)
BRCA 2 (chromosome 13q 12-13)
PREDISPOSING FACTOR
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Diet, obesity, and alcohol
- high-fat diet, obesity, alcohol :risk factor
- but, not clear
PREDISPOSING FACTOR
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Reproductive and hormonal factors
- the risk of breast ca increases with the length of a
women’s reproductive phase
- menarche is lower
early menopause
artificial menopause (oophorectomy)
-> the risk is decreased
-> but, no clear association with irregularity &
duration of menses
-lactation does not affect the breast cancer
->but, risk is high : never pregnant > multiparous
-primigravida: older > younger (high incidence)
-although short-term estrogen treatment for
menopausal symptoms prebably does not increase
the risk of breast ca, prolonged use or higher dosages
of estrogen may increase the risk
-> low dose or combination with progestin
-> but, benbefits in preventing osteoporosis and
heart problem
HISTORY OF CANCER
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Endometrial carcinoma, ovarian carcinoma, or colon
cancer has also been associated with an increased
risk of breast cancer
DIAGNOSIS
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most commonly in the upper outer quadrant
(there is more beast tissue)
mammography and physical examination, the standard
screening modalities, are complementary
-10% to 50 % of cancers detectred mammographically
are not palpable, physocal exam detects 10% to 20%
of cancers not seen on mammography
All women unfergo screening mammography starting at
age 40, along with clinical or self breast examination
DIAGNOSIS
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USG, MRI, CT, PET, sestamibiscans, serum blood
marker: be used only when indicated
palpation: easy- older, more fatty
Malignancy: thickening area amid normal nodulaity
skin dimpling
nipple retraction
skin erosion
clinically malignancy: 30~40% benign on histology
clinically benign: 20~25% malignant by biopsy
Biopsy techniques
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Fine-needle aspiration cytology (FNA)
- 20- or 22- gauge needle
- a high level of diagnostic accuracy
:10-15% false negative
rare false positive
-negative FNA cytology results do not exclude
malignancy and usually are followes by excisional
biopsy or careful observation
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Open biopsy
-FNA cytology has not been performed
the results are negative or eqivocal
1. the location of the mass confirmed
2. local anesthesia: skin, suncutaneous around mass
3. incision: directly over the mass (ellise-cosmetically)
paraareolar(near the nipple-areolar complex)
4. mass: gently grasped with Allis forcep or stay suture
5. the mass should be excised completely
6. adequate hemostasis
breast parenchyma : not reapproximated deeply
subcutaneous fat: with fine absorbable suture
skin: subcuticular suture and adhesive strips
usually a drain is not necessary
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Mammographic localization biopsy
- biopsy of nonpalpable lesion
- mammographer : localization & a biologic dye
surgeon: review & excised
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Stereotactic core biopsy
- localize abnormalities and perform needle biopsy
without surgery
PATHOLOGY AND
NATURAL HISTORY
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Breast ca : in the intermediate-sized ducts or terminal
ducts and lobules
-the diagnosis of lobular and intraductal carcinoma is
based on histological appearance than site of origin
infiltrating ductal carcinoma: 60-70%
-mammographically, stellate density
-macroscopically, gritty and chalky
Medullary carcinoma
-a dence lymphocytic infiltration
-sloe growing, less aggressive malignancy
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Mucinous (colloid) carcinoma : 5% of breast ca
-glossly, mucinous, gelatinous
Papillary carcinoma
-noninvasive ductal carcinoma
Tubualr carcinoma: 1% of breast ca
-better prognosis than infiltrating ductal carcinoma
rarely metastasize to axillary LN