Breast Carcinoma

Anatomy

Epidemiology: 10%

17.1/10 28/10 46/10

1.2 m world wide

6% develop cancer of the breast in their lifetime.

50,000 to 70,000 new cases USA

Risk Factors for Breast Cancer

Major Minor

Gender(female>male) Early menarche

Age Late minopause

Family history(mother,sister,or Obesity

daughter with premenopausal Low-dose radiation

or bilateral cancer)

Personal history of contralateral BC

Nonivasive carcinoma (ductal or lobular

carcinoma in situ)

Benign proliferative changes with atypia

Pathology of Breast Cancer

Noinvasive

1、 Ductal Carcinoma in situ (DCIS)， intraductal

2、 Lobular Carcinoma in situ (LCIS)

Invasive

1、 Infiltrating ductal carcinoma: this is the most common malignant tumor in the breast recognized after biopsy.

2、 Invasive Lobular carcinoma:

Paget’s disease of the nipple

Diagnosis of Breast Mass:

1 history and physical examination

2 Risk factors for breast cancer:

3 fine-needle aspiration

4 breast imaging :

5 ultrasonography, thermography, computed tomography (CT), magnetic resonance imaging (MRI), mammography.

Staging Breast Cancer T1 tumor more than 2 cm or less in greatest dimension

T2 tumor more than 2 cm, but not more then 5 cm in

greatest dimension

T3 tumor more than 5 cm in greatest dimension

T4 tumor in any size with direct extension to chest wall or skin

No no regional lymph node metastasis

N1 metastasis to movable ipsilateral axillary lymph node

N2 metastasis to ipsilateral axillary lymph nodes that are

fixed to one another or to other structures

N3 metastasis to ipsilateral internal mammaryl lymph node

Mo no distant metastasis

M1 distant metastasis (includes metastasis to ipsilateral

supraclavicular lymph node)

Surgical Procedures Past and Present

1) In 1894, Halsted

2) Radical and Extended Radical mastectomy:

3) Modified radial mastectomy:

4) Patey :

5) Auchincloss :

0

10

20

30

40

50

60

70

80

1972 1976 1977 1981

Modi fi ed Radi calMastectomy

Radi cal(Hal sted)Mastectomy

Adjuvant chemotherapy for operable breast cancer: 1)  Adjuvant chemotherapy for lymph node-positive patients

2) Adjuvant chemotherapy for lymph node-negative patients

Hormonal therapy for breast cancer 1) Steroid hormone receptors

2) Adjuvant hormonal therapy for operable breast cancer

Recommendations for Adjuvant Treatment

Menopausal Axilliary Tumor Recommended Treatment

Starus Nodes Characteristics

Premenopausal Positive Favorable or Un Combination chemotherapy

Premenopausal Negative Favorable No data to support adjuvant

Premenopausal Negative Unfavorable Combination Chemotherapy

Postmenopausal Positive Favorable Tamoxifen±Chemotherapy

Postmenopausal Positive Unfavorable Chemotherapy ±Tamoxifen

Postmenopausal Negative Favorable No data to support adjuvant

Postmenopausal Negative Unfavorable No data to support adjuvant

Favorable tumor characteristic include size<2 cm, Er or PgR positive,nuclear and histologic grade good(1 or 2)