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BREAST

DR. WALLACE MEDINA

Breast anatomy

BRCA1

More aggressive breast tumors Estrogen negative  ____ TP53 mutations Rarely exhibit HER2/neu expression Personal history o previous breast

!an!er Bilateral !an!er  "ounger than 5# years ol$  _____ o breast an$ ovarian !an!er

BRCA2

  %&2' early onset breast !an!er  ER ()*  +n!rease ris, o non breast !an!ers -

o Prostate . 015'o allbla$$er bile $u!t . 04'o 6toma!h . 2054'o Malignant melanoma . 2057'

DIAGNOSIS

%0 8BE/6BE20 89B30 +maging

a0 MMb0 :ltrasoun$

!0 MR+

Pathology revie

   Tumor si;e  irst imaging mo$ality  ___ an$ $iagnosti! Evaluation o the !ontralateral breast %#&%5' ailure to $ete!t palpable

lesion ?e!rease a!!ura!y or $ense breast

or!e

estimates the bene@ts o

mammography in Aomen age$ 5#&

years to be a 3#' re$u!tion in ris, o

$eath rom breast !an!er >or Aomen age$ #&4 years the ris,

o $eath is $e!rease by %'

S!ree"i"g Re!o##e"$atio"%

Cmeri!an 8an!er 6o!iety

Age SBE CBE MMG2# &34 Monthly Every 3

yrs

?iagnosti

!# - 4 Monthly Cnnually Cnnually5#) Monthly Cnnually annually

Brea%t I#agi"g Re&orti"g a"$ Data

Sy%te## C$$itional imaging% Routine imaging2 Benign3 Probably benign 6uspi!ious5 Highly malignant1 DnoAn malignant

'ltra%o"ogra&hy

6oli$ vs0 !ysti! is 99palpable lesion

?ire!ting >9CB0 8ore biopsy o lesion 8on@rms position o lesion

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Evaluation o invasive lobular

!ar!inoma Ahi!h has a high in!i$en!e

o multio!al Evaluation o suspe!te$ extensive

high gra$e intra$u!tal !ar!inoma ?ete!tion o o!!ult primary breast

!ar!inoma in the presen!e o  

metastati! a$eno!ar!inoma o 

un,noAn origin Monitoring o the response to

neoa$Guvant !hemotherapy ?ete!tion o re!urrent breast !an!er

Be"ig" (rea%t t)#or%

%0 Breast !yst20 >ibroa$enoma30 Hamartoma an$ a$enoma0 Breast abs!ess50 Papilloma an$ papillomatosis

10 6!lerosing a$enosis0 Ra$ial s!ar

Cla%%i*!atio" o+ Pri#ary Brea%t Ca"!er

No"i"va%ive E&ithelial Ca"!er%

%0

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+mplants autologous tissue

(transverse re!tus ab$ominis

latissimus $orsi* 6ae 9o in!rease in lo!al re!urren!e

A$va"tage% o+ Neoa$)va"t

Che#othera&y

Cssessment o tumor response to

!hemotherapy Potential $e!rease in $e novo

!hemotherapy resistan!e +n!rease in breast !onserving surgery +mprove$ !osmeti! results  Treatment o mi!rometastasis ?e!rease the si;e

Di%a$va"tage% o+ Neoa$)va"t

Che#othera&y : (>*

?oxorubi!in (C*

Epirubi!in (E*

?o!etaxel (T*

Pa!litaxel (P*

A$)va"t !he#othera&y

3ir%t ge"eratio" 08M> (1!y!les* C8 (__ 

!y!les*

2"$  ge" 0 >C8 (1!y!les* 8E> (1!y!les* T8

(!y!les*

4r$  ge" - C8 - pa!litaxel TC8 >E8&

$o!letaxel/pa!litaxel

E"$o!ri"e thera&y

a. &re#e"o&a)%al  Tamoxien 5 years or

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  Cromatase inhibitors - 2#' re!urren!e

postmenopausalo Cromatase inhibitors

 _______________ 

 The 2#%2 gui$elines re!ommen$e$ the

olloAing laboratory stu$ies or all

asymptomati! Aomen Aith early stage

breast !an!er (stage + ++*

& 8B8 Aith $iNerential !ount& T an$ Cl,aline phosphatase

+n a$$ition imaging stu$ies (8Oray !hest

8T6!an or 8T o ab$omen an$ pelvis* !an be

!onsi$ere$ or Aomen Aith stage +++ or

symptomati! $isease0 Tumor mar,ers (8EC

8C _______*may be obtaine$ in these patients

Treat#e"t &roto!ol%