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Disorders of the breasts:

Gail Notes

Diagnostic tests-

  1. Radiological studies-
    1. Mammography- with or without contrast
    2. ultra sound
    3. MRI
  2. Biopsy-
    1. FNA- fine needle aspiration
    2. Lumpectomy- potential for cure. Removal of lesion and additional tissue surrounding it.
    3. Incision biopsy- small portion of the lesion removed. Confirms diagnosis. We want to see if it has progesterone or estrogen receptor sites (positive sign)
    4. Tru cut core biopsy- large needle to obtain sample and cut tissue
    5. Wire needle localization- during mammography the wire is inserted into the tumor site and the doctor does an excisional biopsy. They use the wire as a guide to excise the lesion and send it to the pathologist. F/U mammography to see if the lesion is completely removed.

BENIGN TUMORS OF THE BREAST

  1. Fibrocystic breast changes-usually disappear after menopause 30-60 years- multiple
  2. Fibroademomas-puberty to menopause- single
  3. Cysts- 30-90 years-single

Comparative parameters Benign VS malignant

If malignant irregular shape, fixed- won’t move, there are signs of retraction,

 

Infiltrating ductal carcinoma

Infiltrating lobular carcinoma

Midulary carcinoma

Mucinous carcinoma

Inflammatory carcinoma- whole breast is inflamed

 

PAGETS DISEASE:

Lesion located right under the nipple, can be benign or malignant

S/sx itching around nipple, scaly lesion of skin around nipple

Current research-

  1. Chemoprophylaxis-
    1. Tomoxaphen- drug given to prevent breast cancer in high-risk patients. Aka nolvadex
    2. Evista- drug to prevent osteoporosis and breast ca. Aka raloxifene
  2. Surgical prophylaxis- bilateral mastectomy to prevent breast cancer in high-risk patients.

Breast Cancer-

Etiology- multidimensional

      1. Hormonal
        1. Estrogen
        2. Estrodial
      2. Hereditary- tumor markers
        1. BRCA I
        2. BRCA II
      3. Age- over 50
      4. Early menarche
      5. Late menopause
      6. Women who never delivered a term baby
      7. Obesity
      8. Alcohol abuse
      9. Hormone replacement therapy

        10. s/sx

        1. Lump in outer quadrant of breast
        2. Malignant characteristics
        3. Ulceration of breast skin tissue
        4. Orange like breast colored skin because of obstruction of lymph

Stages

T- tumor size

N-nodal involvement

M-metastasis

Good prognosis if:

No or low number of node involvement

No evidence of metastasis

Presence of progesterone and estrogen receptors

Normal DNA content of tumor

Tumor cells are highly differentiated

 

 

 

Staging of breast cancer

Stage 0- preinvasive stage, breast CIS

Stage 1- lesion less than 2cm

Stage 2- lesion less than 5cm with axillary and lymph nodes moveable

Stage 3- lesion greater than 5cm axillary and lymph fixed and nodes of clavicle involved

Stage 4- metastisis

Treatment is based on stage