Breast Cancer Breast tissue Inner lining of the milk ducts Lobules Prognosis and survival depends on cancer

type and staging 10.4% of all cancer incidence in women Breast carcinoma sensitive to estrogen and progesterone have better prognosis and require less aggressive treatment. Breast cancers which are not sensitive to hormone receptors spread to the lymph nodes and needs more aggressive treatment. Cyclophosphamide, Doxorubicin,etc.

STAGING OF BREAST CANCER Size of the tumor (T) Spread to the lymph nodes (N) Metastasis Stage 0-pre-malignant disease marker(DCIS) Stage 1-3-early signs of cancer,potentially curable Stage 4-advanced,metastatic

HISTOPATHOLOGY Mammary Ductal Carcinoma -derived from epithelium lining the lobules or ducts. Carcinoma in Situ-proliferation of cancer cells within epithelial tissue Invasive Carcinoma-invades the surrounding tissue.

SIGNS AND SYMPTOMS LUMP!!! Changes in breast size or shape Skin dimpling Spontaneous single nipple discharge Nipple inversion Pain (mastodynia)??? Orange peel texture of the breast

RISK FACTORS Sex

Age Lack of childbearing or breastfeeding Higher hormone levels Race and economic status

Risk Factors Estimated Relative Risk Advanced age >4 Family history Two or more relatives (mother, sister) One first-degree relative Family history of ovarian cancer in women

Personal history Personal history Positive BRCA1/BRCA2 mutation Breast biopsy with atypical hyperplasia Breast biopsy with LCIS or DCIS

Early age at menarche ( Late age of menopause Late age of first term pregnancy (>30 y)/nulliparity Use of combined estrogen/progesterone HRT Current or recent use of oral contraceptives

Lifestyle factors- Adult weight gain--1.5-2 Sedentary lifestyle-1.5 Alcohol consumption

PATHOPHYSIOLOGY Breast cancer occurs because of an interaction between the environment and a defective gene. Cells become cancerous when mutation destroy their ability to stop dividing, to attach to other cells and to stay where they belong. P53,BRCA1,BRCA2-mutations The presence of estrogen and progesterone receptors Cells cannot undergo apoptosis even it is not anymore needed.

DIAGNOSTIC PROCEDURES Fine Needle Aspiration Cytology Excision biopsy Core biopsy

MEDICATIONS Surgery Radiotherapy Hormone blocking therapy Chemotherapy Monoclonal antibodies