inflammatory breast cancer

pleomorphic adenoma

superficial parodectomy
TYPES OF LESIONS
 Breast ca

SIGNS AND
SYMPTOMS
Ductal Carcinoma In Situ
(DCIS)
INVASIVE LOBULAR CARCINOMA
(ILC)
Lobular Carcinoma In Situ
Cancer Can Also Invade Lymph Or Blood Vessels
 T = Primary Tumor
Tis (T0) = carcinoma in situ
T1 = less than 2 cm in
diameter T2 = between 2 and 5 cm in diameter
T3
T4 =
= more thanbut
any size, 5 cm in
extends to the skin or chest wall
diameter
N0 = No regional node involvement N = Regional Lymph
nodes
N1 = metastasis to movable same side axillary nodes
N2 = metastasis to fixed same side axillary nodes
N3 = metastasis to same side internal mammary nodes
A painless lump
●● Carcinoma.
●● Cyst.
●● Fibroadenoma.
●● An area of fbroadenosis.
Pain And Tenderness But No Lump
●● Cyclical breast pain.
●● Non-cyclical breast pain.
●● Very rarely, a carcinoma.
Nipple discharge
●● Duct ectasia.
●● Intraduct papilloma.
●● Ductal carcinoma-in-situ (DCIS).
●● Associated with a cyst.
Changes in the nipple and/or areola
●● Duct ectasia.
●● Carcinoma.
●● Paget’s disease.
●● Eczema.
Changes in breast size and shape
●● Pregnancy.
●● Carcinoma.
●● Benign hypertrophy.
●● Rare large tumours
PROLIFERATIVE BREAST DISEASE
• Atypical epithelial hyperplasia
└ increases the risk 5 times.

• Epithelial hyperplasia of usual type

└ increase risk by 1.5 - 2 times.

• Positive family history

└ doubles these risks

Recurrent breast cancer TX
• Where The Cancer Recurs And
• What Treatments You’ve Had Before
HER2 Triple-negative breast cancers TX
Chemotherapy
sensitive to the side effects of radiation therapy
connective tissue diseases such as scleroderma or lupus
Who can get breast-conserving surgery?
 • concerned about losing her breast
• willing to have radiation therapy
• not already had her breast treated with radiation
therapy or BCS Have only one area of cancer on
the breast, or multiple areas that are close enough
• not pregnant
• Do not have a genetic factor
• Do not have certain serious connective tis
• small tumor (5 cm [2 inches] or smaller)
• Do not have inflammatory breast c
• Pain or tenderness or a "tugging" sensation in the breast
• Temporary swelling
• Hard scar tissue
• Change in the shape of the breast Nerve (neuropathic) pain
(sometimes described as burning or shooting pain) in the
chest wall, armpit, and/or arm that doesn’t go away over
time.

• This can also happen in mastectomy patients and is called

post-mastectomy pain syndrome or PMPS.
Simple or (total) mastectomy
Skin-sparing mastectomy
Nipple-sparing mastectomy
Variation Of The Skin-sparing
A modified radical mastectomy
Radical mastectomy
Doublemastectomy
Mastectomy might be recommended if
• Are Unable To Have Radiation Therapy
• Would Prefer A More Extensive Surgery
• Recurrence Tumor Post BCS
• Multiple Tumor
Lymph Node Surgery for Breast Cancer
• Sentinel lymph node biopsy (SLNB)

- Finds And Removes The First Lymph Node(s) To Which A Tumor Is Likely To Spread

• Axillary lymph node dissection (ALND)

- About 10  40 Lymph Nodes Are Removed

Lymph Node Surgery for Breast Cancer
Side Effects :
• Lymphedema
• This is less common after (SLNB) than (ALND).
• Limited arm and shoulder movement
• is more common after ALND than SLNB
• Numbness of the skin on the upper arm
Treatment Of HER2-positive Breast
Cancer
•Ado-trastuzumab emtansine (Kadcyla)
•Lapatinib (Tykerb)
•Neratinib (Nerlynx)
•Pertuzumab (Perjeta)
Types of Breast Cancer
• Invasive Breast Cancer
• Inflammatory Breast Cancer
• HER2-Positive Breast Cancer
• Breast Cancer in Men
• Paget's Disease of the Breast & Nipple
• Triple Negative Breast Cancer
• Ductal Carcinoma Invasive In Situ
• Lobular Carcinoma
Hormone Receptor-Positive Breast Cancer
• About 80% of all breast cancers are “ER-positive.”
That means the cancer cells grow in response to
the hormone Estrogen.

• About 65% of these are also “PR-positive.” They

grow in response to another hormone,
What are the adjuvant Hormonal Therapy for 5 yrs ?
In Patients 𝒲 ER-positive tumors
• Tamoxifen is given to pre-menopausal women, 

%,

• Fulvestrant (Faslodex) is a medication that blocks and damages

estrogen receptors that is sometimes used in the treatment of
{ (Nolvadex, Soltamox)
- reduce of recurrence by 25

- with a 17% death reduction

metastatic breast cancer.

• Toremifene (Fareston) is a drug that blocks estrogen receptors that
can also be given to certain women with metastatic breast ca.
anastrozole (Arimidex),
exemestane (Aromasin),
• Aromatase Inhibitors are given to post-menopausal women. letrozole (Femara
CDK 4/6 inhibitors abemaciclib (Verzenio),
palbociclib (Ibrance) and
ribociclib (Kisqali) are sometimes used with aromatase inhibitors or
the hormone therapy fulvestrant (Faslodex).
 Indications for adjuvant radiation

 Significantly Decreased Recurrence And Improved

Survival In Premenopausal Women With These
Indications Treated With Chemotherapy And Radiation
Therapy
• After mastectomy
• Presence of 1 3 positive axillary nodes
• After BCT (Adjuvant WHOLE-breast radiation)
After mastectomy
× Indications for adjuvant radiation
↘ T3 and T4 tumors
↘ positive surgical margins
↘ skin involvement
↘ internal mammary nodes involvement
↘ inadequate / no axillary dissection
↘ 4 or more +ve lymph nodes
↘ residual tumor on the axillary vein.
External Beam Radiation Therapy
• /a Lumpectomy
• /a Mastectomy ( Chest wall radiation therapy )

• Breast boost
Most Common Type Of Radiation Therapy
• External Beam Radiation Therapy
• External Beam Radiation Complications
*skin changes.

*Infrequent complications
include interstitial pneumonitis, spontaneous rib fracture,
breast fibrosis, pericarditis, pleural effusion, and chest wall
myositis. Radiation to the axilla can increase the incidence
of lymphedema and axillary fibrosis.

* Angiosarcoma (late)
Most Common Type Of Brachytherapy
For Women With Breast Cancer.
• Intra-cavitary Brachytherapy
Neo-adjuvant therapy
 • Before surgery
Reduce tumors Radiation therapy
Adjuvant systemic therapy.
 • After surgery
 Combat metastasis Chemotherapy and hormone therapy

* All node-positive patients : should

receive adjuvant chemotherapy
 • the type of drugs used
• The side effects of chemo depend on: • the amount given
• and the length of treatmen
• Short – term side effects ·
• Hair loss ·
• Loss of appetite or increased appetite ·
• Nausea and vomiting ·
• A higher risk of infection ·
• Stopping of menstrual periods ·
• Easy bruising or bleeding ·
• Being very tired.
• Long - term side effects
• Menstrual changes: infertility
• Nerve damage: pain, burning or tingling and sensitivity to cold or hot.
• Heart damage