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M.S(gen.surgery)
Anatomy
Breast is a mature modified sweat gland
Paired mammary gland develop along with
polythelia
Minimum postnatal development in
males & maximum in females upto age
of 20 yr & atrophy begin pre menopause
~40 yr
Breast extends superiorly from second
rib to inferior mammary fold medially
lateral border of sternum lateraly
ant.axillary line or mid axillary line
Amastia & athelia are rare
Arterial supply
Internal mammary
Lateral thoracic
Intercostal
Thoracoacromial
Venous drainage
Lateral thoracic
Internal mammary
Axillary
Posterior intercotal veins directly
Nerve supply
Medial pectoral
Lateral pectoral
Long thoracic
Cutaneous
Lymphatic drainage
Pectoral (anterior) nodes
Subscapular (posterior) nodes
Humerial (lateral) nodes
Central
Apical
Interpectoral (rotter`s) nodes
Parasternal
Aetiology
Most common cause of death in middle
age women
Geography
Gender
Age
Genetics
Diet
Endocrine
Previous breast biopsy
Personnel history of breast carcinoma
Previous chest wall irradation
Oncogenesis
ERB B2
Hras
Myc
WNT2
Growth factors,
TGF alpha
IGF
ER
Pathology
Breast carcinoma arise from epithelium
Spread
Local
Lymphatic
Haematogenous
Clinical presentation
Lump
Indrawing of nipple
Peaud`s orange skin
Ulceration
Fixation to chest wall
Sign & symptoms of metastasis
Diagnosis
History
Clinical examination
Mammography
MRI
FNAC
Core needle biopsy
Incisional biopsy
Excisional biopsy
Punch biopsy
PET scanning
Classification
DCIS-Comedo
-Noncomedo
Infitrating ductal carcinoma
Medullary carcinoma
Infiltrating lobular carcinoma
Tubular
Mucinus carcinoma
Inflammatory carcinoma
Stagging
0
I
IIA
IIB
IIIA
IIIB
IIIC
IV
Tis
T1
T2
T1
T3
T2
T3
T4
any T
any T
no palpable mass
<2 cm
2-5 cm
<2 cm
>5 cm
2-5 cm
>5 cm
chest wall,skin
no
no
no
n1
no
n1
n2
n2
n3
any n
mo
mo
mo
mo
mo
mo
mo
mo
mo
mI
Treatment
Wide local excision and primary radiotherapy
Partial mastectomy
Segmentectomy
Lumpectomy
Quadrantectomy
QUART
Removing 10 nodes-future recurrence
-stagging
4500 rads to whole breast
Increase mass
awareness
BREAST
CONSERVING
SURGERY
Better Quality
of life
Better psycho-social
Adjustment
Modified radical
mastectomy
Mastectomy
Axillary lymphnodes dissection level 1 or 2
Anatomic complication of
MRM
Vascular injury-1 &2 perforating vessels
st
nd
-axillary vein
Nerve injury -intercostobrachial nervenumbness of the medial aspect of arm
Long thoracic nerve-winged scapula
Medial & lateral thoracic nerve-pectoralis
muscle atrophy
Thoracodorsal nerve-internal rotation &
abduction
of shoulder are weakened
Hormonal
Chemotherapy
Doxorubicin
Paclitaxel
Docitaxel
Capecitabine
Gemcitabine
Biological therapy
Trastuzumab-humanized mouse monoclonal
antibody against HER-2 protein
Biophosphonates-zolendronic acid decreasing
pathological fracures,pain & hypercalcimia
Chemotherapy
Primary therapy
CAF
AC
CMFP
Doxorubicin plus paclitaxel
Secondary therapy
Paclitaxel
Docetaxel
Vinorelbine
Capecitabine
Docetaxel
Trastuzumab
Carboplatin
Hormone therapy
Tamoxifen
Anastrozole
Fulvestrant
Megestol
Aminoglutethimide
ADJUVANT
RADIOTHERAPY
Indications of Radiation therapy
RECENT ADVANCES IN
RADIOTHERAPY
CT simulators and Portal imaging
3DCRT
IMRT
IGRT
DEVELOPING
COUNTRIES
National policy
- NCCP
Team approach
National guidelines of Rx
THANKS