BREAST CANCER

ANATOMY OF THE BREAST

Breasts consist
mainly of fatty tissue
interspersed with
connective tissue
There are also less
conspicuous parts
 lobes
 ducts
 lymph nodes
 Ducts

Ducts carry Lobes, lobules,

milk from bulbs and bulbs are
toward dark area Linked by a
of skin in the network of thin
center of the tubes (ducts)
breast (areola)

Ducts join together

into larger ducts ending
at the nipple, where
milk is delivered
 Lymphatic System
Lymph ducts: Drain fluid that
Lymph node Lymph duct carries white blood cells (that
fight disease) from the breast
tissues into lymph nodes under
the armpit and behind the
breastbone
Lymph nodes: Filter harmful
bacteria and play a key role in
fighting off infection
A network of
vessels
5
• A malignant tumor in the breast is what causes breast cancer.
The malignant tumor consists a group of cancer cells that can
grow and spread (metastasize) to the surrounding tissues. The
disease occurs mostly to women, but men can also have them
but not that commonly like women can.
 FACTS ABOUT BREAST CANCER
• All women are at risk. Approximately 70% of breast cancers occur in
women with none of the known risk factors.
• Only about 5% of breast cancers are inherited. About 80% of women
diagnosed with breast cancer will be the first to be victims in their
families.
• One out of four who are diagnosed with breast cancer die within the
first five years. No less than 40% die within ten years.
• Risk factors are not necessarily causes of breast cancer. Enough
evidence exist linking environmental pollution and contamination to
cause breast cancer.
 FACTS ABOUT BREAST CANCER
• Breast cancer is the leading killer of women ages 35 to 54 worldwide.
More than a million women develop breast cancer without knowing it
and almost 500,000 die from it every year.
• In 2016, the Philippines topped 197 countries with the most number of
cases of breast cancer, data released by Philippine Obstetrical and
Gynecological Society have shown.
• It is also one of the countries worldwide with the highest prevalence
rates of cancer.
 RISK FACTORS

• Early menarche
• Late menopause
• Nulliparous
• Older than 30 at the birth of first child
• Increase in age
• First degree relatives
• Cigarette smoking
SIGNS AND SYMPTOMS
Most common:
lump or
thickening in
breast. Often
painless

Redness or pitting
Discharge of skin over the
or breast, like the skin
bleeding of an orange

Change in
size or Change in color or
contours of appearance of
breast areola
 Noncancerous Conditions

Fibrocystic changes: Lumpiness, thickening and swelling,

often associated with a woman’s period
Cysts: Fluid-filled lumps can range from very tiny to about
the size of an egg
Fibroadenomas: A solid, round, rubbery lump that moves
under skin when touched, occuring most in young women
Infections: The breast will likely be red, warm, tender and
lumpy
Trauma: a blow to the breast or a bruise can cause a lump

8/6/2018
 Noncancerous Conditions

Microcalcifications: Tiny deposits of calcium can appear

anywhere in a breast and often show up on a mammogram
 Most women have one or more areas of microcalcifications of
various sizes
 Majority of calcium deposits are harmless
 A small percentage may be precancerous or cancer (biopsy is
sometimes recommended)
 STAGING OF BREAST CANCER

In Situ Breast Cancer

Stage 0: Noninvasive breast cancer (for example DCIS and

LCIS) that has not spread to the lymph nodes under the arm or
any other lymph nodes
 STAGING OF BREAST CANCER

Early- Stage Invasive Breast Cancer

Stage I: tumor measures 2cm or less, and has not spread to the
lymph nodes under the arm or any other lymph nodes
 STAGING OF BREAST CANCER

Early- Stage Invasive Breast Cancer

Stage II:
Stage IIA:
• no evidence of tumor, but cancer has spread to only to the lymph
nodes under the arm; or
• The tumor is 2cm or less and has spread to the lymph nodes under
the arm but not to any other lymph nodes; or
• The tumor is between 2cm to 5cm (about 2in) and has not spread
to the lymph nodes under the armor any other than lymph nodes.
 STAGING OF BREAST CANCER

Early- Stage Invasive Breast Cancer

Stage II:
Stage IIB:
• The tumor is between 2cm to 5cm and has spread only to the
lymph nodes under the arm on the same side as the breast cancer;
or
• The tumor is more than 5cm but has not spread to the lymph
nodes under the arm or any other lymph nodes.
 STAGING OF BREAST CANCER

Advance Stage of Breast Cancer

Stage III:
• The tumor is any size and has spread to other parts of the body
(possible bones, lungs, liver or brain); or
• The tumor has spread locally to the skin and lymph nodes inside
the neck, near the collarbone.
 STAGING OF BREAST CANCER
Metastatic Breast Cancer
Stage IV:

A tumor of any size or type that has metastasized to

another part of the body (ex. bones, lungs, liver, brain). This is
the least favorable stage to find breast cancer.
0

Ductal Carcinoma in situ (DCIS)

Ductal
cancer
cells

Carcinoma refers to any cancer Normal

that begins in the skin or other ductal
tissues that cover internal cell
organs
• Ductal carcinoma is the most common type of breast cancer.
It begins in the cells of the ducts, until it spreads. Breast
cancer can also begin in the cells of the lobules and in other
tissues in the breast. Invasive breast cancer is breast cancer
which spreads from where it began in the ducts of lobules to
surrounding tissue.
2

Invasive Ductal Carcinoma (IDC – 80% of

breast cancer)

Ductal cancer
cells breaking
through the wall

• The cancer has spread to the

surrounding tissues
3

Range of Ductal Carcinoma in situ

4

Invasive Lobular Carcinoma (ILC)

Lobular cancer
cells breaking
through the wall
5

Cancer Can also Invade Lymph or Blood Vessels

Cancer cells
invade lymph
duct

Cancer cells
invade blood
vessel
 DIAGNOSTIC TESTS
Use a low-dose x-ray system to examine
breasts
Digital mammography replaces x-ray film
by solid-state detectors that convert x-
rays into electrical signals. These signals
are used to produce images that can be
displayed on a computer screen (similar to
digital cameras)
Mammography can show changes in the
breast up to two years before a physician
can feel them
 What Mammogram show?
Two of the most important mammographic indicators
of breat cancers
 Masses

 Microcalcifications: Tiny flecks of calcium – like

grains of salt – in the soft tissue of the breast
that can sometimes indicate an early cancer.
Detection of Malignant Masses
Malignant masses have a more spiculated
appearance

benign
malignant
 MRI - Cancer can have a unique appearance
MRI many small irregular white areas that turned out
Side-to-Side to be cancer (used for diagnosis)

Top-to-Bottom
Probability of
malignancy

Similar images of
known diagnosis

Indicates the unknown

lesion relative to all
lesions in the database
 Breast Ultrasound

• Usually done in addition to the mammogram.

• Shows whether a mass is filled with fluid or solid. Cancers are solid.
• Not 100% accurate
 Biopsy

• take a very small piece of tissue

from the body for examination
and testing.
• examined by a pathologist
• 100% accurate
Which treatments are used for breast cancer?

Local treatments:
• Surgery
• Radiation therapy
Systemic treatments:
• Chemotherapy
• Hormone therapy
• Targeted therapy
 Treatment of Ductal Carcinoma in Situ (DCIS)

• Ductal carcinoma in situ (DCIS) means the cells that line the
milk ducts of the breast have become cancer , but they have
not spread into surrounding breast tissue.
• DCIS is considered non-invasive or pre-invasive breast cancer.
DCIS can’t spread outside the breast, but it still needs to be
treated because it can sometimes go on to become invasive
breast cancer (which can spread).
• In most cases, a woman with DCIS can choose between breast-
conserving surgery (BCS) and simple mastectomy. But
sometimes a mastectomy might be a better option.
Treatment of Ductal Carcinoma in Situ (DCIS)

Breast-conserving surgery (BCS)

Mastectomy

Hormone therapy after surgery

 Breast-conserving surgery (BCS)
• In breast-conserving surgery (BCS), the surgeon removes the tumor
and a small amount of normal breast tissue around it. Lymph node
removal is not always needed with BCS, but it may be done if the
doctor thinks the area of DCIS might also contain invasive cancer.
The chances an area of DCIS contains invasive cancer goes up with
tumor size and how fast the cancer is growing. . If lymph nodes are
removed, this is usually done as a sentinel lymph node biopsy
(SLNB).
 Breast-conserving surgery (BCS)

• If BCS is done, it is usually followed by radiation therapy. This

lowers the chance of the cancer coming back in the same
breast (either as more DCIS or as an invasive cancer). BCS
without radiation therapy is not a standard treatment, but it
might be an option for certain women who had small areas of
low-grade DCIS that were removed with large enough cancer-
free surgical margins.
 Mastectomy
• Simple mastectomy (removal of the entire breast) may be needed if
the area of DCIS is very large, if the breast has several areas of
DCIS, or if BCS cannot remove the DCIS completely (that is, the
BCS specimen and re-excision specimens still have cancer cells in
or near the surgical margins). Many doctors will do a SLNB along
with the mastectomy. This is because if an area of invasive cancer
is found in the tissue removed during a mastectomy, the doctor
won’t be able to go back and do the SLNB later, and so may have
to do a full axillary lymph node dissection (ALND).
• Women having a mastectomy for DCIS may choose to have breast
reconstruction immediately or later.
 Hormone Therapy After Surgery

• If the DCIS is hormone receptor-positive adjuvant treatment

with tamoxifen (for any woman) or an aromatase inhibitor (for
women past menopause) for 5 years after surgery can lower the
risk of another DCIS or invasive cancer developing in either
breast. If you have hormone receptor-positive DCIS, discuss
the pros and cons of hormone therapy with your doctors.
 Treatment of Lobular Carcinoma in Situ
(LCIS)

Lobular carcinoma in situ (LCIS) means abnormal cells are in

the lobules of the breast. LCIS is sometimes grouped with ductal
carcinoma in situ (DCIS) as a type of non-invasive breast
cancer, but LCIS is different from DCIS and is not cancer. It is
a benign (noncancerous) condition that puts you at risk to
develop invasive cancer.
 Treatment of Lobular Carcinoma in Situ
(LCIS)
Having LCIS does increase your risk of developing invasive
breast cancer later on. Sometimes if a needle biopsy result
shows LCIS , the doctor might recommend that it be removed
completely (with an excisional biopsy or some other type of
breast-conserving surgery) to help make sure that LCIS was the
only thing there. This is especially true if the LCIS is described
as pleomorphic or if it has necrosis (areas of dead cells), in
which case it might be more likely to grow quickly.
 Treatment of Lobular Carcinoma in Situ
(LCIS)
With LCIS, close follow-up is very important. This usually
includes a yearly mammogram and a breast exam. Close follow-
up of both breasts is important because women with LCIS in
one breast have the same increased risk of developing cancer in
both breasts. There isn’t enough evidence to recommend getting
routine magnetic resonance imaging (MRI) in addition to
mammograms for all women with LCIS, but it’s reasonable for
women with LCIS to talk with their doctors about their other
risk factors and the benefits and limits of being screened yearly
with MRI.
 CLASSIFICATION OF SURGERY

Lumpectomy
• Removal of the cancerous
tissue and a surrounding area of
normal tissue
 CLASSIFICATION OF SURGERY

Simple Mastectomy

• Removal of the breast tissue,

nipple, areola and skin but not
all the lymph nodes
 CLASSIFICATION OF SURGERY

Modified Radical Mastectomy

• Removal of the entire breast —

including the breast tissue, skin,
areola and nipple — and most
of the underarm (axillary)
lymph nodes.
 CLASSIFICATION OF SURGERY

Radical Mastectomy

• Removal of the breast and the

underlying chest wall muscles,
as well as the underarm
contents.
• This surgery is no longer done
because current therapies are
less disfiguring and have fewer
complications.