THE BREAST Dr.JAMIL SAWAKED. LATISSIMUS DORSI TERES MAJOR SERRATUS ANTER ANATOMY.

THE BREASTTHE BREAST

Dr.JAMIL SAWAKEDDr.JAMIL SAWAKED

LATISSIMUS DORSI

TERES MAJOR

SERRATUS ANTER

ANATOMY

RIBS &intercost.

mPECTORALIS

MAJOR

FAT

LOBE

AMPULLA

20 MAJOR LACT.ORIFICES

LACTOCYTE

MAJOR LACT.DUCT IS THE SITE OF DUCTAL CA.

THEIR CONTRACTION CAUSES SKIN DIMPLING

PEAU d`ORANGE IS DUE TO OEDEMA OF SKIN LYMPHATIC

DUCT SYSTEMDUCT SYSTEM

MAJOR DUCT

[MINORMINOR ] ]OROR

[TERMINALTERMINAL]

MINOR DUCT IS THE SITE OF LOBULAR

CARCINOMA

INTERNAL MAMMARY L.N.

SENTINEL L.N

PECTORAL

LAT.THOR.V

RPOSTERIO

LATERAL

APICAL

85% OF THE BREAST DRAIN

INTO THE AXILLA

CENTRAL

LONG THORACIC N

SUPERIOR THORACIC V.

SUBSCAP.V

IF IT IS FILLED WITH

MILK IT IS GALACTOCELE

MASTITIS;MASTITIS;PLUGGED DUCT OR CRACKED PLUGGED DUCT OR CRACKED

NIPPLE,[NIPPLE,[STAPHYLLOCOCCISTAPHYLLOCOCCI]]

ABSCESS

60%60% OF MASTITIS IN OF MASTITIS IN LACTATING WOMEN LACTATING WOMEN

TYPES OF MASTITISTYPES OF MASTITIS

MASTITIS NEONATORUMMASTITIS NEONATORUM MASTITIS OF PUBERTYMASTITIS OF PUBERTY LACTATING MASTITISLACTATING MASTITIS SPECIFIC MASTITIS;SPECIFIC MASTITIS; 1-T.B MASTITIS1-T.B MASTITIS 2-SYPHILITIC MASTITIS2-SYPHILITIC MASTITIS 3-ACTINMYCOSIS3-ACTINMYCOSIS

BENIGN BREAST DISEASEBENIGN BREAST DISEASE

FIBROADENOMAFIBROADENOMA FIBROCYSTIC DISFIBROCYSTIC DIS DUCTECTASIADUCTECTASIA BENIGN CYSTSBENIGN CYSTS LIPOMA:VERY RARELIPOMA:VERY RARE

]DANGEROUS TO DIAGNOSE LIPOMA[]DANGEROUS TO DIAGNOSE LIPOMA[

FIBROADENOMAFIBROADENOMA

BREAST MOUSE

SMALL ONES COULD BE LEFT ALONE

Giant fibroadenoma> 5 Giant fibroadenoma> 5 CMCMCAN BECOME MALIGNANTCAN BECOME MALIGNANT

DUCTECTASIADUCTECTASIA

CYSTOSARCOMA CYSTOSARCOMA PHYLLOIDESPHYLLOIDES

THOUGHT TO BE MALIGNANTTHOUGHT TO BE MALIGNANT

]NOTICE THE NAME[]NOTICE THE NAME[ BUT IT IS NOT. BUT IT IS NOT.

MAY REACHMAY REACH HUGE HUGE SIZE & SIZE &ULCERATEULCERATE

HOWEVER THERE ARE WORRYINGHOWEVER THERE ARE WORRYING

MITOTICMITOTIC FIGURES SOMETIMES FIGURES SOMETIMES

DENOTING MALIGNANT POTENTIALDENOTING MALIGNANT POTENTIAL

FIBROCYSTIC DISEASE[FIBROCYSTIC DISEASE[ANDIANDI]]

BLUE DOMED CYSTBLUE DOMED CYST

WHEN A BENIGN BREASTWHEN A BENIGN BREASTDISEASE BECOMES WORRYINGDISEASE BECOMES WORRYING??

WHEN A PATHOLOGY SPECIMENWHEN A PATHOLOGY SPECIMEN

SHOWS SHOWS ATYPICAL HYPERPLASIAATYPICAL HYPERPLASIA FLORID HYREPLASIA CARRIES AMILD FLORID HYREPLASIA CARRIES AMILD

RISKRISK

NB;METAPLASIANB;METAPLASIA

AND MILD HYPERPLASIA CARRYAND MILD HYPERPLASIA CARRY

NO RISKNO RISK

CYSTSCYSTS

ANDIANDI LYMPHATIC CYSTSLYMPHATIC CYSTS HYDATID CYSTHYDATID CYST GALACTOCELEGALACTOCELE SEROCYSTIC DISEASE OF BRODIESEROCYSTIC DISEASE OF BRODIE INTRACYSTIC PAPILLIFEROUS CAINTRACYSTIC PAPILLIFEROUS CA COLLOID DEGENERATION OF CA.COLLOID DEGENERATION OF CA. PAPILLARY CYSTADENOMAPAPILLARY CYSTADENOMA

CYSTSCYSTS

BENIGNBENIGN MALIGNANTMALIGNANT MANAGEMENT OF A CYSTMANAGEMENT OF A CYSTASPIRATE & OPERATE OR CORE BIOPSY IF;ASPIRATE & OPERATE OR CORE BIOPSY IF;1-BLOODY ASPIRATE1-BLOODY ASPIRATE2-DID NOT DISAPPEAR COMPLETELY AFTER 2-DID NOT DISAPPEAR COMPLETELY AFTER

ASPIRATIONASPIRATION3-RECURES IN 6 WEEKS3-RECURES IN 6 WEEKS

NIPPLE DISCHARGENIPPLE DISCHARGE

I=NONBLOODY;I=NONBLOODY;

1-FIBROCYSTIC DISEASE1-FIBROCYSTIC DISEASE

2-DUCTECTASIA2-DUCTECTASIA II=II=BLOODY;BLOODY;

1-DUCTECTASIA; 1-DUCTECTASIA; COMMONCOMMON

2-DUCT PAPILLOMA; 2-DUCT PAPILLOMA; MOST COMMONMOST COMMON

3-DUCT CARCINOMA;3-DUCT CARCINOMA;VERYVERY RARERARE

BLOODY NIPPLEBLOODY NIPPLE DISCHARGE DISCHARGE

NORMAL DUCT DUCT PAPILLOMANORMAL DUCT DUCT PAPILLOMA

MICRODOCHECTOMYMICRODOCHECTOMY FOR BLEEDING NIPPLE FOR BLEEDING NIPPLE

BLEEDING SEGMENT IS REMOVED AND SUBMITTED TO

HISTOPATHOLOGY

PROBE

DETERMINE FIRST WHICH ORIFICE OR SEGMENT IS BLEEDING

BY PRESSING AROUND THE AREOLA

BREAST CANCERBREAST CANCER

1.1. DUCTAL CARCINOMA ]90%[DUCTAL CARCINOMA ]90%[

2.2. LOBULAR CARCINOMA]<10%[LOBULAR CARCINOMA]<10%[

3.3. PAGET`S DISEASEPAGET`S DISEASE

4.4. INTRACYSTIC PAPILLIFEROUS CAINTRACYSTIC PAPILLIFEROUS CA

5.5. SARCOMASARCOMA

What Are the Risk What Are the Risk FactorsFactors for Breast Cancer for Breast Cancer?? 1-1-Age; INCREASING AGEAge; INCREASING AGE

2-2-Race;WHITE++.RARE IN JAPAN,Race;WHITE++.RARE IN JAPAN, 3-3-Individual or family history of breast cancerIndividual or family history of breast cancer 4-4-A history of ovarian cancerA history of ovarian cancer 5-5-A genetic predisposition (mutations to the A genetic predisposition (mutations to the BRCA1BRCA1 or or

BRCA2BRCA2 genes cause 2% to 3% of all breast cancers) genes cause 2% to 3% of all breast cancers) 6-6-Estrogen exposure;MENARHE,MENOPAUSEEstrogen exposure;MENARHE,MENOPAUSE 7-7-Atypical hyperplasia of the breastAtypical hyperplasia of the breast 8-8-Lobular carcinoma in situ (LCIS)Lobular carcinoma in situ (LCIS) 9-9-Lifestyle factors (obesity, lack of exercise, alcohol use)Lifestyle factors (obesity, lack of exercise, alcohol use) 10-10-RadiationRadiation

1-1-Age; INCREASING AGEAge; INCREASING AGE 25:25:1/20,0001/20,000.. 45:45:1/1001/100.. 50:50:1/501/50.. 55:55:1/331/33.. 60:60:1/241/24. . 80:80:1/101/10.. 2-2-Race;WHITE++.RARE IN JAPAN,Race;WHITE++.RARE IN JAPAN,3-3-Individual or family history of breast cancerIndividual or family history of breast cancer4-4-A history of ovarian cancerA history of ovarian cancer5-5-A genetic predisposition (mutations to the A genetic predisposition (mutations to the BRCA1BRCA1 or or BRCA2BRCA2 genes cause 2% to 3% of all breast cancers) genes cause 2% to 3% of all breast cancers)6-6-Estrogen exposure;MENARHE,MENOPAUSEEstrogen exposure;MENARHE,MENOPAUSE7-7-Atypical hyperplasia of the breastAtypical hyperplasia of the breast8-8-Lobular carcinoma in situ (LCIS)Lobular carcinoma in situ (LCIS)9-9-Lifestyle factors (obesity, lack of exercise, alcohol use ) Lifestyle factors (obesity, lack of exercise, alcohol use ) 10-10-RadiationRadiation

About 15%About 15%?[3-15]?[3-15]of breast cancers are of breast cancers are inheritedinheritedApproximately 80% of hereditary breast Approximately 80% of hereditary breast cancer is caused by mutations in the cancer is caused by mutations in the BRCA1BRCA1 or or BRCA2 BRCA2 genes.genes.P53P53 has a role too has a role tooWomen who inherit a BRCA mutation have a Women who inherit a BRCA mutation have a 50% to 85%50% to 85% chance of developing breast chance of developing breast cancer in their lifetimecancer in their lifetimeWomen with especially strong family history Women with especially strong family history may consider preventive surgery to remove may consider preventive surgery to remove breast tissue and/or chemopreventionbreast tissue and/or chemopreventionSeveral other genetic syndromes can Several other genetic syndromes can increase breast cancer riskincrease breast cancer risk

SITESSITES

LT.BREAST

60% 12%

10% 6%

12%

RT. LT.

60

6

60

6

MODE OF SPREAD OFMODE OF SPREAD OF DUCTAL CARCINOMA DUCTAL CARCINOMA

LOCALLOCAL LYMPHATICLYMPHATIC BLOOD; BLOOD; BONE BONE SOFT TISSUESOFT TISSUE

1-1-LUMBER V. LUMBER V. 1-1-LIVERLIVER

2-2-FEMUR FEMUR 2-2-LUNGLUNG

3-3-THORAC V. THORAC V. 3-3-BRAINBRAIN

4-4-RIBS RIBS 4-4-KIDNEYKIDNEY

5-5-SKULL SKULL 5-5-ADRENALS ADRENALS

DIAGNOSISDIAGNOSIS

TRIPLE ASSESSMENTTRIPLE ASSESSMENT 1-CLINICAL: A-AGE . 1-CLINICAL: A-AGE .

B-EXAMINATIONB-EXAMINATION 2-IMAGING : A-US . 2-IMAGING : A-US .

B-MAMMOGRAMB-MAMMOGRAM 3-PATHOLOGY: A-FNA. 3-PATHOLOGY: A-FNA.

B-CORECUTB-CORECUT

FNA & CORECUTFNA & CORECUT

FNA FNA ]CYTOLOGY ]CYTOLOGY EXAMINATION[EXAMINATION[ HAS 5% FALSE HAS 5% FALSE –VE MOSTLY DUE TO –VE MOSTLY DUE TO

SAMPLING ERRORSAMPLING ERROR CORECUT ]TRUCUT[ IS A CORECUT ]TRUCUT[ IS A

TISSUE HISTOPATHOLOGYTISSUE HISTOPATHOLOGY THAT IS MORE ACCURATE THAT IS MORE ACCURATE AND TELLS YOU ABOUTAND TELLS YOU ABOUT

THE GRADE & INVASIVENESS; THE GRADE & INVASIVENESS; IN-SITU OR INVASIVE IN-SITU OR INVASIVE

MAMMOGRAMMAMMOGRAM

MALIGNANTMALIGNANT 1-CALCIFICATION;1-CALCIFICATION; CLUSTER]5-6[ OF BRANCHED FINE CLUSTER]5-6[ OF BRANCHED FINE

MICROCALCIFICATIONMICROCALCIFICATION 2-ARCHITECTURAL CHANGES;2-ARCHITECTURAL CHANGES; SPIKY DENSE IRREGULAR MASSSPIKY DENSE IRREGULAR MASS

BENIGNBENIGNWELL DEFINED ROUNDED MASS WITHWELL DEFINED ROUNDED MASS WITHHALO SIGN; CYST,FIBROADENOMAHALO SIGN; CYST,FIBROADENOMA

MAMMOGRAMMAMMOGRAM

CONVENTIONAL & DIGITALCONVENTIONAL & DIGITAL IT IS NON USED FOR YOUNGER IT IS NON USED FOR YOUNGER

WOMEN BECAUSE THEIR DENSE WOMEN BECAUSE THEIR DENSE BREAST TISSUE GIVES FALSE BREAST TISSUE GIVES FALSE POSITIVE RESULTSPOSITIVE RESULTS

BUT IT IS GOOD FOR THE SOFT BUT IT IS GOOD FOR THE SOFT BREASTS BECAUSE THE GLANDULAR BREASTS BECAUSE THE GLANDULAR TISSUE IS SEPERATED BY FAT TISSUE IS SEPERATED BY FAT PLANESPLANES

FIBROADENOMA ON FIBROADENOMA ON MAMMOGRAMMAMMOGRAM

MRIMRI

IS THE MOST SENSITIVEIS THE MOST SENSITIVE

1- CAN PICK UP CARCINOMA IN-SITU1- CAN PICK UP CARCINOMA IN-SITU

2- DIFFERENTIATES BETWEEN LOCAL 2- DIFFERENTIATES BETWEEN LOCAL RECURRENCE AND FIBROSISRECURRENCE AND FIBROSIS

MRIMRI NO RADIATION BUT MAGNETIC FIELDNO RADIATION BUT MAGNETIC FIELD 1-CAN VISUALIZE A PALPAPABLE MASS WHICH IS NOT SEEn 1-CAN VISUALIZE A PALPAPABLE MASS WHICH IS NOT SEEn

ON U/S OR MAMMOGRAMON U/S OR MAMMOGRAM 2-CAN BE USEFUL IN YOUNG WOMEN2-CAN BE USEFUL IN YOUNG WOMEN 3-CAN LOCATE BREAST CANCER WITH AXILLARY L.N. METS 3-CAN LOCATE BREAST CANCER WITH AXILLARY L.N. METS

BUT BREAST FREE ON US OR MAMMOGRAMBUT BREAST FREE ON US OR MAMMOGRAM 4-CAN DETECT MULTICENTRIC LESION4-CAN DETECT MULTICENTRIC LESION 5-CAN DIFFERENTIATE BETWEEN RECURRENCE AND 5-CAN DIFFERENTIATE BETWEEN RECURRENCE AND

FIBROUS TISSUEFIBROUS TISSUE 6-CAN DETECT SILICON LEAK6-CAN DETECT SILICON LEAK DISADVANTAGESDISADVANTAGES 1-CANNOT DETECT CALCIFICATIONS1-CANNOT DETECT CALCIFICATIONS UBOS:UNIDETIFIED BRIGHT OBJECTSUBOS:UNIDETIFIED BRIGHT OBJECTS DISLODGE CERTAIN METALS;RACEMAKERDISLODGE CERTAIN METALS;RACEMAKER EXPENSIVEEXPENSIVE

POSITRON EMISSIONPOSITRON EMISSION MAMMOGRAM SHOWS MAMMOGRAM SHOWS [MULTIFOCAL LESION] [MULTIFOCAL LESION]

RETRACTED BREASTRETRACTED BREAST

SWOLLEN BREAST WITH SWOLLEN BREAST WITH NIPPLE RETRACTIONNIPPLE RETRACTION

CANCER EN-CUIRASSE

درع المحارب

MULTIPLE LOCAL RECURRENCE

LYMPHOEDEMALYMPHOEDEMA

COMBINATION OF SURGERY &RADIOTHERAPY ON THE AXILLA CAN CAUSE THIS

Axillary venous Axillary venous thrombosis in ca. breastthrombosis in ca. breast

DIFF.DIAGNOSIS OFDIFF.DIAGNOSIS OF MASTITISMASTITIS & MASTITIS CARCINOMATOSA & MASTITIS CARCINOMATOSA

MASTITIS CARCINOMATOSAMASTITIS CARCINOMATOSA ]INFLAMMATORY CARCINOMA[]INFLAMMATORY CARCINOMA[ IS THE MOST MALIGNANT OF ALL BR. CA.IS THE MOST MALIGNANT OF ALL BR. CA. MASTECTOMY IS RARELY INDICATED BECAUSE IT IS LATEMASTECTOMY IS RARELY INDICATED BECAUSE IT IS LATE NO CONSTITUTIONAL SYMPTOMSNO CONSTITUTIONAL SYMPTOMS NO FEVER NO FEVER NO LEUCOCYTOSISNO LEUCOCYTOSIS SKIN OEDEMA > 1/3 OF THE BREAST SKIN OEDEMA > 1/3 OF THE BREAST IN BOTH THE BREAST IS WARM,TENDERIN BOTH THE BREAST IS WARM,TENDER BOTH OCCUR IN CHILD BEARING PERIODBOTH OCCUR IN CHILD BEARING PERIOD DIFFICULT TO DISTINGUISH SOMETIMES EXCEPT BY CORECUT DIFFICULT TO DISTINGUISH SOMETIMES EXCEPT BY CORECUT

BIOPSY.BIOPSY. US & MAMMOGRAM ARE US & MAMMOGRAM ARE USELESSUSELESS BECAUSE THERE IS NO MASS BECAUSE THERE IS NO MASS

DIFF.DIAGNOSIS OF DIFF.DIAGNOSIS OF PAGET`S DISEASE &ECZEMA OF THE NIPPLEPAGET`S DISEASE &ECZEMA OF THE NIPPLE

PAGET`S DISEASEPAGET`S DISEASE THERE IS AN UNDERLYING BREAST CANCERTHERE IS AN UNDERLYING BREAST CANCER UNILATERALUNILATERAL NIPPLE DESTRUCTIONNIPPLE DESTRUCTION BOUNDRIES OF THE LESION IS WELL BOUNDRIES OF THE LESION IS WELL

DEMARKATEDDEMARKATED DOES NOT RESPOND TO STEROID LOCAL DOES NOT RESPOND TO STEROID LOCAL

THERAPYTHERAPY

PAGET`S DISEASE OF THEPAGET`S DISEASE OF THE BREAST BREAST

PAGET`S DISEASE OF THEPAGET`S DISEASE OF THE BREAST BREAST

LOBULAR CARCINOMALOBULAR CARCINOMA•ARISE FROM THE

TERMINAL DUCTS

•COULD BE MULTIFOCAL.IT IS BILATERAL

IN 20% OF CASES

•IN UNILATERAL CASES ALWAYS WATCH THE OTHER BREAST

•LCIS DOES NOT NEED

FURTHER ACTION

EXCEPT CAREFUL F.U

Carcinoma in pregnancyCarcinoma in pregnancy

THEY ARE DIAGNOSED LATETHEY ARE DIAGNOSED LATE THEY BEHAVE THE SAME AS NON-PREGN.THEY BEHAVE THE SAME AS NON-PREGN. THEY ARE TREATED THE SAMETHEY ARE TREATED THE SAME NONO BREAST CONSERVING SURGERY BREAST CONSERVING SURGERY NONO RADIOTHERAPY;TERATOGENIC RADIOTHERAPY;TERATOGENIC NONO CHEMOTHERAPY IN THE FIRST CHEMOTHERAPY IN THE FIRST

TRIMESTERTRIMESTER NO NO HORMONAL THERAPY;BECAUSEHORMONAL THERAPY;BECAUSE THEY ARE HORMONE RECEPT.-VETHEY ARE HORMONE RECEPT.-VE

STAGES OF CA. BREASTSTAGES OF CA. BREAST

MASS<2CM .

NO L.N .

MASS2-5CM.MOB.L.N MASS5-10CM.FIX.L.N

OR MASS FIXED

TO CHEST WALL

SUPRACLAV.L.N.OR

DISTANT METS

CIS

STAGE 0

CARCINOMA

IN SITU CONFINED

TO BASEMENT

MEMBRANE.

NON INVASIVE.

CLINICALLY;

IMPALPABLE

II II III

IV

DCIS & LCISDCIS & LCIS

Solid Cribiform Papillary

Comedo Vascular and Lymphatic Invasion

Non-Invasive (In Situ) Cell Growth Subtypes:

COMEDO:ACNE

INVESTIGATIONS FORINVESTIGATIONS FOR DISTANT METASTASIS DISTANT METASTASIS

BLOODBLOOD

S.ALK.PHOSPHATASES.ALK.PHOSPHATASE

GGT]Gamma Glutamin Transferase[GGT]Gamma Glutamin Transferase[ RADIOLOGYRADIOLOGY

CXRCXR

US;LiverUS;Liver NUCLEARNUCLEAR

ISOTOPE BONE SCANISOTOPE BONE SCAN

WHAT DOES STAGING MEANWHAT DOES STAGING MEAN

STAGE I & II :EARLY BREAST CANCERSTAGE I & II :EARLY BREAST CANCER

]POTENTIALLY CURABLE DISEASE[]POTENTIALLY CURABLE DISEASE[ STAGE III & IV : ADVANCED CANCERSTAGE III & IV : ADVANCED CANCER

]INCURABLE DISEASE[]INCURABLE DISEASE[

WHAT IS THE MOST SIGNIFICANT WHAT IS THE MOST SIGNIFICANT PROGNOSTIC FACTORPROGNOSTIC FACTOR ? ?

AXILLARY LYMPH NODES INVOLVEMENT & AXILLARY LYMPH NODES INVOLVEMENT & NUMBER;IS THE MOSTNUMBER;IS THE MOST

NO L.N; 85% 5-YEAR SURVIVALNO L.N; 85% 5-YEAR SURVIVAL 3 L.N. ; 50%3 L.N. ; 50% >3L.N. : 25-40%>3L.N. : 25-40% OTHER FACTORSOTHER FACTORS 1-GRADE1-GRADE,2- -VE HORMONE RECEPTORS,,2- -VE HORMONE RECEPTORS,33--SIZESIZE,,

4-4-VASCULAR&LYMPH.INVASIONVASCULAR&LYMPH.INVASION, , 5-HER5-HER22, , 6-6-EPIDERMALEPIDERMAL GROWTH FACTORGROWTH FACTOR

MANAGEMENT OF EARLYMANAGEMENT OF EARLYBREAST CANCERBREAST CANCER

BREAST CONSERVING SURGERY: BREAST CONSERVING SURGERY:

WIDE LOCAL EXCISION WIDE LOCAL EXCISION ++ AXILLARY AXILLARY

CLEARANCECLEARANCE++ LOCAL BREAST LOCAL BREAST RADIOTHERAPYRADIOTHERAPY

PROVIDED MASSPROVIDED MASS

BREAST RELATIONBREAST RELATION

IS ACCEPTABLEIS ACCEPTABLE

INDICATIONS OF MODIFIEDINDICATIONS OF MODIFIED RADICAL MASTECTOMY RADICAL MASTECTOMY

1. BIG SIZE TUMOUR IN REALATION 1. BIG SIZE TUMOUR IN REALATION TO THE BREASTTO THE BREAST

2.CENTRAL TUMOUR;2.CENTRAL TUMOUR;UNDERUNDER THE NIPPLETHE NIPPLE

3.MULTIFOCAL TUMOUR3.MULTIFOCAL TUMOUR

4. RECURRENCE AFTER LUMPECTOMY4. RECURRENCE AFTER LUMPECTOMY

5. PATIENT`S PREFERENCE5. PATIENT`S PREFERENCE

Sentinel node biopsy is a technique Sentinel node biopsy is a technique which helps determine if a cancer has which helps determine if a cancer has spread (metastisized), or is contained spread (metastisized), or is contained

locally. When a cancer has been locally. When a cancer has been detected, often the next step is to find detected, often the next step is to find

the lymph node closest to the tumor site the lymph node closest to the tumor site and retrieve it for analysis. The concept and retrieve it for analysis. The concept of the "sentinel" node, or the first node of the "sentinel" node, or the first node

to drain the area of the cancer, allows a to drain the area of the cancer, allows a more accurate staging of the cancer, more accurate staging of the cancer,

and leaves unaffected nodes behind to and leaves unaffected nodes behind to continue the important job of draining continue the important job of draining

fluids. The procedure involves the fluids. The procedure involves the injection of a dye (sometimes mildly injection of a dye (sometimes mildly

radioactive) to pinpoint the lymph node radioactive) to pinpoint the lymph node which is closest to the cancer site. which is closest to the cancer site.

Sentinel node biopsy is used to stage Sentinel node biopsy is used to stage many kinds of cancer, including lung many kinds of cancer, including lung

and skin (melanoma).and skin (melanoma).

Sentinel node biopsy

WHAT IS MODIFIED WHAT IS MODIFIED RADICAL MASTECTOMYRADICAL MASTECTOMY

A.VEIN

ApicalLateral

INTERPECTORAL

POSTERIOR

CENTRAL

LONG THORACIC N.

SHOULD BE PRESERVED

INTERCOSTO-BRACHIAL N.

CAN BE SACRIFIED

WHAT IS THE DIFFERENCE WHAT IS THE DIFFERENCE BETWEEN THE 2BETWEEN THE 2

NO DIFFERENCE IN 5-YEAR SURVIVALNO DIFFERENCE IN 5-YEAR SURVIVAL THERE IS A DIFFERENCE IN LOCAL THERE IS A DIFFERENCE IN LOCAL

RECURRENCERECURRENCE RECURRENCE AFTER LUMPECTOMYRECURRENCE AFTER LUMPECTOMY

IS MORE .TREATED BY MASTECTOMYIS MORE .TREATED BY MASTECTOMY

AND THEY DO BETTERAND THEY DO BETTER

THE OTHER MODALITIESTHE OTHER MODALITIES

CHEMOTHERAPYCHEMOTHERAPY;== ;== CMF CMF ==== 1-ADJUVANT & 1-ADJUVANT & 2-NEOADJUVANT2-NEOADJUVANT HORMONAL THERAPY;HORMONAL THERAPY; TAMOXIFENTAMOXIFEN: OESTROGEN BLOCKER : OESTROGEN BLOCKER

LHRHLHRH : OVARIAN ABLATION : OVARIAN ABLATION ANASTROZOLE:ANASTROZOLE: AROMATASE INHIBITOR INHIBIT AROMATASE INHIBITOR INHIBIT CONVERSION OF ANROGENS TO OESTROGENCONVERSION OF ANROGENS TO OESTROGEN IMMUNE THERAPY; IMMUNE THERAPY; HERCEPTIN ]monoclonal HERCEPTIN ]monoclonal

antibody[ ANTI-HER2antibody[ ANTI-HER2 RADIOTHERAPY; LOCAL ACTIONRADIOTHERAPY; LOCAL ACTION

BIOLOGICALLY TARGETED BIOLOGICALLY TARGETED THERAPYTHERAPY MONOCLONAL ANTIBODY ATTACHED MONOCLONAL ANTIBODY ATTACHED

TO PROTEIN MOLLECULE ON THE TO PROTEIN MOLLECULE ON THE SURFACE OF CANCER CELL TO SLOW SURFACE OF CANCER CELL TO SLOW ITS GROWTHITS GROWTH

ANGIOGENESIS INHIBITORANGIOGENESIS INHIBITOR SIGNAL TRANSDUCTION INHIBITORSIGNAL TRANSDUCTION INHIBITOR

Port-a-cathPort-a-cathfor systemic chemotherapyfor systemic chemotherapy

Chemotherapy

kills all dividing cells ]malignant or not malignant[.so bone marrow GIT and skin are affected .

HOW TO EXAMINE YOURHOW TO EXAMINE YOUR OWN BREASTSOWN BREASTS

TEACH PATIENT LOOK AT THE

MIRROR

NOTE ANY ABNORMALITY IN YOUR BREASTS OR AXILLAE AT EVERY SHOWER

USE PALMER ASPECTS OF USE PALMER ASPECTS OF YOUR FINGERS

gynecomastiagynecomastia

MOSTLY IDIOPATHIC

LIVER DISEASE

TESTICULAR ATROPHY

DRUGS

MALE BREAST CANCERMALE BREAST CANCER

THE SAME LIKE FEMALE BREAST PATHOLOGY & MANAGEMENT

BUT THE PROGNOSIS IS WORSE

MALE BREAST CANCER