BREAST DISORDERS BENIGN & MALIGNANT

G. JUMBI

LEARNING OBJECTIVES
At the end of this lecture, the student will be able to: Describe the 6 axillary lymphnode groups. Appreciate the concept of ANDI in the classification of breast disorders Enumerate the vious forms of mastitis Describe the pathogenesis and the natural Hx of acute bacterial mastitis Enumerate the major and minor risk factors in breast cancer Enumerate the modern histological types of breast cancer Appreciate the 3 lymphnode levels of cancer spread Describe the Manchester staging method Describe the TNM staging

ANATOMY
The boundaries (Anatomical & clinical) The nipple The areolar The breast tail

LYMPHATIC DRAINAGE
Axillary nodes 85% Internal mammary nodes 15% Axillary nodes (6 groups) Central group Lateral ,, Anterior ,, Posterior ,, Interpectoral ,, Apical ,, Level 1, 2, 3 (pectoralis minor) NB Sentinel node

CLASSIFICATION OF BREAST DISORDERS

CONGENITAL AQUIRED ANDI disorders Inflammatory disorders Injuries to the breast Neoplastic Benign Malignant

ANDI DISORDERS (Aberations of Normal and Developemental & Involution)

Breast hypertrophy Fibrocystic Disease (Fibroadenosis)(cysts) Mastalgia Mastopathy Galactocoele

INFLAMMATORY BREAST DISEASE

Acute Bacterial Mastitis & Breast Abscess Aetiology S. aureus Risk factors Celluritis stage, Resolution, abscess Chronic mastitis TB, Syphilis, Actinomycosis Other forms of mastitis Duct ectasia Mastitis of infants Breast engorgements Mondors Disease (thromophlebitis)

BREAST INJURIES
Breast haematoma

Fat necrosis

NEOPLASTIC DISEASES
BENIGN Fibroadenomas Phylloides tumour (Cystsarcoma phylloides) (Serocystic Disease of Brodie)

MALIGNANT (Breast Cancer) Primary Breast cancer Breast carcinoma. Breast sarcomas ( ? Phylloides) Lymphomas Secondary

BREAST CARCINOMA
1. 2. 3. 4. 5. MAJOR RISK FACTORS 1ST degree relative Male gender Age >50 yrs Cancer in the other breast Breast cancer genes (BRCA 1& BRCA 2)

MINOR RISK FACTORS (HORMONE RELATED) Early menache, Late menopouse, Nulliparity, HRT, Lack of breast feeding Others: Irradiation. Diet. Obescity, geographical

CA. BREAST
SPREAD Local to Lymphatic to Haematogenous to

CA. BREAST (HITOLOGICAL TYPES)

Ductal carcinoma (85%) Lobular carcinoma (15%) Can be
1). Non invasive (Carcinoma-In-Situ (CIS) 2). Invasive Both can be of different grades of malignancy: Well differentiated (low grade malignancy = Grade I moderately differentiated (moderate grade malignancy = Grade II) Poorly differentiated (high grade malignancy = grade III, IV

CA. BREAST: STAGING

TNM Staging Manchester Staging Others

MANCHESTER STAGING
STAGE I Tumour confined to the breast No nodes STAGE II Tumour confined to the breast Mobile nodes STAGE III Tumour spread to the skin/muscle/ulcerated STAGE IV Tumour any size. Fixed axillary nodes/supraclavicular nodes Distant metastases

TNM STAGING
FIRST CLASSIFY THE TUMOUR SIZE, NODES SPREAD & METASTASES SPREAD INTO THEIR TNM CLASSIFICATION THEN CONVERT CLASSES TO STAGES

TNM CLASSIFICATION (Breast cancer)

Tumour size -T1<2cm, T2=2-5cm, T3=2-5cm, T4= Any size with invasion of skin or mucsle Nodal spread N0 = No nodes N1 = Mobile nodes N2 = Matted/fixed nodes N3 = Supraclavicular nodes Metastases spread M0 = No distant metastes M1 = Distant metastases

TNM STAGING: Convertion of TNM class to stages

Stage 0 Stage I = CIS (Carcinoma-in-situ) = T1, N0, M0. (Early Breast Cancer)

Stage II

= T2, N1, M0. (Early Breast Cancer)

Stage IIIA/B = T3/4, N2/3, M0. (Advanced Breast Cancer) Stage IV = Any T, Any N, M1 (Advanced Breast Cancer)

SUMMARY (must know)

The clinical extent of the breast is larger than the anatomical boundaries. The breast has 15-20 lobes. Each lobe is drained by a lactiferous duct. About 10-100 lobules drain into each lactiferous duct through ductules. 85% of lymphatics drain into the 6 axillary lymphnode groups. Classification of breast disorders include the ANDI group Acute bacterial mastitis has a celluritis phase, resolution phase and necrosis phase and

SUMMARY cont. (must know)

Exclude breast cancer in all cases of breast disease Major risk factors are Fx, 50yrs, female gender, cancer in opposite breast, BRCA genes (1&2). The histological types of breast cancer are the lobular and the ductal carcinoma. Can be non invasive (carcinoma-in-situ) or invasive. Can be of different grades Spread to axillary lymphnode occurs in 3 levels: level 1, 2, & 3 (below, behind and above the pectoralis minor) Manchester staging and TNM staging

THE END THANK YOU