Breast Neoplasia
Physiology
Produce colostrum and
milk
15 - 20 glandular
milk producing units arranged radial around the nipple, ducts transport milk to
the nipple
Neoplastic tissue
A neoplasm is a new
tissue where there is not supposed to be any tissue.
There are two types
of neoplastic tissue benign and malignant
Metastasis,
(pleural), metastases - the spread of a disease process from one part of the
body to another, as in the appearance of neoplasms in parts of the body remote
from the site of the primary tumour; results from dissemination of tumour cells
by the lymphatics or blood vessels, or by direct invasion.
Malignant
breast disease
Epidemiology
29 000 women
diagnosed annually - 15 000 deaths per year
5% of female deaths,
19% of new female cancers
Effects 1 in 12 women
The
Peak incidence age is
late 60s
200 cases per year in
men, 90 deaths per year.
Aetiology
Anyone can get breast
cancer - however risk factors have been identified
Not breast feeding
Endocrine factors -
early menarche, late menopause, nulliparty, child bearing after 30
Family history -
especially in a pre-menopausal first degree relative
High fat diet,
HRT, combined oral
contraception when young
Obesity in the over
60s
Alcohol 6% of cases -
no link with smoking
Probably 5 genes
predispose to breast cancer - the earlier a cancer presents the more likely it
is to be genetic in aetiology
The problem is what to
do with genetic information once you have it - tamoxifen, surgery, and
screening
Cancers in general may be caused by,
Poor diet, too much
bad food or not enough good food
Age, genetics, racial
and geographical factors, carcinogens, radiation, viruses, oncogenes, lack of
effect of tumour suppresser genes
Screening
Breast awareness
Examination after LMP
Mammography
Pathology
Most tumours are
histopathologically adenocarcinomas
Spread is common to
axillary and supraclavicular lymph nodes, brain, lungs, liver and bone
Staging
In situ means the
tumour is contained within the duct system
Not in situ means the
tumours had invaded its way out of the duct system
TNM staging is used
Tumour
Nodes
Metastases
Clinical features
Most malignant
tumours are - ill defined, hard, involve adjacent tissue
A lump - often rapid
increase in size
Lump in the lymph
nodes
Possible Paget`s
disease of the nipple - invasion of the epidermis with malignant cells from the
ducts
Inversion of the
nipple
Change in position of
the nipples
Puckering or dimpling
of the skin, swelling
Any discharge from
the nipple, bleeding or weeping
Any unusual
discomfort in the breast
A breast which turns
in on itself or points upward or outwards unusually
Veins may stand out
more than usual
Rash or unusual
colouring
May be no lump on
palpation, only on investigations
Diagnosis
Palpation,
mammography, fine needle aspiration, biopsy, ultrasound, body imaging
Management
Lumpectomy,
mastectomy, combination chemotherapy, endocrine therapy e.g. tamoxifen,
radiotherapy. Herceptin is a MAB which is useful in early metastatic disease in
the 20 – 40% of patients with over expression or proto-oncogene gene
amplification or expression of HER2, (a protein found on the outer cell
membrane)
Benign
breast disease
Fibroadenoma
The most common
breast mass in young women
Well defined mobile
mass, slow growing and self-limiting,
6 - 12 months to double in size and usually stop at 3cm diameter
Frequently
fibroadenomas are multiple
Fibrocystic disease
A disease of breast
lobules which dilate and encyst
Grow up to 1 – 2 cm in diameter
Often during the
first 2 weeks of lactation
Usually
Staphylococcus aureus, may be Streptococcus
Abscess may occur