Breast cancer is a common and serious form of cancer that affects millions of women globally each year. It starts in the breast tissue and can spread to other parts of the body if not detected early. Some key risk factors include gender, age, family history and lifestyle factors. Symptoms may include a breast lump, skin changes, nipple discharge or inversion. Diagnosis involves examinations, mammography, ultrasound and biopsy. Cancer is staged according to tumor size and spread. Treatment options include surgery to remove all or part of the breast, chemotherapy, radiation therapy, hormone therapy and targeted drug therapies. The goal is cure, remission or palliation depending on the stage and type of cancer.

1. BREAST
CANCER
By
NIDHIL NARAYANAN
TBILISI STATE MEDICAL UNIVERSITY

2. • According to Global cancer statistics 2020 report, 2.3 million new
cases of women diagnosed with breast cancer
• About 10 million deaths in women due to breast cancer globally
• In India number of breast cancer cases is 1,15,000 per year and
expected to rise to 2,76,480 new cases by 2020

3. OBJECTIVES
•Anatomy of Breast tissue
•Breast Cancer
•Risk Factors
•Signs & Symptoms
•Cancer Grading & Stages
•Treatment

4. STRUCTURE
• clavicle superiorly,
• the lateral border of the latissimus
muscle laterally,
• the sternum medially
• inframammary fold inferiorly
BOUNDARIES
ADIPOSE FAT
ASTLEYS COPPERS
LIG

5. BLOOD SUPPLY
• Perforating branches of the internal mammary arteries
• the lateral thoracic arteries
• thoracoacromial arteries
• posterior intercostal arteries

6. LYMPH NODES
AND LYMPHATICS
• 75% -Axillary nodes
• 25% -internal mammary
• Carcinoma of breast spreads mostly
along the lymphatic to the Regional lymph
nodes .

7. MUSCULAR RELATIONS

8. BREAST CANCER
• Abnormal mass of tissue, the growth of
which exceeds and is uncoordinated with
that of the normal tissues and persists in
the same manner after the cessation of
stimuli which evoked the change.
• Breast cancer is cancer originating in
the breast tissue.

9. RISK
FACTORS
• Gender (female 99% and male 1 % )
• Increased age
• Family history (genetic BRCA1 ,2 , P53 ,STK
11 )
• Lack of child bearing or breast feeding
• Higher hormone levels
• Late age of menopause
• Alcohol
• Dense breast tissue
• Diethylstilbesterol exposure
• HRT

10. SIGNS AND
SYMPTOMS
• Lump in the breast ( classsi )
• Changes in the breast size or shape
• Skin dimpling
• Nipple inversion
• Spontaneous discharge from nipple
• Change in texture of the skin
• Pain
• Axilla swelling
• Tender bone

11. TYPES OF BREAST CANCER
• •Non-invasive: ductal carcinoma in-situ
lobar carcinoma in-situ

12. •Invasive : Invasive ductal carcinoma
Invasive lobar carcinoma
•Inflammatory breast cancer
•Phyllodes tumor

13. DIAGNOSIS
• Clinical Breast Examination
• Mammography
• Ultrasound
• MR imaging
• Fine Needle Aspiration & Cytology ( FNAC)
• Core Biopsy
• Excisional biopsy

14. MAMOGRAPHY
• Mammography is a special type of low-
powered x-ray technique
• It gives detailed images of the internal
structure of the breast.
• High resolution mammogram films
can demonstrate micro calcifications
smaller than 100μm

15. ULTRASOUND IMAGING
• Ultrasound is an adjunct modality
that can be used in the assessment
of a breast cancer.
• Its usefulness lies in its ability to
distinguish solid from cystic lesions.

16. Stages of Breast Cancer
• •Staging of breast cancer done by using the TNM classification
• • The American Joint Committee on Cancer recommends this
classification

18. Stages of
Breast
Cancer
Stage 0: non-invasive
carcinoma or carcinoma in situ
Stages I and II: early
Stage III: advanced; tumor > 2
cm across and spread to
underarm LNs or is
extensive in underarm LNs or
spread to LNs near breastbone
or other tissue near breast
Stage IV: spread beyond breast
and underarm LNs to other
body parts

20. CHEMOTHERAPY
• Treatment of cancer with one or
more cytotoxic anti- neoplastic
drugs.
• It can be either curative or palliative
• It is often used in conjugation with
radiation therapy or surgery
• Chemotherapeutic agents act by
killing cells that divide rapidly- one
of the main properties of cancerous
cells

21. Common combination of
chemotherapy regime for breast
cancer patients is
• Cyclophosphomide
• Methotraxate
• 5-Flurouracil
•Drug Delivery- Intravenous
• PVC
• CVC
• PICC
• IP

22. Treatment
Strategies
Induction therapy- for curative purpose as the first
line of treatment
Neoadjunctive- chemotherapy given prior to local
treatment
Adjunctive Chemotherapy- Given after a local
treatment or when little evidence or suspicion
about reoccurrence or subclinical cancer is present
Maintenance Chemotherapy- repeated low dosage
treatment given for prolong remission

23. Side effects of Chemotherapy:

24. Radiation Therapy
• It involves medical use of ionizing
radiation, used in cancer treatment
• It can be used as a curative, adjunctive
or palliative care
• Ionizing radiation work by damaging
the DNA of cancerous tissues leading
to cellular death.

25. • Dossage is calculated in unit Gray (Gy)
• It depends upon the type, stage of cancer
being treated
• For curative purpose typical dose is between
60-80 Gy
• For preventive or Adjunctive purpose- 45- 60
Gy
• Treatment Methods:
• External beam radiation therapy
• Brachytherapy
• Radioisotope therapy

27. Side effects of Radiation
Therapy
• Acute- Nausea,vomiting,damage to epithelial
cells, Lymphedma or infertility
• Late- Fibrosis of exposed tissue, Hair loss occur
with >30Gy and may br permanent. May also
lead to dryness of mouth and eyes

28. Simple/Total
Mastectomy
It involves surgical removal of
entire breast tissue, but
lymphatic tissue and
pectoral muscles are preserved
Involves a low to moderate risk
of Lymphedema due to post-
operative radiation therapy

29. Radical Mastectomy
• Excision of
• complete breast tissue
• pectoral muscles
• axillary lymph nodes
• associated skin and subcutaneous
tissue
• Performed in case of advanced last
stage breast cancer that has invaded
the muscle wall under the breast tissue

30. Associated
Post-
operative
Impairments:
Incisional Pain
Lymphedema due to removal of
axillary lymph nodes which disrupts the
normal circulation of lymph
Weakness of horizontal adductors of
the shoulder, serratus anterior
Postural asymmetry and dysfunction

31. Modified Radical
Mastectomy
Excision of
• Entire breast tissue
• Fascia over the chest muscles
• Axillary lymph nodes
• Pectoral muscles remain intact

32. • Reduces cosmetic deformity
• Upper extremity dysfunction can
be prevented
BENEFITS

33. Breast Conserving
Surgery
• This involves –
• Lumpectomy- Surgical removal of lump, margin of
normal tissue surrounding lump. May include
sampling or removal of axillary lymph nodes.
• Segmental Mastectomy- Excision of mass along
with some portion of breast tissue
• Quadrectomy – excision of affected quadrant of the
breast tissue

34. Treatement strategy
Early invasive breast ca
• BCS ( breast conservative sx)
-size <4cm
- 1 qad ( no micro
cal ,lymphovascular spread )
BCS + sentinel LN + radio ( must )
Bcs c/i in preg
Localy advanced breast cancer
• Step1 – neoadj chemo (CAF )
• STEP 2 – MRM
• STEP 3 – ADJ CHEMO
• STEP 4 – ADJ RADIO

35. Breast Reconstruction
• Breast reconstruction is regarded as an integral part of modern day breast
cancer management
• Various techniques available include:
• Silicone Implants
• Lattissimus Dorsi myocutaneous flaps (LD)
• Transverse Rectus abdominus myocutaneous flaps( TRAM)
• Gluteal Free Flap

36. Lets Raise awareness
&
reduce the stigma of breast cancer