Breast Cancer Path

anatomy

• tear shaped glands

• related to endocrine system

• attached to chest wall, sternum, rest on pectoralis major

• ducts connect lobes, lobules, & glands for nursing

muscles related to breast

pectoralis major & minor, serratus anterior, latissimus dorsi

arteries related to breast

internal mammary artery, axillary artery, lateral thoracic artery

veins related to breast

internal mammary v., intercostal v., empty to pulmonary capillaries by SVC

hormones related to breast

estrogen, progesterone, prolactin

lymphatics

• axillary lymph nodes; 97% of drainage

• internal mammary route - 3%

• transpectoral route, SCLAV - very small %

routes of spread

multifocal and multicentric, direct infiltration of surrounding structures

multifocal

local spread, same quadrant

multicentric

less common, different quadrants

etiology

• GENDER!!!

• early age at menarche, long duration of menstrual life

• late age at first pregnancy

• late age menopause

epidemiology

• 1 in 8 will develop over lifetime

• incidence inc. in males

• young women typically do worse

• 60% will be cured, 1/3 will die from met

signs & symptoms

• mass

• skin dimpling, peau d’orange

• nipple discharge

• paget’s disease of nipple

• alteration in breast contour/shape

• lymphadenopathy

most common histopathology

• infiltrating ductal carcinoma 70-80%

• infiltrating lobular carcinoma 5-10%

detection & diagnosis

mammogram, BSE, CT/MRI, biopsy (fine needle, core, vacuum-assisted, large core, open surgical)

malignant masses

fixed, asymptomatic, & painless, typically postmenopausal

Tis Staging

carcinoma in situ (DCIS, LCIS, Paget w/ no tumor mass)

T1 staging

tumor 2cm or less across

T2 staging

>2cm but not more than 5cm across

T3 staging

>5cm across

T4 staging

any size growing into chest wall or skin including inflammatory breast ca.

Haagensen’s Grave Signs

1. edema of skin (>1/3 of breast)

2. skin ulceration

3. fixation to chest wall

4. axillary LN >2.5cm

5. fixed axillary lymph node

principles of tx

surgery followed by chemo & EBRT

OARs

• lung: 17 gy

• skin: 45 gy

• other breast: 10-20 gy

• heart: 45 gy