Breast cancer
PRESENTATION BY:
DR SAMWELI M, MD 2017
Objectives
• Introduction
• Risk factors
• Clinical features of Breast Ca
• Physical examination of Breast
• Diagnosis of Breast Ca
• Pre referral treatment of Breast Ca
• Supportive care in patient of Breast Ca.
Introduction
Breast cancer is the malignant diseases that forms in the breast cells.
Breast cancer can occur in both men and women but its far common
in women.
Introduction
• Commonest site is the UOQ (50%)
The diseases can spread by
Nodal spread to axillary, internal mammary and supraclavicular nodes
Hematogenous metastases to lungs, liver or bone
Transcelomic spread to ovaries (Kruckenberg) and pelvis (Blummer’s
shelf)
Epidemiology of Breast Cancer
Breast cancer affects 1 in 10 women in the UK.
The risk of developing breast cancer by the age of 50 is 1 in 50, by
age 65, 1 in 17 and by age 85, 1 in 9.
The incidence of breast cancer increases with increasing age and has
increased with the introduction of mammographic screening.
It is the commonest cause of cancer-related deaths in females aged
15–54 (Figure 10.1).
Peak incidence at 45-55 years
Risk factors of Breast Ca
There are multiple inter-related risk factors.
Overall, only 15% of women with breast cancer have an identifiable
risk factor apart from age and gender, which are of course the major
factors.
Male breast cancer does occur but is much rarer, accounting for
about 1 per 300 breast cancers.
The following are the risk factors of Breast Ca
Risk factors cont. ….
Family history
• Between 4 and 10% of breast cancers are due to an inherited trait.
• Overall, if a first-degree relative has breast cancer then a woman has
double the normal risk.
• This risk is increased if the relative had breast cancer at an early age
(<50yrs) or had bilateral breast cancer at any age.
• The commonest breast cancer genes to have been identified are
BRCA1 and BRCA2 genes.
Risk factor cont. ……
Exposure to Oestrogens
• In general, the greater the number of menstrual cycles , the greater
the risk.
• Thus, a late menarche(>12yrs), an early menopause(<55yrs (or
ovariectomy), pregnancy at a young age and increased parity protect
against breast cancer.
• Pregnancy after the age of 35 is associated with an increased risk
compared to nulliparity
Risk factors cont. …..
Oral contraceptive pills
• Use of the oral contraceptive pill (OCP) for greater than 4 years in
younger women before their first pregnancy increases the risk of
premenopausal breast cancer.
• Women who use the OCP for short periods to space pregnancies are
at no increased risk.
Risk factors cont. ….
Hormone Replacement Therapy
• The ‘Million Women Study’ has demonstrated that oestrogen-only
hormone replacement therapy (HRT) carries a small increase of risk.
• Women on oestrogen–progesterone HRT have double the risk of
breast cancer and this risk increases from when HRT is started.
• There is currently considerable doubt about whether it should be
prescribed to prevent osteoporosis or heart disease.
Risk factors cont. ….
Previous Benign Breast Disease
• Fibroadenomas and most types of benign breast disease are not a risk
factor per se, with positive family increase the risk of breast cancer.
Sex ( F:M=10:1)
Age , risk increase with age
High socioeconomic group, a diet high in saturated fats and high
alcohol intake are also linked with an increased risk of breast cancer.
NOTE: Smoking does not seem to be a risk factor and finally lactation
probably protects against breast cancer.
Clinical features of Breast Ca
Commonly presents as a painless palpable lump or mass
Suspicious lesion on screening mammography
Pain is uncommon but may be present with advanced disease
Occasionally presents as bleeding per nipple (usually duct papilloma)
Skin changes ( dimpling, nipple retraction, ‘peau d orange’ eczema of
nipple in Paget’s disease, ulceration, satellite nodules, ‘mastitis
carcinomatosis
Examination of Breast Ca
Inspection
• Ask the patient to sit on the side of the bed exposing the upper half of
her body. If the patient has found a lump ask her to point to it with
her arms relaxed at her side
• Observe for any obvious asymmetry or masses, skin dimpling,
previous scars and inversion or eczema of the nipple
• Then, ask her to raise her arms straight above her head; this strains
the ligaments of Astley Cooper and may result in a skin dimple or
inversion of the nipple if there is a breast cancer present.
Examination cont. ….
Palpation
• Now ask the patient to lie down with arms by her side.
• Start with the normal breast first. Now ask her to put her hand behind
her head.
• This spreads the breast tissue over the chest wall and makes it easier
to examine the breast, particularly if it is large.
• The breast is divided into five areas: the four quadrants and a a
central nipple area
Palpation cont. ….
• Remember that the upper outer quadrant which includes the axillary
tail is the commonest site for malignancies and that the breast
extends from the second rib to the inframammary fold
• Examine the four quadrants and then the central area.
• Palpate each area using the flat surface of your fingers
• If you find a lump, note its site, size (by measuring it with your ruler),
shape, colour, contour, consistency, temperature, tenderness,
tethering, transilluminance, etc.
Diagnosis of Breast Ca
Diagnosis is by Triple Assessment
Clinical Evaluation – history and physical examination
Imaging (ultrasound <35 years old or mammography >35 years old)
Final Needle Aspiration Cytology(FNA) or Biopsy
• A 10 ml syringe is attached to a green needle and inserted into the
lump. A cyst will disappear as it is aspirated, giving an immediate
diagnosis and a happy patient A solid lump may be lumpy breast
tissue, a fibroadenoma or breast cancer.
Pre referral treatment
Basic investigation such as Hb level
Provide hematenics if anemic
Provide analgesia where appropriate
IV fluids if dehydrated.
Broad spectrum antibiotic if signs of infection such as fever, or if
ulcerated.
Supportive care
• Analgesia
• Hematenics if anemic
• Counselling
• Follow up in clinic
• Eductaion to family members
THE END
THANKS
