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BREAST CANCER Part 02

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Pathology

Non-invasive

  1. Ductal carcinoma in situ
    • risk of development of infiltrating ductal carcinoma in same breast
    • excision with clear margins +/- radiation
  2. Lobular carcinoma in situ

    • risk marker for future infiltrating ductal carcinoma
    • in either breast (20 to 30 % twenty year risk)
    • close follow-up (consider bilateral mastectomy for high-risk patient)
Invasive

  1. Infiltrating ductal carcinoma (most common - 80%)
    • characteristics - hard, scirrhous, infiltrating tentacles, gritty on cross-section
  2. invasive lobular carcinoma (8-10%)
    • more apt to be bilateral, better prognosis
  3. Pagetís disease (1-3%)
    • ductal carcinoma that invades nipple with scaling, eczematoid lesion
  4. inflammatory carcinoma (1-4%)
    • ductal carcinoma that involves dermal lymphatics
    • most aggressive form of breast cancer
    • peau d orange indicates advanced disease (IIIb-IV)
  5. also papillary, medullary, colloid, tubular cancers

Sarcomas of breast (rare)
  • most common = giant benign variant of fibroadenoma (cystosarcoma phyllodes) - 1 in 10 malignant

Primary Treatment of Breast Cancer

Stages I, II - surgery for cure

Breast Conserving Surgery (lumpectomy)

  1. removal of tumour along with cuff of normal tissue, preserving cosmetic appearance of breast
  2. adjuvant radiation to breast decreases local recurrence (no change in survival)
  3. results generally equal to mastectomy
Mastectomy

  1. removal of entire breast including nipple and fascia overlying pectoralis muscles, while sparing underlying muscles and innervation
  2. indications

    • factors that increase risk of local recurrance: extensive calcification on mammogram, multiple tumours, or failure to obtain tumour-free margin
    • contraindications to radiation therapy: pregnancy, previous irradiation, collagen vascular disease, physical disability precluding treatment
    • large tumour size relative to breast
    • patient preference (no need for radiation)


 Stages III, IV - operate for local control 


Induction chemotherapy

  1. tumours > 5 cm
  2. inflammatory carcinomas
  3. chest wall or skin extension
BREAST CANCER Part 02 BREAST CANCER Part 02 Reviewed by Radiology Madeeasy on August 30, 2010 Rating: 5
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