الجامعة السورية الخاصة كلية الطب البشري قسم الجـراحـة الجامعة السورية الخاصة كلية الطب البشري قسم الجـراحـة The Breast M.A.Kubtan,MD-FRCS 2nd Lecture M.A.Kubtan

Breast Cysts Commonly occur in the last decade of reproductive life. They are often multiple , may be bilateral and mimic malignancy . Diagnosis can be confirmed by aspiration and ultrasound . Treatment by aspiration , 30% will recur and require further aspiration and cytological examination . Histological examination advisable . M.A.Kubtan

Galactocele Rare , usually present as a solitary sub Areolar Cyst , and dates from lactation. It contains milk . In longstanding cases its wall tend to calcify . M.A.Kubtan

Fibroadenoma Usually arise in the fully developed breast . It is seen between the ages of 15 – 25 years . Occusionally occur in older women . It arise from hyperplasia of a single lobule and usually grow up to 2 – 3 cm in size . They are surrounded by a well marked capsule . A fibroadenoma does not require excision unless associated with suspicious cytology . Giant fibroadenoma occasionally occur during puberty , has the same treatment. M.A.Kubtan

Phyllodes tumour Benign tumour . Previously known as serocystic disease of Brodie . Or cystosarcoma phyllodes . Usually occur in women over the age of 40 years , but it can be appear in younger women . Present as a large ,some times massive tumour with unevenly bosselated surface , the remain mobile on the chest wall. Occasionally ulceration overlying skin occurs because of pressure necrosis . Histologically varies between benign and low grade malignancy ( locally malignant ) . Very rarely develop features of sarcomatous tumour . Treatment : (Enucleation – wide local excision – mastectomy ) M.A.Kubtan

Phyllodes tumour Mammography M.A.Kubtan

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Carcinoma of the Breast The most common cause of death in the middle aged women in western countries . In England and wales 1 in 12 women will develop the disease during their life time . M.A.Kubtan

Breast cancer Etiological factors Breast cancer is the most common site-specific cancer in women It is the leading cause of death from cancer for women age 40 to 44 years It is extremely rare below the age of 20 It occurs more commonly in women with a family history of breast cancer radiation exposure M.A.Kubtan

Predisposal Factors Diet : A high intake of alcohol is associated with an increased risk of developing breast cancer. There is an association between obesity and increased breast cancer risk. Because the major source of estrogen in postmenopausal women is the conversion of Androstenedione to Estrogen by adipose tissue. Obesity is associated with a long-term increase in estrogen exposure. M.A.Kubtan

Predisposal Factors Hormonal factors : Increased exposure to estrogen is associated with an increased risk for developing breast cancer , therefore factors that increase the number of menstrual cycles, such as early menarche, nulliparity, and late menopause, are associated with increased risk. M.A.Kubtan

Pathology Breast cancer may arise from the epithelium of the duct system . May be in situ , common finding in screening of breast cancer . May be massive cancer . M.A.Kubtan

Pathology Degree of differentiation of tumour : Well differentiated . Moderately differentiated . Poorly differentiated . M.A.Kubtan

Current nomenclature Ductal carcinoma most common . Lobular carcinoma 15% of cases . Mixed ( ductal & lobular ) . Rarer histological variant : Colloid carcinoma ( cells produce abundant mucine . Medullary carcinoma(marked lymphocytic reaction ) Tubular carcinoma . Inflammatory carcinoma ( rare , highly aggressive ). Carcinoma in situ (pre invasive cancer has not breached the epithelial basement membrane . M.A.Kubtan

Carcinoma in situ May be ductal ( DCIS ) . Or lobular ( LCIS ) . M.A.Kubtan

Paget's disease of the nipple Superficial manifestation of an underlying breast carcinoma . It presents as an eczema like condition . The nipple is eroded slowly and eventually disappears . M.A.Kubtan

The spread of breast cancer Local spread . Lymphatic metastasis . Spread by the bloodstream . M.A.Kubtan

Clinical presentation Most breast cancer will present as a hard lump . It may be associated with indrawing of the nipple . Their may be skin involvement ( peau d,orange ). Ulceration or fixation to chest wall . Some times may present with local or distant metastasis . M.A.Kubtan

Peau d,orange Sign M.A.Kubtan

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Staging of breast cancer T N M T tumour . N lymph node . M metastasis M.A.Kubtan

Prognosis of breast cancer Size of tumour . Lymph node status . Presence of distal metatasis. M.A.Kubtan

Management of operable breast cancer M.A.Kubtan

Types of surgical treatment Simple mastectomy . Patey mastectomy ( simple mastectomy with axillary clearness ). Radical mastectomy . M.A.Kubtan

Conservative breast cancer Surgery Local excision : aimed at removing the tumour plus a rim of at least 1 cm of normal breast tissue . Quadrantectomy involves removing the entire segment of breast containing the tumour . Both of the above surgery are usually combined with axillary surgery . M.A.Kubtan

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Supportive treatment Radiotherapy . Adjuvant systemic therapy ( chemotherapy ). Hormonal therapy . M.A.Kubtan

Gynaecomastia Idiopathic unilateral or bilateral . Hormonal , accompanied stilbesterol therapy for prostatic cancer . Some times occusrs in patients with cirrhosis due to failure of liver in metabolizing oestrogens. M.A.Kubtan

Carcinoma of the male breast 0.5% of all breast cancer . Predisposing factor gynaecomastia . Treatment surgical as in female breast . M.A.Kubtan

Thank You M.A.Kubtan