1. 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

2. 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

3. 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

4. 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

5. 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

6. Phyllodes tumour
Mammography
M.A.Kubtan

7. M.A.Kubtan

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. 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

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

16. 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

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

18. 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

19. Peau d,orange Sign
M.A.Kubtan

20. M.A.Kubtan

21. M.A.Kubtan

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

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

24. Management of operable breast cancer
M.A.Kubtan

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

26. 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

27. M.A.Kubtan

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

29. 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

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

31. Thank You
M.A.Kubtan