Breast cancer

Modified Sweat gland
Lies in the deep pectoral
fascia

Boundaries:
clavicle superiorly,

the lateral border of the latissimus muscle laterally,

the sternum medially

inframammary fold inferiorly

1. BREAST CANCER Dr.Nidhi Ahya Assistant Professor Cardiovascular & Respiratory PT DVVPF’s College of Physiotherapy, Ahmednagar 414111 Dr.Nidhi Ahya(MPT-CVRPT) 1

2. OBJECTIVES Anatomy of Breast tissue Breast Cancer Risk Factors Signs & Symptoms Cancer Grading & Stages Treatment Dr.Nidhi Ahya(MPT-CVRPT) 2

3. STRUCTURE Modified Sweat gland Lies in the deep pectoral fascia B oundaries: clavicle superiorly, the lateral border of the latissimus muscle laterally, the sternum medially inframammary fold inferiorly Dr.Nidhi Ahya(MPT-CVRPT) 3

4. BLOOD SUPPLY Dr.Nidhi Ahya(MPT-CVRPT) 4 Perforating branches of the internal mammary arteries the lateral thoracic arteries thoracoacromial arteries  posterior intercostal arteries 

5. - LYMPH NODES AND LYMPHATICS 75% -Axillary nodes 25% -internal mammary Carcinoma of breast spreads mostly along the lymphatic to the regional lymph nodes Dr.Nidhi Ahya(MPT-CVRPT) 5

6. MUSCULAR RELATIONS Dr.Nidhi Ahya(MPT-CVRPT) 6

7. BREAST CANCER Abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same manner after the cessation of stimuli which evoked the change. Breast cancer is cancer originating in the breast tissue. Dr.Nidhi Ahya(MPT-CVRPT) 7

8. WHO world cancer report 2009- 192370 women diagnosed with breast cancer About 13.7% deaths in women due to breast cancer globally In India number of breast cancer cases is 1,15,000 per year and expected to rise to 2,50,000 new cases by 2015 Dr.Nidhi Ahya(MPT-CVRPT) 8

9. Risk factors Gender Increased age Family history Lack of child bearing or breast feeding Higher hormone levels Late age of menopause Alcohol Dense breast tissue Diethylstibesterol exposure Dr.Nidhi Ahya(MPT-CVRPT) 9

10. Signs and Symptoms Lump in the breast Changes in the breast size or shape Skin dimpling Nipple inversion Spontaneous discharge from nipple Change in texture of the skin Pain Dr.Nidhi Ahya(MPT-CVRPT) 10

11. Types of Breast Cancer Non-invasive: ductal carcinoma in-situ lobar carcinoma in-situ Dr.Nidhi Ahya(MPT-CVRPT) 11

12. Invasive : Invasive ductal carcinoma Invasive lobar carcinoma Inflammatory breast cancer Phyllodes tumor Dr.Nidhi Ahya(MPT-CVRPT) 12

13. Diagnosis Clinical Breast Examination Mammography Ultrasound MR imaging Fine Needle Aspiration & Cytology ( FNAC) Core Biopsy Excisional biopsy Dr.Nidhi Ahya(MPT-CVRPT) 13

14. MAMOGRAPHY Mammography is a special type of low-powered x-ray technique It gives detailed images of the internal structure of the breast.  High resolution mammogram films can demonstrate micro calcifications smaller than 100μm Dr.Nidhi Ahya(MPT-CVRPT) 14

15. ULTRASOUND IMAGING Ultrasound is an adjunct modality that can be used in the assessment of a breast cancer. Its usefulness lies in its ability to distinguish solid from cystic lesions. Dr.Nidhi Ahya(MPT-CVRPT) 15

16. Stages of Breast Cancer Staging of breast cancer done by using the TNM classification The American Joint Committee on Cancer recommends this classification Dr.Nidhi Ahya(MPT-CVRPT) 16

17. Dr.Nidhi Ahya(MPT-CVRPT) 17

18. Stage 0: non-invasive carcinoma or carcinoma in situ Stages I and II : early Stage III : advanced; tumor > 2 cm across and spread to underarm LNs or is extensive in underarm LNs or spread to LNs near breastbone or other tissue near breast Stage IV : spread beyond breast and underarm LNs to other body parts Dr.Nidhi Ahya(MPT-CVRPT) 18

19. Treatment Dr.Nidhi Ahya(MPT-CVRPT) 19

20. Chemotherapy Treatment of cancer with one or more cytotoxic anti- neoplastic drugs. It can be either curative or palliative It is often used in conjugation with radiation therapy or surgery Chemotherapeutic agents act by killing cells that divide rapidly- one of the main properties of cancerous cells Dr.Nidhi Ahya(MPT-CVRPT) 20

21. Common combination of chemotherapy regime for breast cancer patients is- Cyclophosphomide Methotraxate 5-Flurouracil Drug Delivery- Intravenous PVC CVC PICC IP Dr.Nidhi Ahya(MPT-CVRPT) 21

22. Treatment Strategies Induction therapy- for curative purpose as the first line of treatment Neoadjunctive - chemotherapy given prior to local treatment Adjunctive Chemotherapy- Given after a local treatment or when little evidence or suspicion about reoccurrence or subclinical cancer is present Maintenance Chemotherapy- repeated low dosage treatment given for prolong remission Dr.Nidhi Ahya(MPT-CVRPT) 22

23. Side effects of Chemotherapy: Immunosuppression and myelosuppression Gastrointestinal distress Anemia Fatigue Hair loss Infertility Peripheral Neuropathy Dr.Nidhi Ahya(MPT-CVRPT) 23

24. Radiation Therapy It involves medical use of ionizing radiation, used in cancer treatment It can be used as a curative, adjunctive or palliative care Ionizing radiation work by damaging the DNA of cancerous tissues leading to cellular death. Dr.Nidhi Ahya(MPT-CVRPT) 24

25. Dossage is calculated in unit Gray ( Gy ) It depends upon the type, stage of cancer being treated For curative purpose typical dose is between 60-80 Gy For preventive or Adjunctive purpose- 45- 60 Gy Treatment Methods: External beam radiation therapy Brachytherapy Radioisotope therapy Dr.Nidhi Ahya(MPT-CVRPT) 25

26. Dr.Nidhi Ahya(MPT-CVRPT) 26

27. Side effects of Radiation Therapy Acute- Nausea,vomiting,damage to epithelial cells, Lymphedma or infertility Late- Fibrosis of exposed tissue, Hair loss occur with >30Gy and may br permanent. May also lead to dryness of mouth and eyes Dr.Nidhi Ahya(MPT-CVRPT) 27

28. Radical Mastectomy Excision of complete breast tissue pectoral muscles axillary lymph nodes associated skin and subcutaneous tissue Performed in case of advanced last stage breast cancer that has invaded the muscle wall under the breast tissue Dr.Nidhi Ahya(MPT-CVRPT) 28

29. Associated Post-operative Impairments: Incisional Pain Lymphedema due to removal of axillary lymph nodes which disrupts the normal circulation of lymph Weakness of horizontal adductors of the shoulder, serratus anterior Postural asymmetry and dysfunction Dr.Nidhi Ahya(MPT-CVRPT) 29

30. Modified Radical Mastectomy Excision of Entire breast tissue Fascia over the chest muscles Axillary lymph nodes Pectoral muscles remain intact Dr.Nidhi Ahya(MPT-CVRPT) 30

31. Benefits: Reduces cosmetic deformity Upper extremity dysfunction can be prevented Dr.Nidhi Ahya(MPT-CVRPT) 31

32. Simple/Total Mastectomy It involves surgical removal of entire breast tissue, but lymphatic tissue and pectoral muscles are preserved Involves a low to moderate risk of Lymphedema due to post-operative radiation therapy Dr.Nidhi Ahya(MPT-CVRPT) 32

33. Breast Conserving Surgery This involves – Lumpectomy- Surgical removal of lump, margin of normal tissue surrounding lump. May include sampling or removal of axillary lymph nodes. Segmental Mastectomy- Excision of mass along with some portion of breast tissue Quadrectomy – excision of affected quadrant of the breast tissue Dr.Nidhi Ahya(MPT-CVRPT) 33

34. Breast Reconstruction Breast reconstruction is regarded as an integral part of modern day breast cancer management Various techniques available include: Silicone Implants Lattissimus Dorsi myocutaneous flaps (LD) Transverse Rectus abdominus myocutaneous flaps ( TRAM) Gluteal Free Flap

35. SUMMARY Anatomy of Breast tissue What is Breast Cancer Risk Factors Signs & Symptoms Cancer Grading & Stages Treatment Dr.Nidhi Ahya(MPT-CVRPT) 35