breast cancer presentation for news.pptx

Good for Juniors

1. Detailed history taking, and Triple Assessment in breast clinics Presenter ; Dr Mziray

2. Outlines History taking in breast diseases Physical examination Imaging Biopsies

3. Patient History The patient’s age R eproductive history (age at menarche,age at menopause, and history of pregnancies, including age at first full-term pregnancy.) H istory of breast biopsies, a hysterectomy and whether the ovaries were removed, a recent history of pregnancy and lactation History of HRT or hormones for contraception. The family history of the breast and ovaries cancers.

4. H istory of a mass, breast pain, nipple discharge and any skin changes ,duration and its relation to the menstrual cycle. Constitutional symptoms, bone pain, weight loss, respiratory changes

5. RISK FACTORS

6. Physical Examination Visual inspection : Inspects the woman’s breast with her arms by her side (Fig. 17-18A), with her arms straight up in the air (Fig. 17-18B), and with her hands on her hips (with and without pectoral muscle contraction ). Look for : Symmetry , size, and shape of the breast , as well as any evidence of edema ( peau d’orange ), nipple or skin retraction, or erythema . With the arms extended forward and in a sitting position, the woman leans forward to accentuate any skin retraction.

7. Palpation : With the patient in the supine position (see Fig. 17-18C) the clinician gently palpates the breasts, making certain to examine all quadrants of the breast from the sternum laterally to the latissimus dorsi muscle and from the clavicle inferiorly to the upper rectus sheath. The examination is performed with the palmar aspects of the fingers, avoiding a grasping or pinching motion. The breast may be cupped or molded in the examiner’s hands to check for retraction. Breast mass size, shape, consistency, location and fixation to the skin or underlying musculature. the presence of enlarged axillary lymph nodes, the supraclavicular and infraclavicular spaces Any tenderness

8. BREAST IMAGING Mammography P rimary imaging modality for screening asymptomatic women a screening mammogram uses mediolateral oblique and craniocaudal views. A diagnostic mammogram is indicated for further evaluation of abnormalities identified on a screening mammogram or of clinical findings or symptoms. Magnification views are obtained to evaluate calcifications and compression views are used to provide additional detail when a mass lesion is suspected. Mammographic sensitivity is limited by breast density, with as many as 10% to 15% of clinically evident breast cancers having no associated mammographic abnormality.

9. Ultrasonography Useful in determining whether a lesion detected by mammography is solid or cystic. Useful for discriminating lesions in the patient with dense breasts. Combined with mammography, increases the diagnostic yield

10. Magnetic Resonance Imaging U seful for identifying the primary tumor in the breast in patients who present with axillary lymph node metastases without mammographic evidence of a primary breast tumor (unknown primary). Useful for assessing the extent of the primary tumor, particularly in young women with dense breast tissue Useful for evaluating invasive lobular cancers. Useful in determining eligibility for breast conservation

11. Magnetic Resonance Imaging Useful as a screening tool in patients with known BRCA gene mutations and for detecting contralateral breast cancers in women diagnosed with a unilateral cancer on mammography. The sensitivity of MRI for invasive cancer is higher than 90%, but is only 60% or less for DCIS. The specificity of MRI is only moderate, with significant overlap in the appearance of benign and malignant lesions

12. Nonpalpable Mammographic Abnormalities A bnormalities that cannot be detected by physical examination i.e clustered microcalcifications and areas of abnormal density (e.g., masses, architectural distortions,asymmetries ) Diagnostic biopsy is by image-guided core needle biopsy.

13. Nonpalpable Mammographic Abnormalities Breast Imaging Reporting and Data System (BI-RADS) is used to categorize the degree of suspicion of malignancy To avoid unnecessary biopsies for low-suspicion mammographic findings , probably benign lesions are designated BI-RADS -3 and are monitored with a schedule of short-interval mammograms over a 2-year period. Biopsy is performed only for lesions that progress during follow-up

14. Non palpable Mammographic Abnormalities

15. Goals of Therapy and Determination of Risk of Harm For stages I to III invasive breast cancer, the goals of treatment for patients are curative. T he volume (extent) of disease at diagnosis and the biologic characteristics of an individual tumor affect the risk of cancer recurrence Biomarkers—ER, PR, and HER-2—affect prognosis and are also predictive of response to different therapies. Tumors that have low levels of expression of estrogen and PR, as well as tumors with high levels of HER-2, are associated with worse cancer outcomes when compared with tumors that are strongly estrogen- and PR-positive and HER-2–negative or normal.

16. Biopsy Fine-Needle Aspiration Biopsy U sefulness at differentiation of solid from cystic masses Does not discriminate between noninvasive and invasive breast cancers

17. Core Needle Biopsy M ethod of choice to sample non palpable, image-detected breast abnormalities P referred for the diagnosis of palpable lesions Can determine the histologic subtype, grade, and receptor status of a malignant lesion

18. Thanks