Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.
Learning Objectives
Learning Objectives Introduction & History Relevant Anatomy, Physiology Aetiology Pathophysiology Pathology Classification Clinical Features Investigations Management Prevention Guidelines Take home messages
Introduction & History.
Introduction & History. Carcinoma that doesn’t invade basement membrane is call in-situ carcinoma . With increased use of mammography now patient are presenting with these in greater numbers. Currently accounts for approximately 25% of all newly diagnosed breast cancers in west
Pathophysiology
Pathophysiology LCIS was initially believed to be a malignant lesion, but is now regarded more as a risk factor for the development of breast cancer. Outline of the normal lobule is maintained.
Pathophysiology The papillary and cribriform types of DCIS are generally of lower grade The solid and comedo types of DCIS are generally higher grade lesions. DCIS transforms into an invasive cancer. DCIS sometimes coexist with invasive cancer. The calcifications seen on a mammogram generally correspond to areas within the central involved duct in which there is often necrosis and debris.
Clinical Features
Clinical Features Demography Symptoms Signs Prognosis Complications
Demography
Demography DCIS, or intraductal cancer, currently accounts for approximately 25% of all newly diagnosed breast cancers,
Symptoms
Symptoms An area of clustered calcifications on a screening mammogram, without an associated palpable abnormality. Rarely, DCIS will be manifested as a palpable mass Unilateral, single-duct nipple discharge.
Signs Rarely palpable lump/ Nipple discharge.
Prognosis
Prognosis DCIS is viewed as a precursor of invasive ductal cancer.
Complications
Complications DCIS is viewed as a precursor of invasive ductal cancer
Investigations
Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histology Germ line Testing and Molecular Analysis Diagnostic Laparotomy.
Mammographic findings Clustered calcifications without an associated density Calcifications coexisting with an associated density Density alone . DCIS calcifications tend to cluster closely together are pleomorphic, and may be linear or branching, thus suggesting their ductal origin.
Management
Management Treatment aims to remove the DCIS to prevent progression to invasive disease Because the risk for metastatic disease in patients with DCIS without demonstrable invasion is rare (<1%), systemic chemotherapy is not required. Hormonal therapy may be used for prevention of new primary tumors and to improve local control after breast-conserving therapy but is generally only recommended when the DCIS is positive for ER on immunohistochemistry .
Operative Therapy
Operative Therapy Treatment recommendations for an individual patient with DCIS are based on the extent of disease within the breast, histologic grade, ER status, and presence of microinvasion , as well as patient age and preference. Treatment options for DCIS include mastectomy, breast-conserving surgery with irradiation, and breast-conserving surgery alone.
Adjuvant aherapy When the patient is treated with breast conservation or unilateral mastectomy, there is also the option of adjuvant hormonal therapy with tamoxifen as risk reduction for future breast cancers.
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