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Normal Breast
A. Breast Duct System B. Lobules C. Breast Duct System D. Nipple E. Fat F. Chest Muscle G. Ribs
A. Breast Duct System B. Lobules C. Breast Duct System D. Nipple E. Fat F. Chest Muscle G. Ribs
A. Cells lining duct B. Cancer cells, breaking through the basement membrane C. Basement membrane
A. Breast Duct System B. Lobules C. Breast Duct System D. Nipple E. Fat F. Chest Muscle G. Ribs A. Cells lining duct B. Extra cancer like cells, but aaacontained within duct C. Intact basement membrane D. Open central duct
A. Breast Duct System B. Lobules C. Breast Duct System D. Nipple E. Fat F. Chest Muscle G. Ribs
A. Cells lining lobule B. Cancer cells, breaking through the basement membrane. C. Basement membrane
A. Breast Duct System B. Lobules C. Breast Duct System D. Nipple E. Fat F. Chest Muscle G. Ribs
A. Cells lining lobule B. Cancer cells, but all contained within the lobules C. Basement membrane
Symptoms
In
early breast ca
breast ca
Diagnosis tool
Breast sonography
Superior in dense breast, young age
Mammography
Superior in loose(fatty) breast, elder
Cytology
Fine-needle aspiration (FNA)
Biopsy
Incision Excision
stage morphology
Tumor
receptor
TNM
T1:
tumor<2cm
2-5cm T3: >5cm T4: chest wall, skin invasion, or inflammatory breast cancer
TNM
N
M0 or M1
I IIA IIB
IIIA
IIIB IIIC
Tumor morphology
Grade
VLI
A. Cells lining duct B. Cancer cells, breaking through the basement membrane. C. Broken basement membrane D. Cancer entering a lymph channel. E. Cancer entering a vein. F. Normal breast tissue.
Receptor status
Hormone
receptor
Estrogen receptor (%) Progesterone receptor (%) >10% predict response to hormone tx
Her2/neu
Associate with invasion, metastasis Predict poor prognosis IHC stain, FISH
No specific ligands
Heregulins
Receptor domain
Extracellular Membrane
Intracellular K K K
erbB3 HER3
erbB4 HER4
0 (negative)
1+ (negative)
2+ (equivocal)
3+ (positive)
Treatment
Localized
breast cancer
Hopkins
Metastatic
breast cancer
Systemic treatment
Radical mastectomy
LNs in the level 1 (B) and level 2 (C ), and even sometimes more distant lymph node groups (D, E and F) were also removed.
A. Entire breast is removed Classically some lymph nodes in the level 1 (B) and level 2 (C ) were removed, called an axillary lymph node dissection.
Surgical evolution
Radical
mastectomy
1885 ~ 1960s
Modified
Lumpectomy
Distant
micrometastasis
systemic treatment
therapy
Adjuvant chemotherapy
CMF,
recurrence Survival
Adjuvant chemotherapy
CAF
Adjuvant chemotherapy
Incorporate
Adjuvant Herceptin
Effective
in Her2+ pts
ICH3+ FISH+
Herceptin
+ adjuvant chemotherapy
premenopausal woman
Selective estrogen receptor antagonist Effective in pre- and post-menopausal Effective in adjuvant setting
inhibitor
in pre-menopausal state
Type
role to be defined
Treatment of metastatic dz
Usual sites: bone, lung, liver, brain Incurable
Treatment strategy
Principle:
Treatment effectiveness only in limited duration To avoid unnecessary toxicity Ultimately incurable
Chemotherapy
In
general, chemotherapy
therapy
Chemotherapeutic agents
Single
agents:
Chemotherapy regimens
Combination:
Example - 1
55y/o woman, ER/PR +/+, Dz recurred 5yrs after surgery Only neck and mediastinum LNs Slowly progressed clinically(!)
Example - 2
45 y/o woman, ER/PR -/ Dz recurred 3 yrs after operation Only right supraclavicle LNs Slowly progressed
RT alone Observation
Example - 3
50 y/o woman, ER/PR +/+ Back, shoulder, hips pain, 3m, progress Massive bone mets over spine, pelvis, shoulder, and ribs
Example - 4
55 y/o woman, ER/PR +/+ Dyspnea progressively Lung mets bilaterally
Treatment principle
For