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Breast Cancer Overview

Breast Cancer Overview. Jamal Masad Melhem Professor Surgical oncology Jordan University Amman, Jordan. Breast Cancer overview. Objectives: Participants should be able to: Assess and realize the significance of risk factors. Take relevant focused history.

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Breast Cancer Overview

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  1. Breast Cancer Overview Jamal Masad Melhem Professor Surgical oncology Jordan University Amman, Jordan

  2. Breast Cancer overview Objectives: Participants should be able to: • Assess and realize the significance of risk factors. • Take relevant focused history. • Perform standardized breast clinical examination. • Understanding and practicing triple assessment concept. • Surgical management of breast cancer.

  3. Breast Cancer Overview • Lecture outlines: • Introduction: • Relevant anatomy and physiology. • Cancer facts. • Focused history taking. • Standardized Examination • Breast imaging. • Cytological and histological Examination • Metastatic workup • Staging and prognosis • Surgical management

  4. Why Are We Concerned ? • Body image and wellbeing. • Positive psychological balance. • nutrition nutrition

  5. Relevant Anatomy & Physiology 12/19/2019

  6. Anatomy of the Breast & Axilla 12/19/2019

  7. TripleAssessment Clinical Evaluation Imaging (ultrasound <35 years old or mammography >35 years old) Cytology or Histology 12/19/2019

  8. Symptoms 11

  9. Risk factors Age Gender (100:1) White race Obesity ). BMI >30) Exogenoushormones • Reproductivefactors. • previous suspicious breast biopsy Personalhistoryofbreastcancer Family history of breast cancer one first-degree relative 2x 2 first degree relatives 3x Inherited genetic mutations only 5-6% of all breast cancers are directly attributable to inheritance of a breast cancer susceptibility gene such as BRCA1, BRCA2, p53 Lifestyle factors Alcohol Smoking Exposure to therapeutic ionizing radiation. 70% of women have no risk factors!

  10. Gail Model Risk of Breast Cancer • Developed in 1994, Published in JNCI

  11. http://www.cancer.gov/bcrisktool/Default.aspx

  12. StandardizedBreastExamination 12/19/2019

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  18. Malignant Masses • Hard. • Painless: Malignant masses painful in only 10-15% of patients. • Irregular. • Skin Dimpling. • Nipple Retraction. • Bloody or Water Discharge. • Possibly fixed to the skin or chest wall. 12/19/2019

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  22. Inflammatory 12/19/2019

  23. Peaud’orange

  24. Skin Ulceration

  25. Breast Imaging The breast can be imaged with mammography, ultrasound or MRI. Mammography is the most sensitive of breast imaging modalities. Sensitivity is reduced in young women due to the presence of increased glandular tissue. For symptomatic patients, imaging always be performed as part of triple assessment. 12/19/2019

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  27. www.profjamalmelhem.net

  28. www.profjamalmelhem.net

  29. Breast Ultrasound Ultrasound is useful in the assessment of breast lumps Complements mammography and is able to differentiate solid and cystic lesions Also able to guide fine needle aspiration and core biopsies Can be used to assess tumour size and response to therapy In the diagnosis of malignancy it has a sensitivity and specificity of 75% and 97% respectively Cysts and solid lesions have typical appearances 12/19/2019

  30. Paget's Disease of the Nipple 12/19/2019

  31. MR Imaging, breast Enhancement curves for carcinomas. About 90% of all caricnomas enhance according to the patterns represented by curves marked C, D and E. NU = normalized units 12/19/2019

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  34. Biopsy FNA CNB cuttingneedle greatertrauma highsensitivity - 100% distinguishesbetweeninvasiveandin-situ stereotacticwithmammographyandUS • relatively atraumatic • sensitivity of 73-99% • ideal for simple cyst aspiration • can’t distinguish in-situ vs invasive cancer

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  36. Stereotactic Image- Guided Breast Biopsy 12/19/2019

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