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Ch 35 BREAST CANCER

Ch 35 BREAST CANCER. 부산백병원 산부인과 R1 서 영 진. 1/3 of all cancers in women 2 nd only to lung cancer as the leading cause of cancer deaths in women Incidence: increased significantly one in every eight women in U.S.A But, mortality rate actually declined

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Ch 35 BREAST CANCER

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  1. Ch 35 BREAST CANCER 부산백병원 산부인과 R1 서 영 진

  2. 1/3 of all cancers in women • 2nd only to lung cancer as the leading cause of cancer deaths in women • Incidence: increased significantly one in every eight women in U.S.A • But, mortality rate actually declined -increased success in earlier diagnosis & treatment

  3. PREDISPOSING FACTOR • 25세 미만: less than 1% 30세 이후: a sharp increase 45세-50세: short plateau 이후: increases steadily with age

  4. PREDISPOSING FACTOR • Family hystory -only 20%: family hystory -mother & sister : breast cancer after menopause -> risk is not increased bilateral premenopausally -> at least 40%~50% unilateral premenopausally -> 30% -inherited oncogenes: BRCA 1 (chromosome 17q 21) BRCA 2 (chromosome 13q 12-13)

  5. PREDISPOSING FACTOR • Diet, obesity, and alcohol - high-fat diet, obesity, alcohol :risk factor - but, not clear

  6. PREDISPOSING FACTOR • Reproductive and hormonal factors - the risk of breast ca increases with the length of a women’s reproductive phase - menarche is lower early menopause artificial menopause (oophorectomy) -> the risk is decreased -> but, no clear association with irregularity & duration of menses

  7. -lactation does not affect the breast cancer ->but, risk is high : never pregnant > multiparous -primigravida: older > younger (high incidence) -although short-term estrogen treatment for menopausal symptoms prebably does not increase the risk of breast ca, prolonged use or higher dosages of estrogen may increase the risk -> low dose or combination with progestin -> but, benbefits in preventing osteoporosis and heart problem

  8. HISTORY OF CANCER • Endometrial carcinoma, ovarian carcinoma, or colon cancer has also been associated with an increased risk of breast cancer

  9. DIAGNOSIS • most commonly in the upper outer quadrant (there is more beast tissue) • mammography and physical examination, the standard screening modalities, are complementary -10% to 50 % of cancers detectred mammographically are not palpable, physocal exam detects 10% to 20% of cancers not seen on mammography • All women unfergo screening mammography starting at age 40, along with clinical or self breast examination

  10. DIAGNOSIS • USG, MRI, CT, PET, sestamibiscans, serum blood marker: be used only when indicated • palpation: easy- older, more fatty • Malignancy: thickening area amid normal nodulaity skin dimpling nipple retraction skin erosion • clinically malignancy: 30~40% benign on histology clinically benign: 20~25% malignant by biopsy

  11. Biopsy techniques • Fine-needle aspiration cytology (FNA) - 20- or 22- gauge needle - a high level of diagnostic accuracy :10-15% false negative rare false positive -negative FNA cytology results do not exclude malignancy and usually are followes by excisional biopsy or careful observation

  12. Open biopsy -FNA cytology has not been performed the results are negative or eqivocal 1. the location of the mass confirmed 2. local anesthesia: skin, suncutaneous around mass 3. incision: directly over the mass (ellise-cosmetically) paraareolar(near the nipple-areolar complex) 4. mass: gently grasped with Allis forcep or stay suture 5. the mass should be excised completely

  13. 6. adequate hemostasis breast parenchyma : not reapproximated deeply subcutaneous fat: with fine absorbable suture skin: subcuticular suture and adhesive strips usually a drain is not necessary

  14. Mammographic localization biopsy - biopsy of nonpalpable lesion - mammographer : localization & a biologic dye surgeon: review & excised • Stereotactic core biopsy - localize abnormalities and perform needle biopsy without surgery

  15. PATHOLOGY AND NATURAL HISTORY • Breast ca : in the intermediate-sized ducts or terminal ducts and lobules -the diagnosis of lobular and intraductal carcinoma is based on histological appearance than site of origin • infiltrating ductal carcinoma: 60-70% -mammographically, stellate density -macroscopically, gritty and chalky • Medullary carcinoma -a dence lymphocytic infiltration -sloe growing, less aggressive malignancy

  16. Mucinous (colloid) carcinoma : 5% of breast ca -glossly, mucinous, gelatinous • Papillary carcinoma -noninvasive ductal carcinoma • Tubualr carcinoma: 1% of breast ca -better prognosis than infiltrating ductal carcinoma rarely metastasize to axillary LN

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