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    This document discusses the management of breast disorders including painful breasts, inflammatory diseases, benign breast diseases, and breast cancer. It covers symptoms, examinations, investigations like mammography and biopsies, and treatments for various conditions that may affect the breast. For breast cancer specifically, it discusses predisposing factors, types, methods of spread and factors influencing prognosis, staging, curability rates, diagnosis, and treatment options including surgery, chemotherapy, radiation, and palliative care. Prevention focuses on modifying predisposing factors and early detection/treatment through education and screening tests.

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    This document discusses the management of breast disorders including painful breasts, inflammatory diseases, benign breast diseases, and breast cancer. It covers symptoms, examinations, investigations like mammography and biopsies, and treatments for various conditions that may affect the breast. For breast cancer specifically, it discusses predisposing factors, types, methods of spread and factors influencing prognosis, staging, curability rates, diagnosis, and treatment options including surgery, chemotherapy, radiation, and palliative care. Prevention focuses on modifying predisposing factors and early detection/treatment through education and screening tests.

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    464 views17 pages

    Management of Breast Disorders

    Uploaded by

    khadzx
    This document discusses the management of breast disorders including painful breasts, inflammatory diseases, benign breast diseases, and breast cancer. It covers symptoms, examinations, investigations like mammography and biopsies, and treatments for various conditions that may affect the breast. For breast cancer specifically, it discusses predisposing factors, types, methods of spread and factors influencing prognosis, staging, curability rates, diagnosis, and treatment options including surgery, chemotherapy, radiation, and palliative care. Prevention focuses on modifying predisposing factors and early detection/treatment through education and screening tests.

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    of 17

    MANAGEMENT OF BREAST

    DISORDERS. By Dr. L.D.Lugaria


    • Introduction
    • Painful Breast.
    • Inflammatory Diseases of the Breast.
    • Benign Breast Disease.
    • Cancer of the Breast.
    MANAGEMENT BREAST
    DISORDERS.
    • History: Common symptoms
    -Discrete abnormality,
    -Premenstrual discomfort,
    -Nipple discharge/retraction,
    -Previous breast
    complaints/invest., -marital
    status
    -Obs/Gyn: Menarche, LMP, Deliveries &
    Breastfeeding.
    MANAGEMENT OF BREAST
    DISORDERS.
    • P/E:
    -Inspection: Asymmetry,
    Lumps, Flattening, Tethering, Abnormal
    fixation, Nipple retraction/altered position.
    -Palpation: Tenderness,
    Lumps, LNs (pectoral, axillary,
    supraclavicular). –Lumps:
    Position, Consistency, discretness/fixity.
    –Nipple
    Discharge: Type, Blood, Clinitest,
    cytology.
    MANAGEMENT OF BREAST
    DISORDERS….
    • INVESTIGATIONS: -FNA
    –Mammography (High resolution and X-ray of
    low penetration). –CXR.
    –Biopsy
    (Trucut needle or incisional/excition).
    • TREATMENT: Cause dependent.
    • PAINFUL BREAST: -Cyclical (predominantly
    premenestrual or hormonal related).
    –Noncyclical (inflammatory or Duct actasia).
    –Invest. Mammography (>35yrs).
    –Treatment:
    -severe pain-
    Bromocryptin 2.5mg BD or clamizol or Tamoxifen.
    –Cysts
    :Aspirate -Fibrous nodules: Excision.
    –Normal –Reassure/psychological support.
    INFLAMMATORY DISEASE OF
    THE BREAST.
    • Acute :
    -Mastitis- Antibiotics.
    –Breast Abscess –I/D
    +Antibiotics.
    • Chronic:
    BENIGN BREAST LESIONS
    • Fibroadenoma
    - soft -excision
    - giant – complete local excision.
    • Phyloides tumour (cystosarcoma phylloides)
    - Rapidly growing unilateral breast mass,
    common in 40-50yr.
    - Sarcomatous degeneration
    occurs in 10%. –Treat: small-wide margin
    excision; Large- mastectomy with axillary LN
    sampling.
    BENIGN BREAST LESIONS
    • Cystic Disease and Epethelial Hyperplasia –Cystic
    disease of the breast lobules :Duct Actasia (dilatation of
    the duct system); common in late menopause.
    • Benign Epithelial Hyperplasia -Non neoplastic change of
    the glandular elements= focal increase in epithelial cell
    layers (>3layers).
    -May be mild, mod, severe.
    -Atypical hyperplasia= Borderline between
    benign & ca in situ.
    -Diagnosis: Clinical - Diffuse
    cystic ds =heavy thickened lumpy breast + pain;
    Mammography curvilinear shadows) ; FNA ;Biopsy.
    BENIGN DISEASE OF THE
    DUCTS
    • Nipple Discharge, Duct actasia, Duct Papilloma.
    • Nipple Discharge:
    -History:
    –PE:
    –INVEST: Microscopy, Cytology,
    Mammography & Biopsy.
    –Treatment:
    -None if cytology &
    mammography are normal. -Surgery for
    profuse discharge, patient concern or multiple
    lesions.
    DUCT ACTASIA
    • Def: Dilatation of major breast ducts which fill with
    inspissated creamy secretion & associated periductal
    inflammation.
    • Pathophysiology:
    -Dil.+ leakage of secretion= inflammation.
    –prim inflammation, destruction of
    breast elasticity, dilatation.
    • Presentation: asymptomatic or symptomatic
    –Symptoms: Discharge (Bloody, serous or
    creamy); Nipple retraction/involution; Acute inflammation
    in breast segment +/- non lactating abscess or fistula;
    localized /segmental inflammation.
    • Treatment: Excision of the involved ducts &surrounding
    breast tissue; Plastic surgery to restore nipple contour.
    DUCT PAPILLOMA
    • Defn. Growth arising from the main duct
    epithelium (usually within 1cm of the nipple).
    • Symptoms: Bleeding from a single point of the
    nipple.
    • PE: -Small nodule at the nipple.
    –Discharge on pressure.
    • INVEST: Mammography; Ductography (filling
    defect).
    • Treatment: Surgical Excision.
    CARCINOMA OF THE BREAST.
    • PREDISPOSING FACTORS:
    -Environmental: Dietary
    (especially fat) & social class (high).
    –Sex –Female has
    higher incidence; Functioning ovaries;
    Increased risk with Early menarche ,late
    menopause, nulliparity & Late 1st
    pregnancy. –Age: Peak
    at 50-60 years.
    -Genetic:1st degree relatives (autosomal
    dominance trait chromosome 17).
    CARCINOMA OF THE BREAST…
    • TYPES OF BREAST CANCER:
    -Carcinoma in situ =confined to
    ducts or acini & within the basement
    membrane. It has good prognosis but
    transforms to invasive ca with delayed
    treatment. –Invasive carcinoma:
    Ductal (90%) Lobular(10%).
    –Ductal ca:
    Medullary (better progn.); Tubular &
    Mucoid. –Lobular
    Ca: Cribriform; Solid & Tubular.
    CARCINOMA OF THE BREAST…
    • BIOLOGICAL BEHAVIOUR.
    -Spread: Lymphatic/Haematogenous.
    –Lymphatic: Axillary (lower, apical,
    supraclavicular). –
    Blood :Bone, Lungs, Liver, Brain, Ovaries, Peritonium.
    • FACTORS INFLUENCING PROGNOSIS (Tumour, LNs
    & Mets).
    –Tumour: Size, Contour, Histological
    type,Grade of differentiation, DNA ploidity (diploid),
    Degree of elastosis, Presence of necrosis, Oestrogen
    receptor. Poor prognosis: undifferentiated, aneuploid,ER
    negative- -LNs: Tumour involvement, No involved &
    Reactive changes.
    –Distant Metastases.
    CARCINOMA OF THE BREAST…
    • CURABILITY: <40% with surgery; <20% all
    cases.
    • DIAGNOSIS:
    -History: Painless lump in the Breast;
    Tingling sensation.
    –PE: Asymmetry, Nipple
    fixity/scaling, Dimpling/Peau derange; Examine
    both breasts & compare. –Lump: Site,
    Mobility/fixity, Skin ulceration; LNs (size,
    mobility, matted, fixity). –
    INVESTIGATION: FNA, Mammography
    (sensitivity>95%), True cut biopsy.
    TNM STAGING
    TREATMENT
    • Surgery
    – Breast Conserving: Lumpectomy;
    Quadrantectomy.
    -Mastectomy.
    • Chemotherapy.
    • DXT
    • Combination.
    • Palliative Treatment.
    PREVENTION
    • Predisposing Factors
    • Early Detection and Treatment:
    -Education: -Self palpation &Treatment –
    Mammography, U/S, FNA

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