Universidad de GuadalajaraCentro Universitario de Ciencias de la Salud

Departamento de Clínicas Quirúrgicas

Breast CancerDr. Benjamín Robles MariscalProfesor: Dr. Héctor Manuel Virgen AyalaBeatriz Tonántzin Gómez Fierro

Epidemiology

The most common invasive cancer in women

2nd leading cause of death

99% 1%

Risk Factors

White womenAge

Family historyBRCA1 or BRCA2 mutations (5-10%)Personal history of

breast or endometrial cancer

RadiationCertain breast changesBeing overweightPregnancy historyMenstrual historyAlcoholism

Signs and Symptoms

A lump 70%Swelling of all or part of the breast

Skin irritation or dimpling

Breast pain

Nipple pain or the nipple turning inward

Redness, scaliness, or thickening of the nipple

or breast skin

A nipple discharge other than breast milk

A lump in the underarm area

45%15%

25%

5% 10%

Frequency

Diagnosis

Physical examination

Schwartz. Principios de cirugía. Mc Graw Hill. Vol I. 8va edición. Houston, Texas. P. 476

CBE

BSE

Diagnosis

Screening testMammography

Ductography

Breast MRI

Ultrasound

PET scans

Chest X-rays

Schwartz. Principios de cirugía. Mc Graw Hill. Vol I. 8va edición. Houston, Texas. P. 479.

CC MLO

BI-RADSBreast Imaging Reporting and Data System

I II III

IV V

MLO MLO CC

MLO

Diagnosis

Biopsy

60% malignant lesions

30% benign lesions

Benign

Malignant

Fine needle aspiration biopsy (FNA)

Core needle biopsy

Excisional biopsy

Schwartz. Principios de cirugía. Mc Graw Hill. Vol I. 8va edición. Houston, Texas. P. 487

Staging

T

N

M

Lymph node

Metastasis

Tumor

American Joint Committe on Cancer & International Union Against Cancer

Histopathology

In situ

Invasive

Lobular (LCIS)

Ductal (DCIS)

Lobular (ILC)

Ductal (IDC)

BiomarkersER 60%

PR 80%

HER-2/neu

VEGF

p53

nm23

DNA 5cER

u-PA

PAI-1

Surgical techniques in breast cancer treatment

Excisional biopsy

Sentinel lymph node biopsy

Lumpectomy

Mastectomy

Simple

Modified radical mastectomy

Halsted

1 3

2

Schwartz. Principios de cirugía. Mc Graw Hill. Vol I. 8va edición. Houston, Texas. P. 489-491.

Radiotherapy

Chemotherapy

Anti- estrogen therapy

Non surgical treatments

Special clinical forms of breast cancer

Paget´s carcinoma

1%

Basic lesion

DCISLick, R. F. Atlas de patología quirúrgica. HARLA. México, D.F. 1981. P. 124-131.

Inflammatory carcinoma

3%

Breast cancer during pregnancy or breastfeeding

Complicates one in 3000 pregnancies

Bilateral breast cancer

<5%

Lick, R. F. Atlas de patología quirúrgica. HARLA. México, D.F. 1981. P. 124-131.

Male breast cancer

The average age of occurrence is close to 60 years

Clinical manifestations

A lump

A nipple discharge

Nipple retraction

Ulceration

Staging = Women

Modified radical mastectomy

Treatment

Cancer stage

Prognosis

Bibliography

Schwartz. Principios de cirugía. Mc Graw Hill. Vol I. 8º edición. Houston, Texas. P. 466-497.

M. Doherty, G. Diagnóstico y tratamiento quirúrgicos. Mc Graw Hall. LANGE. 13º edición. México, D.F. 2011. P. 244-262.

Lick, R. F. Atlas de patología quirúrgica. HARLA. México, D.F. 1981. P. 124-131.

http://www.breastcancer.org/

Elías, A. Contreras, A. Cáncer o Carcinoma de mama. Rev Pacena Med Fam 2008; 5(7): 14-23