E. T. 78 year old Male Catholic From Pangasinan.

62

Transcript of E. T. 78 year old Male Catholic From Pangasinan.

Page 1: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 2: E. T.  78 year old  Male  Catholic  From Pangasinan.

E. T.78 year oldMaleCatholic From Pangasinan

Page 3: E. T.  78 year old  Male  Catholic  From Pangasinan.

Breast mass, right

Page 4: E. T.  78 year old  Male  Catholic  From Pangasinan.

1 year PTA, Noted enlarging breast mass on his right

breast confined at nipple areolar complex

Firm, non tender, movable breast mass, right

No consult done

Page 5: E. T.  78 year old  Male  Catholic  From Pangasinan.

1month PTA, Consult at QMMC OPD FNAB was done▪ Suspicious for Malignant Cells▪ Suggest Frozen section for Definitive Surgery

Page 6: E. T.  78 year old  Male  Catholic  From Pangasinan.

(-) DM (-) Hypertension (-) Asthma (-) Cancer (-) Pulmonary tuberculosisNo allergies to food and drugs

Page 7: E. T.  78 year old  Male  Catholic  From Pangasinan.

Previous smokerPrevious alcoholic drinkerNo illicit drug use

Page 8: E. T.  78 year old  Male  Catholic  From Pangasinan.

General: awake, conscious, coherent, not in cardiorespiratory distress

HEENT: anicteric sclera, pink palpebral conjunctiva, no cervical lymphadenopathy

Page 9: E. T.  78 year old  Male  Catholic  From Pangasinan.

Thorax and lungs Symmetrical chest expansion, no

retraction, no chest lag, clear breath sounds

(+)2x2cm firm mass, non tender, movable right breast on nipple areolar complex, (-) nipple discharge

Page 10: E. T.  78 year old  Male  Catholic  From Pangasinan.

Cardiovascular adynamic precordium, regular rate and

rhythm, no murmurAbdomen

Flat, normoactive bowel sounds, soft, non tender

• Extremities▪ Full and equal pulses, no cyanosis

Page 11: E. T.  78 year old  Male  Catholic  From Pangasinan.

Patient was cp cleared for the operation

Underwent Excision Biopsy, Frozen section, MRM for the right breast, OR procedure was uneventful and was well tolerated by the patient

Page 12: E. T.  78 year old  Male  Catholic  From Pangasinan.

Frozen Section rendered: Infiltrating Ductal Carcinoma Right

breast Basal Margin positive for tumor

involvement

Page 13: E. T.  78 year old  Male  Catholic  From Pangasinan.

Histopathologic Report:

Infiltrating Ductal Carcinoma (variant of Papillary Carcinoma) Nottingham Grade 1 (1+2+1)

Tumor size: 2x2cm Negative Tumor Metastasis in all 19 nodes

isolated Negative for Tumor involvement , skin,

nipple, and all margins submitted No Lymphovascular invasion noted

Page 14: E. T.  78 year old  Male  Catholic  From Pangasinan.

PHOTOS!

Page 15: E. T.  78 year old  Male  Catholic  From Pangasinan.

Malignant tumor that starts from cells of the breast.

Group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body.

Many people do not realize that men have breast tissue and that they can develop breast cancer.

Page 16: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 17: E. T.  78 year old  Male  Catholic  From Pangasinan.

Carcinoma

This term describes a cancer that begins in the lining layer (epithelial cells) of organs such as the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).

Page 18: E. T.  78 year old  Male  Catholic  From Pangasinan.

Adenocarcinoma a type of carcinoma that starts in

glandular tissue (tissue that makes and secretes a substance)

The ducts and lobules of the breast are glandular tissue (they make breast milk in women), so cancers starting in these areas are sometimes called adenocarcinomas.

Page 19: E. T.  78 year old  Male  Catholic  From Pangasinan.

Carcinoma in situ an early stage of cancer, when it is

confined to the layer of cells where it began.

In breast cancer, in situ means that the abnormal cells remain confined to ducts (ductal carcinoma in situ, or DCIS).

These cells have not grown into (invaded) deeper tissues in the breast or spread to other organs in the body

Page 20: E. T.  78 year old  Male  Catholic  From Pangasinan.

Invasive (or infiltrating) carcinoma

An invasive cancer is one that has already grown beyond the layer of cells where it started (as opposed to carcinoma in situ).

Most breast cancers are invasive carcinomas, either invasive ductal carcinoma or invasive lobular carcinoma.

Page 21: E. T.  78 year old  Male  Catholic  From Pangasinan.

SarcomaSarcomas are cancers that start in

connective tissues such as muscle tissue, fat tissue, or blood vessels.

Sarcomas of the breast are rare.

Page 22: E. T.  78 year old  Male  Catholic  From Pangasinan.

Ductal carcinoma in situ (DCIS)

also known as intraductal carcinoma

cells that lined the ducts have changed to look like cancer cells

considered noninvasive or pre-invasive breast cancer

Page 23: E. T.  78 year old  Male  Catholic  From Pangasinan.

Ductal carcinoma in situ (DCIS)

DCIS accounts for about 1 in 10 cases of breast cancer in men.

It is almost always curable with surgery.

Page 24: E. T.  78 year old  Male  Catholic  From Pangasinan.

Infiltrating (or invasive) ductal carcinoma (IDC)

This type of breast cancer breaks through the wall of the duct and grows through the fatty tissue of the breast.

At this point, it can spread (metastasize) to other parts of the body.

Page 25: E. T.  78 year old  Male  Catholic  From Pangasinan.

Infiltrating (or invasive) ductal carcinoma (IDC)

At least 8 out of 10 male breast cancers are IDCs (alone or mixed with other types of invasive or in situ breast cancer).

Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so they are more likely to spread to the nipple

Page 26: E. T.  78 year old  Male  Catholic  From Pangasinan.

Infiltrating (or invasive) lobular carcinoma (ILC) 

This type of breast cancer starts in the breast lobules (collections of cells that, in women, produce breast milk) and grows into the fatty tissue of the breast.

Page 27: E. T.  78 year old  Male  Catholic  From Pangasinan.

Infiltrating (or invasive) lobular carcinoma (ILC) 

ILC is very rare in men.

Accounts for only about 2% of male breast cancers. This is because men do not usually have much lobular tissue.

Page 28: E. T.  78 year old  Male  Catholic  From Pangasinan.

Paget disease of the nipple

This type of breast cancer starts in the breast ducts and spreads to the nipple.

It may also spread to the areola (the dark circle around the nipple).

The skin of the nipple usually appears crusted, scaly, and red, with areas of itching, oozing, burning, or bleeding.

Page 29: E. T.  78 year old  Male  Catholic  From Pangasinan.

Paget disease of the nipple

Paget disease may be associated with DCIS or with infiltrating ductal carcinoma.

Accounts for about 1% of female breast cancers and a higher percentage of male breast cancers.

Page 30: E. T.  78 year old  Male  Catholic  From Pangasinan.

Inflammatory breast cancer an aggressive, but rare type of breast

cancer.

It makes the breast swollen, red, warm and tender rather than forming a lump.

It can be mistaken for an infection of the breast. This is very rare in men.

Page 31: E. T.  78 year old  Male  Catholic  From Pangasinan.

The American Cancer Society estimates for breast cancer in men in the United States for 2014 are:

About 2,360 new cases of invasive breast cancer will be diagnosed

About 430 men will die from breast cancer

Page 32: E. T.  78 year old  Male  Catholic  From Pangasinan.

Breast cancer is about 100 times less common among men than among women.

For men, the lifetime risk of getting breast cancer is about 1 in 1,000.

The number of breast cancer cases in men relative to the population has been fairly stable over the last 30 years.

Page 33: E. T.  78 year old  Male  Catholic  From Pangasinan.

In the Philippines:

“It is very rare. It’s seen in less than 1% of all breast cancer. Still the incidence is less than 1% In males even though the Philippines has a very high rate of breast cancer in Asia”

- Dr. Aldine Basa – Breast Surgeon from The Medical City (Sept 2010)

Page 34: E. T.  78 year old  Male  Catholic  From Pangasinan.

Aging Family history of Breast Cancer Inherited gene mutations Klinefelter syndrome Radiation exposure Alcohol/Liver Disease Estrogen treatment Obesity Testicular Conditions/Occupational

Hazards

Page 35: E. T.  78 year old  Male  Catholic  From Pangasinan.

Although certain risk factors may increase a man's chances of developing breast cancer, the cause of most breast cancers in men is unknown

Hormone levelsGene Mutation

Page 36: E. T.  78 year old  Male  Catholic  From Pangasinan.

Early detection improves the chances that male breast cancer can be treated successfully.

Differences affecting early detection of male and female breast cancers

There are many similarities between breast cancer in men and women, but there are some important differences that affect finding it early.

Page 37: E. T.  78 year old  Male  Catholic  From Pangasinan.

Breast sizeLack of awareness

Page 38: E. T.  78 year old  Male  Catholic  From Pangasinan.

A lump or swelling, which is usually (but not always) painless

Skin dimpling or puckeringNipple retraction (turning inward)Redness or scaling of the nipple or

breast skinDischarge from the nipple

Page 39: E. T.  78 year old  Male  Catholic  From Pangasinan.

History and PEDiagnosticsNipple discharge exam

Page 40: E. T.  78 year old  Male  Catholic  From Pangasinan.

Biopsy/Histopath Grading: Grade 1 (well differentiated) cancers have relatively normal-

looking cells that Do not appear to be growing rapidly and are arranged in small tubules.

Grade 2 (moderately differentiated) cancers have features between grades 1 and 3.

Grade 3 (poorly differentiated) cancers have cells that appear very abnormal, grow rapidly, and rarely form tubules.

ER/PR /Her2Status

Page 41: E. T.  78 year old  Male  Catholic  From Pangasinan.

CXRMammogramBone ScanCT-ScanMRIUltrasoundPETscan

Page 42: E. T.  78 year old  Male  Catholic  From Pangasinan.

Uses TNM staging

Page 43: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 44: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 45: E. T.  78 year old  Male  Catholic  From Pangasinan.

Stage 5-year relativesurvival rate0 100% I 100% II 91% III 72% IV 20%

Page 46: E. T.  78 year old  Male  Catholic  From Pangasinan.

Most of the information about treating male breast cancer comes from doctors' experience with treating female breast cancer. Because so few men have breast cancer, it is hard for doctors to study the treatment of male breast cancer patients separately in clinical trials.

Treatments can be classified into broad groups, based on how they work and when they are used.

  The main types of treatment for breast cancer are: · Surgery · Radiation therapy · Chemotherapy · Hormone therapy · Targeted therapy · Bone-directed therapy

Page 47: E. T.  78 year old  Male  Catholic  From Pangasinan.

The main types of treatment for breast cancer are:

SurgeryRadiation therapyChemotherapyHormone therapyTargeted therapyBone-directed therapy

Page 48: E. T.  78 year old  Male  Catholic  From Pangasinan.

MastectomyBreast-conserving surgery

Page 49: E. T.  78 year old  Male  Catholic  From Pangasinan.

Aside from post-surgical pain, temporary swelling, and a change in the appearance of the breast, possible side effects of surgery include bleeding and infection at the surgical site, hematoma (buildup of blood in the wound), and seroma (buildup of clear fluid in the wound).

Page 50: E. T.  78 year old  Male  Catholic  From Pangasinan.

Ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or signs of treatment side effects.

Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life.

Page 51: E. T.  78 year old  Male  Catholic  From Pangasinan.

Now is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.

At first, your follow-up appointments will probably be scheduled for every 3 to 6 months.

The longer you have been free of cancer, the less often the appointments are needed.

After 5 years, they are typically done about once a year.

Page 52: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 53: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 54: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 55: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 56: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 57: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 58: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 59: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 60: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 61: E. T.  78 year old  Male  Catholic  From Pangasinan.
Page 62: E. T.  78 year old  Male  Catholic  From Pangasinan.