ch 35 breast cancer 부산백병원 산부인과 r1 서 영 진 r1 서 영 진

Ch 35 BREAST Ch 35 BREAST CANCERCANCER

부산백병원 산부인과부산백병원 산부인과 R1 R1 서 영 진서 영 진

1/3 of all cancers in women1/3 of all cancers in women 22ndnd only to lung cancer as the leading cause of only to lung cancer as the leading cause of

cancer deaths in womencancer deaths in women

Incidence: increased significantlyIncidence: increased significantly

one in every eight women in U.S.Aone in every eight women in U.S.A But, mortality rate actually declinedBut, mortality rate actually declined

-increased success in earlier diagnosis & -increased success in earlier diagnosis & treatmenttreatment

PREDISPOSING FACTORPREDISPOSING FACTOR

2525 세 미만세 미만 : less than 1%: less than 1%

3030 세 이후세 이후 : a sharp increase: a sharp increase

4545 세세 -50-50 세세 : short plateau: short plateau

이후이후 : increases steadily with age: increases steadily with age


Family hystoryFamily hystory -only 20%: family hystory-only 20%: family hystory

-mother & sister : breast cancer after menopause-mother & sister : breast cancer after menopause -> risk is not increased-> risk is not increased bilateral premenopausallybilateral premenopausally -> at least 40%~50%-> at least 40%~50% unilateral premenopausallyunilateral premenopausally -> 30%-> 30% -inherited oncogenes: BRCA 1 (chromosome 17q 21)-inherited oncogenes: BRCA 1 (chromosome 17q 21) BRCA 2 (chromosome 13q 12-13)BRCA 2 (chromosome 13q 12-13)


Diet, obesity, and alcoholDiet, obesity, and alcohol

- high-fat diet, obesity, alcohol :risk factor- high-fat diet, obesity, alcohol :risk factor

- but, not clear- but, not clear


Reproductive and hormonal factorsReproductive and hormonal factors - the risk of breast ca increases with the length of a - the risk of breast ca increases with the length of a women’s reproductive phasewomen’s reproductive phase

- menarche is lower- menarche is lower early menopause early menopause artificial menopause (oophorectomy)artificial menopause (oophorectomy) -> the risk is decreased-> the risk is decreased -> but, no clear association with irregularity & -> but, no clear association with irregularity & duration of mensesduration of menses

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

HISTORY OF CANCERHISTORY OF CANCER

Endometrial carcinoma, ovarian carcinoma, or Endometrial carcinoma, ovarian carcinoma, or coloncolon

cancer has also been associated with an cancer has also been associated with an increasedincreased

risk of breast cancerrisk of breast cancer

DIAGNOSISDIAGNOSIS

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

DIAGNOSISDIAGNOSIS

USG, MRI, CT, PET, sestamibiscans, serum bloodUSG, MRI, CT, PET, sestamibiscans, serum blood marker: be used only when indicatedmarker: be used only when indicated palpation: easy- older, more fattypalpation: easy- older, more fatty Malignancy: thickening area amid normal nodulaityMalignancy: thickening area amid normal nodulaity skin dimplingskin dimpling nipple retractionnipple retraction skin erosionskin erosion clinically malignancy: 30~40% benign on histologyclinically malignancy: 30~40% benign on histology clinically benign: 20~25% malignant by biopsy clinically benign: 20~25% malignant by biopsy

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

Open biopsyOpen biopsy -FNA cytology has not been performed-FNA cytology has not been performed the results are negative or eqivocalthe results are negative or eqivocal 1. the location of the mass confirmed1. the location of the mass confirmed 2. local anesthesia: skin, suncutaneous around mass2. local anesthesia: skin, suncutaneous around mass 3. incision: directly over the mass (ellise-cosmetically)3. incision: directly over the mass (ellise-cosmetically) paraareolar(near the nipple-areolar complex)paraareolar(near the nipple-areolar complex) 4. mass: gently grasped with Allis forcep or stay suture4. mass: gently grasped with Allis forcep or stay suture 5. the mass should be excised completely5. the mass should be excised completely

6. adequate hemostasis6. adequate hemostasis breast parenchyma : not reapproximated deeplybreast parenchyma : not reapproximated deeply subcutaneous fat: with fine absorbable suturesubcutaneous fat: with fine absorbable suture skin: subcuticular suture and adhesive stripsskin: subcuticular suture and adhesive strips usually a drain is not necessaryusually a drain is not necessary

Mammographic localization biopsyMammographic localization biopsy - biopsy of nonpalpable lesion - biopsy of nonpalpable lesion - mammographer : localization & a biologic dye- mammographer : localization & a biologic dye surgeon: review & excisedsurgeon: review & excised

Stereotactic core biopsyStereotactic core biopsy - localize abnormalities and perform needle biopsy- localize abnormalities and perform needle biopsy without surgerywithout surgery

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

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

ch 35 breast cancer 부산백병원 산부인과 r1 서 영 진 r1 서 영 진

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