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Group I
WHAT IS CANCER?
More than 70% of all cancer deaths in 2005 occurred in low and
middle income countries. Deaths from cancer in the world are
projected to continue rising, with an estimated 9 million people
dying from cancer in 2015 and 11.4 million dying in 2030.
The most frequent cancer types world wide are:
وذكرت وكالة النباء السعودية نقل عن الحصائية التي أصدرها السجل الوطني
حيث يقدر،للورام أن سرطان الثدي هو السرطان الكثر شيوعا بين السعوديات
. حالة2741 عددهن في السعودية بنحو
كما،غير أن هذا الرقم يبقى أقل بكثير من عدد الصابات في المجتمعات الغربية
.ذكرت الحصائية
Being 40 or younger is an independent risk factor for relapse in
operable breast cancer patients: The Saudi Arabia
experience
Naser Elkum, Said Dermime, Dahish Ajarim, Ali Al-Zahrani, Adher Alsayed,
Asma Tulbah, Osama Al Malik, Mohamed Alshabanah, Adnan Ezzat and Taher
Al-Tweigeri
Results
Conclusion
• Age
• Genetics
• Other pathology
• Years menstruating
• Exogenous factors
o Dichlorodiphenyldichloroethylene, a metabolite of
the insecticide dichlorodiphenyltrichloroethane
(DDT), exposure increases risk.
Both of these can result in continuous pain both before and after
the menopause. The pain can be in the whole of the breast, in a
specific area, or in both breasts at the same time.
Causes
PAINFUL LUMP :
1- An area of fibroadenosis
2 – cyst
4 – abscess
5 – sometimes carcinoma
س
عيد
History & General examination of
Breast
History
• Age : rare in young women (most common in 70 yrs old
female)
• Previous pregnancies
• Menstrual pattern
» Regularity
» Duration
» Quantity of bleeding
• Medication
• Association symptoms
Breast Lung
Hotness cough
Ulcer Dyspnea
Skin change Bloody sputum
Dnipple discharge
GI Lymph nodes
Jundice Axillary L.N
Neck L.N
Wt. loss
Inguinal L.N
Abdominal distention
Nausea & vomiting CNS
Constipation Headach
Acitis Dizziness
photophobia
• And can cause:
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Physical Examination
• Hand & Nail
Koilonychia è Fe deficiency
» Anorexia
Scratch mark
tremur
• Respiratory system
Cyanosis
– Tongue
Dyspnea
Sputum
•Muscular
problem
•Skull
•Vertebae
•Ribs
•Sternum
Can affect bone marrow •Pelvis
And cause : •Upper femur
•Anemia •Upper
And cause pallor humerus
• GI examination
Jaundice
Pruritus
Wt. loss
Nail
– Leuconchia
• Spider nevi
• Ascitis
• Palpation :
– Liver
– Spleen
• liver
Jaundice
– Sclera
– Leuconychia è hypo-albuminaemia
enlarged
Spider nevi
Ascitis
Flapping tremor
liver
ed
n
u
Ja
ic
Breast lump
Examination of
Breast
- Anatomy
Inspection:
Look for :
• Skin appearance:
• Arms at sides
• Leaning forward
Palpation:
• The breast tissue is flattened when the patient is lying
supine.
• Use the finger pad of the 2nd , 3rd , and 4th fingers.
Finger Use:
• Tenderness.
• Nodules:
- Size
- Tenderness
- Mobility:
first in relation to skin; moving breast à
dimpling
The axilla
• Inspection:
inspect the skin of the axilla looking for :
- Rash
- Unusual pigmentation
• Palpation:
DCIS
• It is Pre invasive cancer.
LCIS
• Incidental finding.
• Has family Hx .
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Invasive types
• Palpaple mass …50% will have axillary LN metastasis.
• Retraction of nipple.
• Firm to hard
Medullary carcinoma
• 1-5 % of breast cancers.
• LN metastasis is infrequent.
• Better prognosis.
• ER -
• BRCA1
• Majority ER +
Prognosis
• In-situ VS invasive
in situ is curable
• Postmenopausal patients.
Staging
1 - T N M Staging:
Tumour )T(
Nodes )N(
Nx Regional lymph nodes cannot be assessed
Metastases )M(
Mx Presence of distant metastasis cannot be assessed
M0 No sign of cancer spread
M1 Cancer has spread to another part of the body:
1- lungs, 2- liver, 3- bone, or
4- brain.
based on:
Tumor Size.
Metastasized spread.
Stage 0:
Stage I:
Stage II:
Stage III:
Stage III a:
1 - Chest wall
Stage IV:
According to:
1- Tubule formation.
2- Nuclear pleomorphism.
3- Mitotic Activity.
1. CBC
2. LFT
3. LDH
4. tumor markers
CBC
NORMALY the RBC and the WBC are normal in the breast
carcinoma but when it metastasize to the bone marrow
there may be change
Hb concentration
Differential count
Neutro.
Lymph.
Eosino.
Mono.
Baso.
LFT
The LFT is normal in the breast carcinoma except when it is
metastasize to the liver there will be elevation to the liver
enzymes
5-Direct bilirubin
1-hemolysis
2-cardiac infarction
3-carcinoma (lymphoma)
4-empysema
5-maningiitis
6-HIV
Tumor markers
These are some of the markers that may indicate breast
carcinoma
CA15.3
CA125
CA27.29
TRU-Quant
Radiological Investigation for breast cancer
Mammography
MRI
Biopsy
Fine-needle aspiration
Surgical intervention
Operable Breast tumours
Those tumors:
1- Restricted to the breast
2- Associated with axillary lymph nodes.
1- Breast-conserving treatment :
Is usually only suitable for single cancers measuring less than 4cm.
2-Mastectomy
Mastectomy removes all the breast tissue with some overlying skin but
leaves the chest wall muscle intact.
Types!
1-External
2-Internal
Adjuvant Systemic
Immediately following surgery
Types!
1- Endocrine Therapy
Tamoxifen
Aromatase Inhibitors
Ovarian Ablation
2- Chemotherapy
Higher risk
3- Herceptin
1- Endocrine Therapy
3- Low toxicity
• - screening.