Breast Diseases: Carcinoma Overview

Breast Diseases

• Carcinoma of the breast is the most common cancer in women in the USA.
• It accounts for 35% of all malignancies in Egyptian women.
• Risk factors include race (Black and Asian women less affected), age (risk increases with age, plateaus at 50 in low-risk populations), genetics (BRCA1/2 mutations), endocrine factors (early menarche, late menopause, obesity, high saturated fat intake, late first pregnancy), and precancerous lesions (hyperplasia, ductal papilloma, lobular carcinoma in situ).
• Sites most commonly affected are upper outer quadrant (60%), followed by inner, lower (central, or upper inner).
• Pathological types include ductal (infiltrating/non-infiltrating, comedocarcinoma/non-comedocarcinoma, papillary/solid) and lobular (infiltrating/non-infiltrating) carcinomas, and Paget's disease.
• Hormone receptors are present in approximately 60% of breast cancers.
• Spread can be local (through breast, overlying skin, and underlying muscles), lymphatic (to axillary nodes, and internal mammary chain), and blood stream (micro-metastases, lungs, bones, brain, liver).
• Staging: various systems, including TNM (Tumor, Nodes, Metastasis) and UICC. Early stage (I and II for UICC) is considered potentially curable.
• Clinical features include lump, pain, nipple retraction, blood-stained nipple discharge, skin dimpling, peau d'orange, and nipple erosion.
• Differential diagnosis includes solitary cysts, fibrocystic disease, fibroadenomas, traumatic fat necrosis, inflammatory lesions (chronic abscess, duct ectasia, TB), and other tumors (duct papilloma, sarcoma).
• Investigations include mammography, ultrasound, MRI, biopsy (excision, frozen section, true-cut, fine needle aspiration cytology), and aspiration of cysts.
• Treatment strategies for different stages are described including surgery (conservative, modified radical mastectomy), hormone therapy, chemotherapy, and radiotherapy.

Clinical Forms

• Paget's disease of the nipple: usually bilateral, occurs at menopause, no itching, no vesicle - not oozing, nipple erosion.
• Inflammatory carcinoma: Rapidly progressing, breast swelling (red, edematous, and warm), no distinct mass, clinically resembles acute mastitis.
• Carcinoma in situ (infiltrating or lobular): ductal (DCIS, more common) or lobular (LCIS, less common) in situ cancers. DCIS is more common and associated with increased risk of invasive cancer.

Prognosis

• Prognosis depends on the tumor type, T-stage, site, involved lymph nodes and metastasis.
  • Involvement of nodes, particularly high-level nodes, is generally associated with poorer prognosis.
  • Patients with hormone receptor positive tumors often respond better to hormone therapy
• Investigations for clinically doubtful breast masses are detailed - including fine-needle aspiration cytology (FNAC) and histopathology.

This quiz explores the various aspects of breast diseases, focusing on carcinoma, which is the most common cancer among women. It discusses risk factors, affected sites, pathological types, hormone receptors, and patterns of spread. Enhance your understanding of breast cancer and its implications.