Pathology Non-invasive Ductal carcinoma in situ risk of development of infiltrating ductal carcinoma in same breast excisi...
Pathology
Non-invasive
- Ductal carcinoma in situ
- risk of development of infiltrating ductal carcinoma in same breast
- excision with clear margins +/- radiation
- Lobular carcinoma in situ
- risk marker for future infiltrating ductal carcinoma
- in either breast (20 to 30 % twenty year risk)
- close follow-up (consider bilateral mastectomy for high-risk patient)
- Infiltrating ductal carcinoma (most common - 80%)
- characteristics - hard, scirrhous, infiltrating tentacles, gritty on cross-section
- invasive lobular carcinoma (8-10%)
- more apt to be bilateral, better prognosis
- PagetÃs disease (1-3%)
- ductal carcinoma that invades nipple with scaling, eczematoid lesion
- inflammatory carcinoma (1-4%)
- ductal carcinoma that involves dermal lymphatics
- most aggressive form of breast cancer
- peau d orange indicates advanced disease (IIIb-IV)
- also papillary, medullary, colloid, tubular cancers
Sarcomas of breast (rare)
- most common = giant benign variant of fibroadenoma (cystosarcoma phyllodes) - 1 in 10 malignant
Primary Treatment of Breast Cancer
Stages I, II - surgery for cure
Breast Conserving Surgery (lumpectomy)
- removal of tumour along with cuff of normal tissue, preserving cosmetic appearance of breast
- adjuvant radiation to breast decreases local recurrence (no change in survival)
- results generally equal to mastectomy
- removal of entire breast including nipple and fascia overlying pectoralis muscles, while sparing underlying muscles and innervation
- indications
- factors that increase risk of local recurrance: extensive calcification on mammogram, multiple tumours, or failure to obtain tumour-free margin
- contraindications to radiation therapy: pregnancy, previous irradiation, collagen vascular disease, physical disability precluding treatment
- large tumour size relative to breast
- patient preference (no need for radiation)
Induction chemotherapy
- tumours > 5 cm
- inflammatory carcinomas
- chest wall or skin extension
