Describe the normal anatomy of the breast in female ? Describe the breast cancer and its different type ,stages and grading ? List the tumor marker of breast cancer ? Clinical significance of progesterone and estrogen in breast cancer ? How the breast cancer spread in different sites ? Define the paraneoplastic syndrome ?

1. By : asem shadid
435032467
Pbl 2 – pod 2

2. 1. Describe the normal anatomy of the breast in female ?
2. Describe the breast cancer and its different type ,stages and
grading ?
3. List the tumor marker of breast cancer ?
4. Clinical significance of progesterone and estrogen in breast
cancer ?
5. How the breast cancer spread in different sites ?
6. Define the paraneoplastic syndrome ?
Objectives :

3. • Describe the normal
anatomy of the breast in
female ?

4. • Anatomy of the Breasts
• The lobes, lobules, and bulbs are all linked by thin tubes called ducts.
• Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce
milk.
• The nipples contain no fat, hair or sweat glands.
• There are many smooth muscle fibres in tissues of the breast, which are specially arranged
to help the nipple to become erect when stimulated

5. • The structures associated with the mammary gland are:
• Nipple – where mammary ducts open to surface
• Areola – reddish brown skin around nipple; contains large sebaceous glands
• Lobes – make up glandular tissue of the mammary gland
• Lobules - grape-like secretory structures of the lobes; sometimes called alveoli
• Lactiferous ducts – formed by converging ducts from several lobules; 15-20/ nipple
• Lactiferous sinus – expanded chamber formed by the enlargement of the lactiferous duct near nipple
• Suspensory ligaments - extend inward from the skin of the breast to the pectoral tissue in order to
support the weight of the breast

6. • Describe the breast
cancer
• and its different type
,stages and grading ?

7. • Breast cancer is a malignant (cancer) tumor that starts in the cells of the breast. It is
found mostly in women, but men can get breast cancer, too.
• How many women get breast cancer?
• The American Cancer Society’s estimates for breast cancer in women in the United
• States for 2015 are: About 231,840 new cases of invasive breast cancer
1. Chest wall
2. Pectoralis muscles
3. Lobules
4. Nipple
5. Areola
6. Milk duct
7. Fatty tissue
8. Skin
normalnormal

8. Types of breast cancers :
.
Ductal carcinoma in situ (DCIS)
DCIS means that abnormal cells start in the cells
lining the ducts without growing
(invading) into the tissue of the breast. DCIS is also
sometimes called a non-invasive breast cancer.
Invasive (or infiltrating) ductal carcinoma (IDC)
This is the most common breast cancer. It starts in
the cells lining a duct, and grow into (invade) the
tissue of the
Breast. Then spared .
Invasive (infiltrating) lobular carcinoma (ILC)
This cancer starts in the cells lining the milk glands
(the lobules). The cells grow through
the wall of the lobules and then can spread to nearby
lymph nodes or other parts of the body.
Inflammatory breast cancer (IBC)
This is a rare type of invasive breast cancer. Often,
there is no single lump or tumor.
IBC makes the skin of the breast look red and feel
warm. It also may make the
skin look thick and pitted,

9. Types of breast cancers

10. • Staging and grading of breast cancer in women
• The stage of a cancer describes its size and if it has spread from
where it started.
• TNM staging
• T: size or direct extent of the primary tumor
• N: degree of spread to regional lymph nodes
• M refers to metastases, or whether the cancer has spread to other body parts.
• Some of the stages are further divided into sub stages using the letters A, B, and
C.
• Stage 1 or 2 breast cancer is often called early breast cancer.
• As a rule, the lower the number, the less the cancer has spread.
• And within a stage, an earlier letter means a lower (and often better) stage.
Staging

11. There are two kinds of stage 0 breast cancer:
Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a milk duct and
have not spread outside the duct.
Lobular carcinoma in situ (LCIS): Abnormal cells are in the lining of a lobule.

12. • To find out the grade of a tumour, the biopsy sample is examined under a microscope.
A grade is given based on how the cancer cells look and behave compared with normal
cells. This can give an idea of how quickly the cancer may be growing. There are three
grades.
• grading
• Grade 1 or low-grade
• The cancer cells look similar to normal cells (are well differentiated) and usually
grow slowly. The cancer cells are less likely to spread.
• Grade 2 or moderate- or intermediate-grade
• The cancer cells look more abnormal and grow slightly faster than grade 1 cells.
• Grade 3 or high-grade
• The cancer cells look very different from normal cells (are poorly differentiated) and
may grow quicker than grade 1 or 2 cells.

13. • Clinical significance
of progesterone and
estrogen in breast
cancer ?

14. Estrogen receptors (ER) and progesterone receptors (PR; also called PgR) may be found in breast
cancer cells. Cancer cells with these receptors depend on estrogen and related hormones, such as
progesterone, to grow.
• If breast cancer cells have estrogen receptors, the cancer is called ER-positive breast cancer.
• If breast cancer cells have progesterone receptors, the cancer is called PR-positive breast
cancer.
• If the cells do not have either of these two receptors, the cancer is called ER/PR-negative.
 All patients with invasive breast cancer or a breast cancer recurrence should have their tumors
tested for estrogen and progesterone receptors.
Why ?
Learning whether a tumor has estrogen and/or progesterone receptors helps doctors determine a
patient's risk of recurrence (return of the cancer after treatment) and whether the cancer can be
treated with hormone therapy.
Hormone therapy blocks the tumor from using estrogen and/or progesterone only for cancers
that are ER and/or PR positive, slowing or stopping tumor growth.
Estrogen receptors (ER) and progesterone
receptors (PR )

15. • Testing the tumor for both estrogen and progesterone receptors is a standard part of a breast
cancer diagnosis. Because the results are used to guide treatment .
• The most common method currently used called immunohistochemistry or IHC.
• IHC testing can detect receptors in cancer cells from a sample of tissue.
• Sometimes, a breast cancer is positive for estrogen receptors, but negative for progesterone
receptors. Because current hormone therapies are designed to treat ER+ cancers,and these
cases are treated the same as breast cancers that are positive for both hormone receptors.
How do hormone therapies work?
Hormone therapies can stop tumor growth by preventing the cancer cells from getting the estrogen
they need to grow.
They can do this in different ways.
the drug tamoxifen, attach to hormone receptors inside the cancer cells and block estrogen from
attaching to the receptors.
the drug aromatase inhibitors, lower the level of estrogen in the body so the cancer cells cannot
get the estrogen they need.

16. How the breast cancer
spread in different sites ?

17. Metastatic Breast Cancer
• What is Metastatic Breast Cancer?
• Metastatic breast cancer is also classified as Stage 4 breast cancer. The cancer has
spread to other parts of the body.
• This usually includes the lungs, liver, bones or brain.

18. Where in the body does breast cancer usually spread?
The most common sites for breast cancer to spread (and methods for localized treatment)
are:
Lymph nodes Under the arm (or axilla, called axillary nodes) .
Bones – the ribs, spine, pelvis and long bones of the arms and legs are the most common
metastatic sites , but breast cancer can spread to many parts of the skeleton.
• Roughly 70% of all patients living with advanced breast cancer have bone metastases.
Very often bone metastases can be successfully managed for a long time.
Bone marrow - cancer cells in the bone marrow are often present with metastatic breast
cancer, especially when there are bone metastases.
Brain - Although any kind of metastatic breast cancer can spread to the brain, certain
kinds are more likely to do so.
• Brain metastasis is observed in 10% of breast cancer patients with metastatic
properties.

19. • The most common sites of metastasis
includes the axillary lymph nodes, bone,
lungs, liver and brain.
Muscle, fatty tissue and skin – usually in the
area near where the initial tumor was, for
example the muscles of the chest wall .
Liver – because the blood supply is filtered by
the liver, this is a very common site for breast
cancer to spread.
Where in the body does breast cancer
usually spread? Also

20. Paraneoplastic syndrome

21. Paraneoplastic syndrome
A syndrome is a set of medical signs and symptoms that are correlated with
each other and, often, with a specific disease.
A paraneoplastic syndrome is a syndrome that is the consequence of cancer in the body but
not due to the local presence of cancer cells.
are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by
an immune response to the tumor.
most commonly present with cancers of the lung, breast, ovaries or lymphatic system

22. • By : asem shadid
• 435032467
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