Posts filed under 'EDUCATION'
N.B This topic will make you understand why it is important to do monthly breast exam. The earlier the cancer is detected, the better the prognosis.
Breast cancer staging
To stage cancer, the American Joint Committee on Cancer, first places the cancer in a letter category using the tumor, nodes, metastasis (TNM) classification system. The stage of a breast cancer describes its size and the extent to which it has spread. The staging system ranges from stage 0 to stage IV according to tumor size, lymph nodes involved, and distant metastasis.
T indicates tumor size. The letter T is followed by a number from 0 to 4, which describes the size of the tumor and whether it has spread to the skin or chest wall under the breast. Higher T numbers indicate a larger tumor and/or more extensive spread to tissues surrounding the breast.
TX: The tumor cannot be assessed.
T0: No evidence of a tumor is present.
Tis: The cancer may be LCIS, DCIS, or Paget disease.
T1: The tumor is 2 cm or smaller in diameter.
T2: The tumor is 2-5 cm in diameter.
T3: The tumor is more than 5 cm in diameter.
T4: The tumor is any size, and it has attached itself to the chest wall and spread to the pectoral (chest) lymph nodes.
N indicates palpable nodes. The letter N is followed by a number from 0 to 3, which indicates whether the cancer has spread to lymph nodes near the breast and, if so, whether the affected nodes are fixed to other structures under the arm.
NX: Lymph nodes cannot be assessed (eg, lymph nodes were previously removed).
N0: Cancer has not spread to lymph nodes.
N1: Cancer has spread to the movable ipsilateral axillary lymph nodes (underarm lymph nodes on the same side as the breast cancer).
N2: Cancer has spread to ipsilateral lymph nodes (on the same side of the body as the breast cancer), fixed to one another or to other structures under the arm.
N3: Cancer has spread to the ipsilateral mammary lymph nodes or the ipsilateral supraclavicular lymph nodes (on the same side of the body as the breast cancer).
M indicates metastasis. The letter M is followed by a 0 or 1, which indicates whether the cancer has metastasized (spread) to distant organs (eg, lungs or bones) or to lymph nodes that are not next to the breast, such as those above the collarbone.
MX: Metastasis cannot be assessed.
M0: No distant metastasis to other organs is present.
M1: Distant metastasis to other organs has occurred.
August 26th, 2005
Classification
Breast cancer is a heterogeneous (origination from self) disease in terms of its clinical course, gross and microscopic pathology, and imaging characteristics.
Several histologic classifications exist. One example is the World Health Organization (WHO) classification, which divides breast cancers into noninvasive type, (in situ), invasive type, and Paget disease of the nipple.
In situ carcinoma is characterized by growth within the ducts without penetration of the basement membrane. In situ carcinoma is subdivided into ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).
Invasive carcinoma denotes neoplastic penetration of the basement membrane of a duct containing DCIS and extension of neoplastic cell aggregates into the mammary stroma. It is further subdivided into these types:
- ductal, which accounts for about 75% of all invasive breast cancers.
- medullary
- mucinous, or colloid
- papillary
- tubular
- adenoid cystic carcinoma
- carcinoma with metaplasia.
Paget disease of the nipple is a type of breast cancer that starts in the breast ducts and spreads to the skin of the nipple and then to the areola. It is rare, accounting for only 1% of all breast cancers. Paget disease may be associated with in situ carcinoma or with infiltrating breast carcinoma. If no lump can be felt in the breast tissue, and if the biopsy shows DCIS but no invasive cancer, the prognosis is excellent.
August 26th, 2005
Breast cancer incidence
Breast cancer is one of the most important diseases for women in the United States and constitutes one fourth of all cancers in females, making it the most common cancer in females. Breast cancer develops in as many as 1 in 8 women by the time they are aged 80 years and is 100 times less common in men. Breast cancer accounts for approximately 15% of female cancer deaths. Approximately 182,800 new cases per year occur in the United States, causing 40,800 deaths per year. Breast cancer is the leading cause of death in women aged 44-50 years. The 5-year survival rate is 60% overall but is greater than 80% for early disease.
Approach to evaluation
As with all clinical conditions, approach breast cancer evaluation in the systematic way learned at the start of clinical training, namely with an ordered inquiry beginning with symptoms and general clinical history, followed by clinical examination and, finally, investigation, which can include imaging and ultimately biopsy. This approach naturally lends itself to a gradually increasing degree of invasiveness, so that when a diagnosis is obtained, the process can be stopped with the minimum amount of invasion and, consequently, minimum discomfort to the patient. Because the more invasive investigations also tend to be the most expensive, this approach is usually the most economical.
Evaluation goals
The aims of evaluation of a breast lesion are to judge whether surgery is required and, if so, to plan the most appropriate surgery. Therefore, the ultimate goal is to achieve the most appropriate degree of breast conservation while minimizing the need for reoperation.
Triple assessment
In breast cancer, the general approach to evaluation has become formalized as triple assessment, involving clinical examination, imaging (usually mammography and/or ultrasound), and needle biopsy, but always perform this as part of a more general assessment beginning with clinical history.
See more breast Cancer Information Here
August 15th, 2005