Upload
koustav-majumder
View
720
Download
7
Tags:
Embed Size (px)
DESCRIPTION
COMMONEST CANCER AMONG FEMALE IN INDIA.....SEMINER PRESENTED IN MEDICAL COLLEGE & HOSPITAL, KOLKATA ..
Citation preview
LYMPHATIC DRAINAGE, DIAGNOSIS, TNM CLASSIFICATION OF BREAST CANCER
Dr. KOUSTAV MAZUMDERMD PGT, DEPT of RADIOTHERAPYMEDICAL COLLEGE & HOSPITAL, KOLKATA
• Breast cancer may be one of the oldest known forms of cancerous tumors in humans.
• The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.
• The French surgeon Jean Louis Petit (1674–1750) and later the Scottish surgeon Benjamin Bell (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest
muscle.• Their successful work was carried on by William Stewart Halsted
who started performing mastectomies in 1882• The first case-controlled study on breast cancer epidemiology was
done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health
• LYMPHATIC DRAINAGE
• DIAGNOSIS
• TNM CLASSIFICATION
SUPLACLAVICULAR LN
AXILLARY LN
AXILLARY LN
INTERNAL MAMMARY LN
LEVEL III
LEVEL II
LEVEL I
Pectoralis minor
Lateral Thoracic vein
Anterior axillary nodes
Apical axillary nodes
Axillary vein
Central Axillary Nodes
Lateral Axillary Nodes
Posterior Axillary nodes
Subscapular vein
Pectoralis minor
Pectoralis major
Interpectoral node
Internal mammary node
LYMPHTIC DRAINAGE OF BREAST
Draining the PARENCHYMA of BREASTIncluding AREOLA and NIPPLE
Draining the overlying SKIN except AREOLA and NIPPLE
Draining the overlying SKIN except AREOLA and NIPPLE
Anterior abdominal wall
Supraclavicular LNInfraclavicula LN
Internal mammary LN
Axillary LN
Subperitoneal lymphatic plexus
Sub Diaphragmatic node
Hepatic Nodes
Draining the overlying SKIN except AREOLA and NIPPLE
Supraclavicular LNInfraclavicula LN
Internal mammary LN
Axillary LN
Retromammary fat
Lactiferous duct
areola
nipple
lobules
Pectoralis major
Chest wallSubareolar plexus of sappay
Lymphatic Lake of Haller
Draining the PARENCHYMA of BREAST Including AREOLA and NIPPLE
Draining the PARENCHYMA of BREAST Including AREOLA and NIPPLE
Supraclavicular LNInfraclavicula LN
Internal mammary LN
Axillary LN
75%
Draining the PARENCHYMA of BREAST Including AREOLA and NIPPLE
Supraclavicular LNInfraclavicula LN
Internal mammary LN
Axillary LN
•LYMPHATIC DRAINAGE
•DIAGNOSIS
SCREENING• CLINICAL BREAST EXAMINATION
• BREAST AWARENESS
• RADIOLOGICAL INVESTIGATION
MAMMOGRAPHY
BI-RADS (Breast Imaging Reporting And Data System)
PERFORMS=PERsonal perFORmance in
Mammographic Screening
Woman at normal risk
20-39 yrs
•CBE every 1-3 yrs
•Breast awareness
>40 yrs
•Annual CBE
•Breast awareness
•Mammography
Woman at increased risk
•Prior Thoracic irradiation
•>35 yrs
•Lifetime risk >20%
•F/H or genetic predisposition
•LCIS/ Atypical hyperplasia
•H/O Breast Cancer
SCREENING GUIDELINE in NCCN 2012
DIAGNOSIS• HISTORY & CLINICAL EXAMINATION
• RADIOLOGICAL EVALUATION
• BIOPSY
RADIOLOGICAL EVALUATION
• Diagnostic Mammography Spot compression view or magnifiacation view
• Breast ultrasonography woman< 30 yrs of age,
woman>30 yrs age (BIRADS 1-3)
spontaneous nipple discharge/ skin change
BIRADS category 0
• Diagnostic Breast MRI BIRADS 1-3,
IBC
BREAST BIOPSY
• Fine needle aspiration(FNA) Biopsy
• Core needle Biopsy Non palpable lesion
• Excisional Biopsy Atypical hyperplasia, LCIS, mucin producing tumor, Phylloids
• Duct excision(with or without ductography) Non sponteneous discharge from duct with BIRADS 1-3
Guidelines for the basic elements of a pathology report for breast cancer have been established by the College of American Pathologists
• LYMPHATIC DRAINAGE
• DIAGNOSIS
• TNM CLASSIFICATION
• PRIMARY TUMOR (T)
• REGIONAL LYMPH NODE(N)
• DISTANT METASTASES(M)
PRIMARY TUMOR (T)
REGIONAL LYMPH NODE(N)
CLINICAL PATHOLOGICAL
N1
Metastasis to movable ipsilateral level I, II axillary lymph node(s)
N2a
Metastasis in ipsilateral level I, II axillary lymph nodes fixed to one another (matted) or to other structures
N2b
Metastasis only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident level I, II axillary lymph node metastasis
N3a
Metastasis in ipsilateral infraclavicular lymph node(s)
N3b
Metastasis in ipsilateral internal mammary lymph node(s) and axillary lymph node(s)
N3c
Metastasis in ipsilateral supraclavicular lymph node(s)
pN1a
Metastasis in 1 to 3 axillary lymph nodes(at least one >2 mm)
pN1b
Metastasis in internal mammary nodes with micrometastasis or macrometastasis detected by SLNB but not clinically detected
pN1c
Metastasis in 1 to 3 axillary lymph nodes and in internal mammary lymph nodes with micrometastasis or macrometastasis detected in SLNB but not clinically detected
pN2a
Metastasis in 4 to 9 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm)
pN2b
Metastasis in clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases
pN3a
Metastasis in 10 or more axillary lymph nodes(at least one tumor deposit >2 mm
pN3a
metastasis to the infraclavicular (level III) lymph nodes
pN3b
>1
Metastases in clinically detected ipsilateral internal mammary lymph nodes in the presence of 1 or more positive axillary lymph nodes
2
more than 3 axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected
pN3b
pN3c
Metastasis in ipsilateral supraclavicular lymph nodes
• PRIMARY TUMOR (T)
• REGIONAL LYMPH NODE(N)
• DISTANT METASTASES(M)
Distant Metastasis (M)
Stage 0• Tis, N0, M0
Stage IA• T1, N0, M0
Stage IB• T0, N1mi, M0
• T1, N1mi, M0
Stage IIA• T0, N1, M0
• T1, N1, M0
• T2, N0, M0
Stage IIB• T2, N1, M0
• T3, N0, M0
Stage IIIAT0, N2, M0T1, N2, M0T2, N2, M0T3, N2, M0T3, N1, M0
Stage IIIBT4, N0, M0T4, N1, M0T4, N2, M0
Stage IIICAny T, N3, M0
Stage IVAny T, Any N, M1
HISTOLOGIC GRADE (G)
ELSTON- ELLIS modification of SCARFF- BLOOM- RECHARDSON grading system
• TUBULE FORMATION
• NUCLEAR PLEOMORPHISM
• MITOTIC COUNT