Breast cancer is the most common cancer in women worldwide. It arises from breast tissue which contains lobules, ducts, fat and connective tissue. Risk factors include genetic mutations, family history, age and lifestyle factors. Clinical presentation includes lumps, nipple discharge or changes. Diagnosis involves imaging like mammography, biopsy and assessing tumor markers. Treatment is multidisciplinary and may include surgery, chemotherapy, radiation therapy, hormone therapy and targeted therapy based on cancer type and stage. Prevention emphasizes early detection through screening and modifying risk factors.
Ovarian cancer usually happens in women over age 50, but it can also affect younger women. Its cause is unknown. Ovarian cancer is hard to detect early.
The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early. Many times, women with ovarian cancer have no symptoms or just mild symptoms until the disease is in an advanced stage and hard to treat.
Ovarian cancer usually happens in women over age 50, but it can also affect younger women. Its cause is unknown. Ovarian cancer is hard to detect early.
The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early. Many times, women with ovarian cancer have no symptoms or just mild symptoms until the disease is in an advanced stage and hard to treat.
Morphology and diagnosis of Ovarian Tumors
• Clinical Features of Ovarian Tumors
Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel.
Bloating; abdominal distention or discomfort
Pressure effects on the bladder and rectum
Constipation
Vaginal bleeding
Indigestion and acid reflux
Shortness of breath
Tiredness
Weight loss
Early satiety
------prepared by med_students0-----
Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer.
According to the American Cancer Society, more than 193,000 cases of breast cancer are diagnosed each year, with an estimated 40,000 deaths.
About 1% of these cancers occur in men.
This includes introduction its classification,etiology,clinical manifestations,diagnostic criteria,management.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
3. Introduction
What are breasts made of?
The different types of breast tissue include:
•Glandular: Also called lobules, glandular tissue produces milk.
•Fatty: This tissue determines breast size.
•Connective or fibrous: This tissue holds glandular and fatty
breast tissue in place.
What parts make up breast anatomy?
•Lobes: Each breast has between 15 to 20 lobes or sections.
•Glandular tissue (lobules): These small sections of tissue found
inside lobes have tiny bulblike glands at the end
•Milk (mammary) ducts: These small tubes, or ducts, carry milk
from glandular tissue (lobules) to nipples.
•Nipples: The nipple is in the center of the areola. Each nipple
has about nine milk ducts, as well as nerves.
•Areolae: Areolae have glands called Montgomery’s glands that
secrete a lubricating oil. This oil protects the nipple and skin
from chafing during breastfeeding.
4. Anatomy of the breast
Shape and position:
• conical in shape
• It extends from the sternal margin to the
mid axillary line at the level of 4th rib.
• Vertically, it extends from the 2nd rib to the
6th rib along the midclavicular line
7. Lymph nodes
1 -The anterior (pectoral) group
2-the posterior (subscapular)
group
3 – The apical group
4 central basal group
5 lateral (brachial) group
8.
9. Breast Cancer
• Breast cancer is the most common life-
threatening cancer and the leading cause of
cancer mortality among women.
• It is the second most common cause of
death from cancer among women in the
world..
10. Epidemiology
• 1 in 8 women will be diagnosed in their lifetime.
• 1 in 1000 men will be diagnosed in their lifetime
(Primarily after the age of 60).
• In Bangladesh incidence rate of breast cancer
was about 22.5 per 100000 females.
• Breast cancer has been reported as the highest
prevalence rate (19.3 per 100,000) among
Bangladeshi women between 15 and 44 years of
age.
REF: Begum SA, Mahmud T, Rahman T, Zannat J, Khatun F, Nahar K, Towhida M, Joarder M, Harun A, Sharmin F.
Knowledge, Attitude and Practice of Bangladeshi Women towards Breast Cancer: A Cross Sectional Study. Mymensingh
Med J. 2019 Jan;28(1):96-104. PMID: 30755557.
14. Classic histopathologic classification:
- Ductal adenocarcinoma (70% to 80%)
- Lobular carcinoma (10% to 15%).
- Special breast cancer subtypes with a favorable
prognosis include papillary, tubular, mucinous, and pure
medullary carcinomas.
- Inflammatory breast cancer
- Paget disease of the breast,
- Cystosarcoma phyllodes (<1%)
- Rare tumors include squamous cell carcinoma,
lymphoma, and sarcoma.
15.
16. Clinical Presentation
• LUMP is the commonest presentation. Spontaneous
nipple discharge is the Second most common sign
• 10% of patients present with nipple change.
• 5% of patients present with skin contour changes.
• Breast pain/mastalgia alone is a very uncommon
presentation.
• Ductal carcinoma may present as a bloody discharge
from the nipple.
17.
18.
19. Diagnosis
• HISTORY:
• Age: commonest between 45-65yr age –group
• Sex: 99-100 times commoner in females
• Painless, progressive breast swelling, most common
site being the upper outer quadrant of the breast.
• The swelling may be painful in inflammatory breast CA
• Ulceration of overlying skin, axillary swelling, upper
limb swelling (lymphedema)
• Blood-stained nipple discharge.
• Nipple changes: deviation, retraction, destruction
20. • History of Complications
• Metastasis
• CNS: headache, blurring of vision, altered consciousness,
vomiting
• Chest: cough, dyspnoea
• Abdomen: jaundice, ascites (abdominal distension)
• MSS: bone pains, weakness in limb, backache,
numbness/tingling sensation in lower limbs
• Fatigue due to anaemia
21. Physical examination
•General:
• Breasts: examine the normal breast before
the diseased breast
• Breast symmetry:
• Skin changes: peau d’orange (from blockage of dermal lymphatics),
Dimpling of skin due to infiltration of ligament of Cooper, Retraction of
nipple due to infiltration of lactiferous duct, Ulceration, discharge from the
nipple and areola, Skin ulceration and fungation, nipple changes
• A lump is palpable in the breast in about 50% of patients and in over 90% of
these there is a co-existing invasive cancer.
• When a lump is present, axillary nodes may be felt.
22. Physical examination
• CVS
• Abdomen
• Hepatomegaly and ascites from liver metastases.
• Rectal examination is done for pelvic metastases.
• Extremities and back
• The spine and skull are examined for tenderness or swelling.
• Neurological examination
25. INVESTIGATIONS- BREAST USG:
• Useful to differentiate solid from cystic breast lesions.
• Useful in women < 35yrs with dense breast tissue. Sensitivity is 70-90%,
specificity is 80-95%. It is operator dependent.
26. MAMMOGRAPHY (Screen-film mammography-SFM)
• Useful after 30yrs of age when the breast tissue contains less dense
glandular tissue (but comprises more of fat)
• 10-15% of breast cancers are not seen on mammography
• Invasive breast cancer can look like a white patch or mass on a
mammogram. The tumor cells that began in the milk duct. The outer
edges of these cells look fuzzy or spiky (called speculated)
28. MRI
Useful for :
the extent of multi focal or multicentric disease,
for identifying primary foci in non-palpable lesions,
axillary metastases
assessing response to neoadjuvant chemotherapy, for
recurrence in breast after surgery and/or radiotherapy
and also for screening high-risk and BRCA-positive
patients especially younger than 50 years.
for detecting bone marrow metastases and
spinal cord compression.
29.
30. CYTOLOGY:
• To determine if the lesion is benign or malignant.
• Can also distinguish ductal from lobular Cancer, though cannot
distinguish in-situ from invasive Cancer
• Yield increased by USG-guided FNAC or mammography-
guided FNAC
31. BIOPSY
Useful to make a definitive diagnosis of breast Cancer,
differentiates DCIS from invasive Cancer, determines
the histologic grade, level of differentiation and also in
determining the hormone receptor status (ER, PR and
Her-2/neu receptor status of the tumour. The BRCA 1
gene can also be done if indicated.
Biopsy technique:
1) needle biopsy
2) incisional biopsy
3) excisional biopsy
33. Staging workup
• CXR: secondaries in the chest (canon-ball metastases, pleural
effusion or bony erosion).
• Abdominal USG: secondaries in the liver, ascites
• LFT: raised ALP may be due to metastasis to the liver
• SKELETAL SURVEY: Involve x -rays of the spine, pelvis and skull.
It is done to find the presence or otherwise of asymptomatic
osseous metastases.
• SKELETAL SCINTIGRAPHY: refers to bone scan using 87Sr or
18F. Picks up bony metastases 3- 6 months before they become
demonstrable by conventional X-ray.
• CT-scan of the brain: in suspected cranial metastasis
• PET/CT scan: if available, it is considered the most accurate
and useful imaging modality for staging metastatic breast
cancer because it provides whole-body assessment of soft
tissue, visceral and bony sites at a single examination.
37. LOCAL INVASION:
Affects surrounding breast tissue, overlying skin, underlying
muscle, and chest wall.
• Occurs via:
• Direct infiltration into the surrounding parenchyma: - Macroscopic
stellate appearance
• Direct infiltration along the lactiferous duct: nipple retraction
• Involvement of the ligaments of cooper: dimpling of the skin
• Skin involvement leads to skin tethering (skin attachment), peau
d’orange (obstruction of dermal lymphatics), skin ulceration
39. TREATMENT
The Rx is multidisciplinary,
• Oncologists,
• Radiologists,
• Surgeons,
• pathologists,
• and other professionals
such as counsellors and
breast care nurses
41. Surgery
Breast-conserving surgery: Surgery to remove just the
cancerous lump (tumor).
• Lumpectomy:
• Partial mastectomy
• segmental mastectomy
Mastectomy: Surgery to remove the whole breast.
• Total (Simple) mastectomy
• Modified radical mastectomy
• Radical mastectomy
46. RADIOTHERAPY
• It reduces the incidence of loco-regional metastases in "early" breast
cancer,
INDICATIONS FOR RADIOTHERAPY
• After mastectomy in patients with high risk of loco-regional
recurrence
• Patients with 4 or more positive nodes
• Advanced primary tumour >5cm
• One invading the underlying muscle or adjacent skin
• Poorly differentiated tumour or one with lymphovascular invasion.
• Advanced metastatic carcinoma: Radiotherapy is beneficial for
alleviating bone pains and for controlling or treating the local
disease or recurrence
49. HORMONAL THERAPY
• If the tumour is ER +, hormonal therapy is given postoperatively.
• Indications for hormonal therapy
• Post-menopausal patients with ER + tumours with or without positive axillary
nodes.
Premenopausal patients may be similarly treated, but oophorectomy is
advised in developing countries.
• For palliation in patients with advanced ER+ carcinoma
• Preoperatively to shrink large ER + tumours and make them operable.
• During 3 months of tamoxifen, the tumour shrinks rapidly and there may not be any
evidence of tumour in the mastectomy specimen. The tumour shrinks by 25-50% in 2
weeks if 100mg is given daily.
50. • Drugs Used:
• Anti-oestrogens:
• Tamoxifen: better used in pre-menopausal women
• SAI (selective aromatase inhibitors): better used in post-menopausal women
• Reversible: Anastrozole/Arimidex
• Irreversible: Exemestane, Formestane
• Pure anti-oestrogens: Fulvestrant (Faslodex), given IM, once monthly. They are
steroids that bind oestrogen receptor and prevent oestrogen receptor dumerization
and DNA binding
• Progestins:
• Medroxyprogesterone acetate (500-1000mg/day)
• Megestrol acetate (80mg b.d)
HORMONAL THERAPY
51. • Targeted therapy
• Useful as an adjunct to other treatment modalities that reduce tumour burden.
• 20% of tumours express the human epidermal growth factor receptor gene (HER2/neu
gene). This receptor encodes a protein that accelerates the growth of metastatic breast
cancer.
• Trastuzumab is a recombinant monoclonal antibody against the HER2/neu gene.
• Pertuzumab
• Lapatinib inhibits the tyrosine kinase activity associated with two oncogenes, EGFR
(epidermal growth factor receptor) and HER2/neu (human EGFR type 2).
• Palbociclib, is a selective inhibitor of the cyclin-dependent kinases CDK4 and CDK6.
• Everolimus
52. Immunotherapy
Pembrolizumab is a drug that targets PD-1 (a protein on
immune system T cells that normally helps keep them from
attacking other cells in the body). By blocking PD-1, these
drugs boost the immune response against breast cancer cells.
This can often shrink tumors.
53. FACTORS AFFECTING PROGNOSIS
• Lymphovascular involvement
• Presence or absence of axillary nodes: this is the most important prognostic index.
• Presence or absence of systemic dissemination.
• Histologic sub-type of tumour and grade of the tumour (different biologic
propensity):
• Intraductal mucinous, papillary, cribriform & tubular carcinomas have a slower
growth and better prognosis.
Medullary carcinoma with lymphocytic infiltration also has a good
prognosis. (pure variant of medullary has poor prognosis)
• Invasive ductal CA Nos (not otherwise specified) is the commonest form of invasive
ductal Cancer. It has an intermediate prognosis
• Some rare forms of breast cancer (e.g. sarcomatoid carcinoma, inflammatory
carcinoma) have a poor prognosis..
54. • Size of the tumour at the time of diagnosis: small tumours have a
better prognosis than big tumours. Tumours < 1cm are unlikely to
metastasize
• Hormone receptor status: tumours with oestrogen receptors have a
best prognosis within the first 5 years and over than those without.
They have > 70% response rate to hormonal therapy
• Over-expression of oncogenes such as HER-2/neu gene:
Good prognosis.(But only if targeted therapy given).
• Tripple Negative Breast Cancer: Worst prognosis
• Menstrual status of the patient: pre-menopausal patients do better
than post-menopausal patients. Women between 35 and 49 have on
the whole a better prognosis than those over 50yrs or less than 35.
• Age & Sex
55. SCREENING FOR BREAST CANCER
• Self breast examination: done on 7th-10th days of the cycle, in
supine position.
56. • Women ages 40 to 44 should have the choice to start annual
breast cancer screening with mammograms if they wish to do so.
• Women age 45 to 54 should get mammograms every year.
• Women age 55 and older should switch to mammograms every 2
years.
• Indications
• Women > 50yrs
• Patients who have had breast conservation for breast CA. Both breasts
should be screened
• Those who have had mastectomy.
• Strong family History.(starts screening in 30-35 years)
• Detects small lesions, sometimes not yet palpable. These are
biopsied.
Mammography
57. • Suspicious features include:
• Stellate or irregular densities
• Altered breast architecture
• Micro-calcification (> 2mm), which may be clustered, punctate,
microlinear or branching and concentrated in an area > 1cm in
diameter.
•Disadvantages/limitations
• 10-15% of cancers are not detected by mammography. Cancer may also occur
in-between screening (interval carcinoma).
• Difficult to detect lobular carcinoma, because of minimal calcification
60. BREAST CANCER PREVENTION
1. Early detection and treatment; screening and surveillance
2. Chemoprevention
• Tamoxifen; recommended only for women who have a Gail relative risk of 1.66% or
higher, who are aged 35 to 59, women over the age of 60 or women with a diagnosis
of LCIS or atypical ductal or lobular hyperplasia. When taken for 4-5 years, it reduces
the incidence of invasive breast cancer
• Aromatase inhibitors (AIs); have been shown to be more effective than tamoxifen in
reducing the incidence of contralateral breast cancers in postmenopausal women
receiving AIs for adjuvant treatment of invasive breast cancer.
3. Risk reducing surgeries
• Prophylactic bilateral mastectomy: recommended for BRCA 1 and 2 mutation carriers
and other high-risk patients after genetic counselling. It reduces breast cancer risk by
90%.
• Prophylactic bilateral oophorectomy (in premenopausal women): reduces risk by
50%.
Malignant lesions are commonly hypoechoic lesions with ill-defined borders. Typically, a malignant lesion presents as a hypoechoic nodular lesion, which is 'taller than broader' and has spiculated margins, posterior acoustic shadowing and microcalcifications