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• Breast Cancer - Coggle Diagram
• Breast Cancer
1• Overview and Risk Factors
• Prevalence: Breast cancer is the most common cancer among women, affecting 1 in every 8 women.
• Common Location: Most cases (60-65%) are found in the upper outer quadrant of the breast.
• Key Risks/Causes:
1• Gender and Age: Female gender is a major risk (higher than male), and risk increases sharply after the age of 40.
2• Hormonal Factors: Early menarche, late menopause, late age of first pregnancy, absence of lactation, and use of OCPs or HRT (with estrogen).
3• Other Factors: Personal or family history, radiation therapy to the chest, obesity, and diets high in saturated fat.
2• Clinical Features (Signs and Symptoms)
• The main presentation is often a hard, painless mass in the breast and/or the axilla (armpit).
• Other possible signs include:
• Change in breast size or shape.
• Skin changes such as dimpling, thickening, or peau d'orange (redness/pitting of the skin, like an orange peel).
• Nipple abnormalities like inversion, persistent eczema, or bloody discharge.
• Redness involving a large area of the skin.
3• Types of Breast Cancer
• Based on Origin:
1• Ductal Carcinoma: Arises from the milk ducts.
2• Lobular Carcinoma: Arises from the milk-producing lobules.
• Based on Invasiveness:
1• Noninvasive (In Situ): Cancer is contained and has not spread (e.g., Ductal Carcinoma In-Situ - DCIS).
2• Invasive: Cancer has spread to other parts of the breast from ducts or lobules (e.g., Invasive Ductal Carcinoma).
4• Stages of Breast Cancer
• Staging describes the extent of the cancer (tumor size, lymph node spread, distant spread, and biomarkers).
• Stage 0: Non-invasive cancer (DCIS) confined only to the breast ducts.
• Stage I: Small tumor (<2 cm), invasive, with no spread to axillary lymph nodes.
• Stage II: Larger tumor (2-5 cm) that has spread to mobile axillary lymph nodes. (Stages I and II are considered early breast cancer).
• Stage IV (Metastatic): Cancer of any size that has spread to distant organs (most commonly bones, lungs, brain, or liver).
• Stage III (Locally Advanced): Larger mass (>5 cm), fixation to the chest wall, severe skin changes, or fixed/supraclavicular lymph node involvement.
5• Diagnosis (Triple Assessment)
• A confident diagnosis is reached in 99% of cases through the Triple Assessment:
1• Clinical: History and physical/clinical examination (checking for features like hardness or fixation).
2• Imaging: Radiological imaging, typically Ultrasound and Mammography (Mammogram).
3• Pathology: Biopsy to collect cells or tissue for analysis, such as Fine Needle Aspiration Cytology (FNA) or Core Biopsy.
6• Management (Treatment)
1• Surgery
• Breast Conservation: Removal of the cancerous tissue with a margin of normal tissue, always followed by radiotherapy.
2• Mastectomy: Removal of the entire breast. This can be Simple (breast only), Modified Radical (breast plus axillary lymph nodes), or Conservative (sparing skin/nipple for reconstruction).
2• Radiotherapy: Local treatment using radiation to kill cancer cells. It is indicated after breast conservation or after mastectomy if axillary lymph nodes were positive.
3• Chemotherapy: Systemic treatment often used post-surgery (adjuvant) for positive lymph nodes, or pre-surgery (neo-adjuvant) for locally advanced cancer or certain molecular types (e.g., HER2nu positive).
4• Hormonal Treatment: Systemic treatment indicated for HR-positive tumors to slow growth by blocking or interfering with hormone effects.
5• Targeted Therapy: Treatments that target specific cancer cell characteristics (e.g., Herceptin for HER2nu positive).