first month second month first month second month milk line remnant milk line remnant accessory...
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First monthFirst month Second MonthSecond Month
• Milk line remnantMilk line remnant• Accessory axillary breast tissueAccessory axillary breast tissue• Congenital nipple inversionCongenital nipple inversion
Risk FactorsRisk Factors• AgeAge• Genetics: BRCA1,BRCA2(first degree relatives)Genetics: BRCA1,BRCA2(first degree relatives)• Carcinoma of contralateral breastCarcinoma of contralateral breast• Endometrial carcinomaEndometrial carcinoma• Reproductive life( early menarche, late Reproductive life( early menarche, late
menopause)menopause)• Parity( nulliparous > multiparous)Parity( nulliparous > multiparous)• First live birthFirst live birth• Race (Northern Europe)Race (Northern Europe)• Geographic Influence (immigration)Geographic Influence (immigration)• Radiation Exposure (therapeutic or environmental)Radiation Exposure (therapeutic or environmental)
Risk Factors Cont’edRisk Factors Cont’ed
• Estrogen exposureEstrogen exposure
• Obesity( specially in postmenopausal Obesity( specially in postmenopausal state)state)
• DietDiet
• ExerciseExercise
• Breast feedingBreast feeding
• Environmental toxinsEnvironmental toxins
• TobaccoTobacco
Prognostic and predictive Prognostic and predictive factorsfactors
Major:Major:
• Invasive vs In situInvasive vs In situ
• Distant Metastasis Distant Metastasis
• Lymph node metastasisLymph node metastasis
• Locally advanced diseaseLocally advanced disease
• Inflammatory carcinomaInflammatory carcinoma
Prognostic Factors cont’edPrognostic Factors cont’ed
Minor:Minor:
• Histological typeHistological type
• Tumor gradeTumor grade
• Estrogen and progesterone receptorsEstrogen and progesterone receptors
• Lymphovascular invasionLymphovascular invasion
• Proliferative rateProliferative rate
• DNA contentDNA content
StagingStagingStage 0:Stage 0: DCIS or LCIS ( 5 year survival 92%)DCIS or LCIS ( 5 year survival 92%)Stage I : Invasive <2 cm, including in situ and Stage I : Invasive <2 cm, including in situ and microinvasivemicroinvasiveStage II: Invasive <5cm or >5cm without nodal Stage II: Invasive <5cm or >5cm without nodal involvementinvolvementStage III: Invasive>5 cm+ nodal involvement or Stage III: Invasive>5 cm+ nodal involvement or any breast ca+ fixed L.N, orany breast ca+ fixed L.N, or inflammatory breast cancerinflammatory breast cancerStage IV: Any form of breast Ca+ distant breast Stage IV: Any form of breast Ca+ distant breast metastasismetastasis
Treatment option based on LN Treatment option based on LN involvementinvolvement
0: 0: NoNo systemic therapy depends on the mainsystemic therapy depends on the main
tumortumor
1-31-3: some form of standard systemic : some form of standard systemic treatmenttreatment
indicated ( hormonal or chemotherapy)indicated ( hormonal or chemotherapy)
4-94-9: high dose chemotherapy: high dose chemotherapy
10 or more10 or more: autologous bone marrow : autologous bone marrow
transplantationtransplantation