SGD 1

Breast Cancer
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Scenario
35 years old woman complained about the
mass in her left breast since last year. Her mothers
sister also has breast cancer which lead her to death
at 45 years.
On examination, theres nodule, marbles
alike, on superior lateral sinistra quadrant , the
surface isnt smooth, immobile, painless and also
found peau dorange.
What disease does she has?
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Problems
1. A mass in her left breast since last year
2. Her family died because of breast cancer
3. Theres nodule, marbles alike, on superior lateral
sinistra quadrant , the surface isnt smooth,
immobile, painless and also found peau dorange
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Analysis
A mass? Maybe Infection; Inflammation; Neoplasia;

She has familial risk factors of breast cancer

The tumor might be a malignancy.

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Hypothesis
35 years old woman might have
breast cancer
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Learning Objectives
1. Classification and epidemiology of neoplasia
2. Pathophysiology of neoplasia
3. Risk factors and clinical manifestation of breast
cancer
4. Diagnosis and differential diagnosis of breast
cancer
5. Treatment and prevention of breast cancer
6. Complication and prognosis of breast cancer
 Classification and
Epidemiology of Neoplasia

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8 Classification of neoplasia

Benign
Benign tumors grow slowly and usually has a
capsule.
Malignant
Malignant tumors grow rapidly , infiltrating and
damaging the surrounding tissue
Intermediate
Epidemiology of neoplasia

Data from 13 Pathology Laboratory

Centre throughout Indonesia in order:
- Cervix uteri 16.8 %
- Breast 12.8 %
- Leather 7.9 %
- Nasopharyngeal 5.6 %
 Pathopysiology of Neoplasia

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 Risk factors and Clinical
Manifestation of Breast Cancer

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Clinical manifest Risk factor

Tumor mass - Family history and
skin changes genes associated
changes in mammary mammary carcinoma
papilla - Reproduction
enlargement of - Abnormalities of the
regional lymph nodes mammary gland
-The use of drugs in the
past - Diet and Nutrition
Diagnosis and Differential
Diagnosis of Breast Cancer
19 Diagnosis
1. Anamnesis
2. Physical examination :
a. Inspection : symmetric, dimpling, oudem, peau
dorange , erotion or ulceration on nipple.
b. Palpation : massage mammae following the
clockwise direction on the areola of mammae,
papila mamae ( to know if theres a secret or not ). If
theres a tumor, write about its location,
consistension, surface, pain, also palpation on
axila, supraclavicula and infraclavicula lymph gland
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Imaging test
a. Mammografi
b. Usg
c. MRI Mammae
Lab test
a. Cytology
b. Histology from needle punction
c. biopsy
 Staging
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T0 No evidence of primary tumour
TX Primary tumour cannot be assessed 4c Both 4a and 4b
Tis Carcinoma in situ 4d Inflammatory carcinoma
T1 2 cm or less in greatest dimension N0 No lymphadenopathy
1a 0.5 cm or less in greatest dimension N1 Ipsilateral mobile axillary
1b >0.5 cm but not >1 cm in greatest nodes
dimension N2 Ipsilateral axillary nodes
1c >1 cm but not >2 cm in greatest fixed to one
dimension another or to adjacent structures
T2 >2 cm but not >5 cm in greatest N3 Ipsilateral internal
dimension mammary node
T3 >5 cm in greatest dimension metastases
T4 Tumour of any size with extension to M1 Involvement of
chest wall and/or skin supraclavicular nodes
4a Invasion of chest wall (ribs, serratus or distant metastases.
anterior, intercostal muscles)
4b Oedema/peau dorange, ulceration,
satellite nodules confined to same
breast
22 Differential Diagnosis

Fibroadenoma mamae
Hyperplasia cystic mammae gland
Tumor papilform intraduktal
Kista retension of ASI
Tuberculosis Mammae Gland
 Treatment and Prevention
of Breast Cancer

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24 Treatment

Breast Conserving Surgery

Mastectomy
Radiotherapy
Chemotherapy
Hormone Therapy
25 Prevention

Avoid risk factors

Educate people to use SADARI method
 Complication and Prognosis of
Breast Cancer

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27 Complications

Metastasis through limfogen or

hematogenous
Brain
Pleura
Lungs
Heart
Bones
Complications of the breast
Death
28 Prognosis

As malignancy in general, the prognosis of breast

cancer demonstrated by survival or disease-free
interval. the prognosis of patients with breast
malignancies are expected bad if young age, bilateral
breast cancer, undergo a genetic mutation, and their
triple negative tumors are high grade and uniform, ER
and PR receptor negative, receptor cell surface HER-2
negative.
A 35 y.o woman came with a mass on her superior sinister lateral quadrant of
her breast. The tumor size is about half an inch, immobile, rough surface, and
theres peau dorange. She also has familial risk factors for breast cancer. We
diagnosed her for having breast cancer. Next step we do are educate her to
avoid any risk factors and refer her to oncolgy surgeon to get work-up such as
mammography and biopsy-for-histopathologic-test. If she positive has breast
cancer, she should get a treatment depends on her stage.

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THANKS!
Any questions?