60 Breast cancer
PREDISPOSITIONS LOCATION
GENETIC HORMONAL
FHx Low, late parity
BrCa1 Anovulatory cycles
Cancer 15% 45%
BrCa2 Postmenopausal oestrogen
Caucasian
5% 10%
o
IRRADIATION
25%
STAGING
retroalveolar
or central
?
CARDINAL SIGNS
IIa 1˚ <2cm + Unfixed nodes IIIa
IV
or 1˚ <5cm Fixed nodes
I Unfixed Metastases Lymph nodes
& <2cm
Painless
Fixed
Hard
IIb <5cm + Unfixed nodes IIIb
or 1˚ ≥5cm Fixed 1˚
IIIc
Regional nodes
Tumour Nodes Metastases NIPPLE CHANGES
IS In situ — — IN BREAST CANCER
0 No residual None None
disease Destroyed
1 1a 1–5 mm Unfixed Present o
1b 5–10 mm Homolateral Deviated
1c 10–20 mm
Displaced
2 2–5 cm Fixed —
Homolateral Depressed
3 >5 cm Contralateral —
Discoloured
or clavicular
4 Chest wall/ — — Discharging blood
ulcerated/
satellites
Definition Epidemiology
Malignant lesion of (predominantly) the female breast. M : F 1:100. >30 years. 1 in 9 women develop breast cancer in their
lifetime.
Key points Aetiology
• Breast lump: triple assessment, clinical, radiology, cytology. • Female gender, advanced age, personal or family history of breast
• Early breast cancer treatment intent is curative. cancer (genetic factors – BRCA1 or BRCA2 gene mutations).
• Late breast cancer treatment intent is palliative. • Early menarche and late menopause, nulliparity, HRT.
• HER2+ tumours to be treated with trastuzumab (Herceptin®). • Smoking, alcohol, fat consumption, lack of exercise and obesity.
• Higher socioecomnomic groups, developed world.
142 Surgery at a Glance, Fifth Edition. Pierce A. Grace and Neil R. Borley. © 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.
PREDISPOSITIONS LOCATION
GENETIC HORMONAL
FHx Low, late parity
BrCa1 Anovulatory cycles
Cancer 15% 45%
BrCa2 Postmenopausal oestrogen
Caucasian
5% 10%
o
IRRADIATION
25%
STAGING
retroalveolar
or central
?
CARDINAL SIGNS
IIa 1˚ <2cm + Unfixed nodes IIIa
IV
or 1˚ <5cm Fixed nodes
I Unfixed Metastases Lymph nodes
& <2cm
Painless
Fixed
Hard
IIb <5cm + Unfixed nodes IIIb
or 1˚ ≥5cm Fixed 1˚
IIIc
Regional nodes
Tumour Nodes Metastases NIPPLE CHANGES
IS In situ — — IN BREAST CANCER
0 No residual None None
disease Destroyed
1 1a 1–5 mm Unfixed Present o
1b 5–10 mm Homolateral Deviated
1c 10–20 mm
Displaced
2 2–5 cm Fixed —
Homolateral Depressed
3 >5 cm Contralateral —
Discoloured
or clavicular
4 Chest wall/ — — Discharging blood
ulcerated/
satellites
Definition Epidemiology
Malignant lesion of (predominantly) the female breast. M : F 1:100. >30 years. 1 in 9 women develop breast cancer in their
lifetime.
Key points Aetiology
• Breast lump: triple assessment, clinical, radiology, cytology. • Female gender, advanced age, personal or family history of breast
• Early breast cancer treatment intent is curative. cancer (genetic factors – BRCA1 or BRCA2 gene mutations).
• Late breast cancer treatment intent is palliative. • Early menarche and late menopause, nulliparity, HRT.
• HER2+ tumours to be treated with trastuzumab (Herceptin®). • Smoking, alcohol, fat consumption, lack of exercise and obesity.
• Higher socioecomnomic groups, developed world.
142 Surgery at a Glance, Fifth Edition. Pierce A. Grace and Neil R. Borley. © 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.
