乳腺癌 武汉协和医院 讲课ppt 全英文.ppt

Breast Carcinoma AnatomyEpidemiology:10%17.1/10 28/10 46/10 1.2 m world wide 6%develop cancer of the breast in their lifetime.50,000 to 70,000 new cases USARisk Factors for Breast Cancer Major MinorGender(femalemale)Early menarcheAge Late minopauseFamily history(mother,sister,or Obesity daughter with premenopausal Low-dose radiation or bilateral cancer)Personal history of contralateral BCNonivasive carcinoma(ductal or lobular carcinoma in situ)Benign proliferative changes with atypiaPathology of Breast CancerNoinvasive1、Ductal Carcinoma in situ(DCIS)，intraductal2、Lobular Carcinoma in situ(LCIS)Invasive1、Infiltrating ductal carcinoma:this is the most common malignant tumor in the breast recognized after biopsy.2、Invasive Lobular carcinoma:Pagets disease of the nippleDiagnosis of Breast Mass:1history and physical examination2Risk factors for breast cancer:3 fine-needle aspiration 4 breast imaging:5 ultrasonography,thermography,computed tomography(CT),magnetic resonance imaging(MRI),mammography.Staging Breast Cancer T1 tumor more than 2 cm or less in greatest dimension T2 tumor more than 2 cm,but not more then 5 cm in greatest dimension T3 tumor more than 5 cm in greatest dimension T4 tumor in any size with direct extension to chest wall or skin No no regional lymph node metastasis N1 metastasis to movable ipsilateral axillary lymph node N2 metastasis to ipsilateral axillary lymph nodes that are fixed to one another or to other structures N3 metastasis to ipsilateral internal mammaryl lymph node Mo no distant metastasis M1 distant metastasis(includes metastasis to ipsilateral supraclavicular lymph node)Surgical Procedures Past and Present 1)In 1894,Halsted2)Radical and Extended Radical mastectomy:3)Modified radial mastectomy:4)Patey:5)Auchincloss:0 01010202030304040505060607070808019721972197619761977197719811981Modified RadicalMastectomyRadical(Halsted)MastectomyAdjuvant chemotherapy for operable breast cancer:1)Adjuvant chemotherapy for lymph node-positive patients 2)Adjuvant chemotherapy for lymph node-negative patientsHormonal therapy for breast cancer 1)Steroid hormone receptors 2)Adjuvant hormonal therapy for operable breast cancerRecommendations for Adjuvant TreatmentMenopausal Axilliary Tumor Recommended Treatment Starus Nodes Characteristics Premenopausal Positive Favorable or Un Combination chemotherapyPremenopausal Negative Favorable No data to support adjuvantPremenopausal Negative Unfavorable Combination ChemotherapyPostmenopausal Positive Favorable TamoxifenChemotherapyPostmenopausal Positive Unfavorable Chemotherapy TamoxifenPostmenopausal Negative Favorable No data to support adjuvantPostmenopausal Negative Unfavorable No data to support adjuvant Favorable tumor characteristic include size2 cm,Er or PgR positive,nuclear and histologic grade good(1 or 2)