Breast diseases
By : Omar M. Subhi Altaie
Carcinomas of the breast are malignant tumors, adenocarcinoma is a malignant tumor found in the epithelial tissue of the mammary glands' lobules of the breasts.
Inflammatory breast cancer IBC
It is not a very popular disease, but it is very aggressive (grows and spreads very fast) disease that blocks the lymph vessels in the skin of the breast.
It constitutes 1- 5% of all kinds of cancer in the US. the most popular kind of this disease is invasive ductal carcinomas, which start in the small milk ducts of the breast and spread out of the ducts to other parts of the breast.
Studies show that the IBC tends to infect younger women more than older ones. Also, overweight women in more prone to getting the disease.
The IBC cannot be treated with hormone therapies that is because it is hormone receptor-negative
(Which is when a kind of protein connects to the surface of the cell called a protein receptor that is ready to connect with a specific hormone to do a specific job ) , thus tamoxifen which is used in other types of cancers cannot be used with IBC.
It constitutes 1- 5% of all kinds of cancer in the US. the most popular kind of this disease is invasive ductal carcinomas, which start in the small milk ducts of the breast and spread out of the ducts to other parts of the breast.
Studies show that the IBC tends to infect younger women more than older ones. Also, overweight women in more prone to getting the disease.
The IBC cannot be treated with hormone therapies that is because it is hormone receptor-negative
(Which is when a kind of protein connects to the surface of the cell called a protein receptor that is ready to connect with a specific hormone to do a specific job ) , thus tamoxifen which is used in other types of cancers cannot be used with IBC.
Some symptoms of IBC that may present in less than 6 months, can be used to detect IBC through:
• Third or more of the breast may get swollen and redness or change in color bruised (which is skin discoloration due to tissue or skin damage that affects the vessels and causes them to leak)
• Peau d’orange and its symptoms could be the detection of the IBC (as discussed below)
Diagnosis of the IBC is quite difficult especially when the woman has dense breast tissue. A diagnostic mammogram and an ultrasound of the breast and (nearby) lymph nodes can be useful to detect the disease in its early stages and have the best chance to treat it before invading other parts of the body.
Treatment of the IBC is basically by using systematic chemotherapy ( that is anticancer drugs that flow in the bloodstream ) to minimize the size of the tumors, then surgical intervention takes place to remove the tumor, and afterward, radiation therapy (X-ray and Gama ray and other sources) is used to kill the cancer cells and make them shrink.
• Third or more of the breast may get swollen and redness or change in color bruised (which is skin discoloration due to tissue or skin damage that affects the vessels and causes them to leak)
• Peau d’orange and its symptoms could be the detection of the IBC (as discussed below)
Diagnosis of the IBC is quite difficult especially when the woman has dense breast tissue. A diagnostic mammogram and an ultrasound of the breast and (nearby) lymph nodes can be useful to detect the disease in its early stages and have the best chance to treat it before invading other parts of the body.
Treatment of the IBC is basically by using systematic chemotherapy ( that is anticancer drugs that flow in the bloodstream ) to minimize the size of the tumors, then surgical intervention takes place to remove the tumor, and afterward, radiation therapy (X-ray and Gama ray and other sources) is used to kill the cancer cells and make them shrink.
Peau d’orange
When part of the skin on the breast turns into a thinker orange-peel-like shape that is rough, bumpy, and pitted skin that can sometimes appear on the breast. the main reason for this disease is cancer, but there are many other reasons behind it.
Symptoms that can be detected in breasts to ensure that Peau d’orange in this case is caused by inflammatory breast cancer (IBC) are as follows:
• Redness and swelled breast
• One of the breasts is growing faster than the other
• Pain or tenderness in the breast
• Inverted nipple
• Swollen lymph nodes especially in the armpit
Otherwise, inflammatory breast cancer is hard to detect; because it starts at first in lymph vessels that are deep to be felt by the patient.
Symptoms that can be detected in breasts to ensure that Peau d’orange in this case is caused by inflammatory breast cancer (IBC) are as follows:
• Redness and swelled breast
• One of the breasts is growing faster than the other
• Pain or tenderness in the breast
• Inverted nipple
• Swollen lymph nodes especially in the armpit
Otherwise, inflammatory breast cancer is hard to detect; because it starts at first in lymph vessels that are deep to be felt by the patient.
Lymph is the important factor that helps the malignant tumers' cells of cancer to metastasize (spread) to several parts of the body. the lymph carries the cancer cells through lymph nodes especially those in the axilla, the cells become firmly embedded in these nodes, producing nets of tumor cells.
When the pectoralis major muscle contracts the breast elevates, this is used as a clinical sign of breast cancer that might happen in the retro mammary space after invading the interpectoral nodes or the pectoral fascia that overlies the muscle.
To observe that, the physician asks the patient to tense her pectoral muscles by placing her hand on her hip and pressing while pulling her elbow forward.
The figure below shows a locally advanced carcinoma located on the patient's left breast, just behind the areola at the nipple. Having the patient press their hands against their hips during the inspection produced this clinical sign.
When the pectoralis major muscle contracts the breast elevates, this is used as a clinical sign of breast cancer that might happen in the retro mammary space after invading the interpectoral nodes or the pectoral fascia that overlies the muscle.
To observe that, the physician asks the patient to tense her pectoral muscles by placing her hand on her hip and pressing while pulling her elbow forward.
The figure below shows a locally advanced carcinoma located on the patient's left breast, just behind the areola at the nipple. Having the patient press their hands against their hips during the inspection produced this clinical sign.
Cells can metastasize to other parts of the body by venous drainage of the intercostal veins that drain into the azygos and hemiazygos systems, cancer cells can spread from breasts to the vertebrae and then may infect the carnium (bones that surround and protect the brain) and then to the brain .
Most carcinomas (type of cancer the occur in the breast) occur in the upper lateral quadrant, that (as mentioned) drain into the axillary nodes, in this case axillary nodes and vessels that drain into it must be removed surgically .
Cancer may be spread to the abdominal cavity , neck or other parts caused by the obstruction (blockage) of the lymphatic pathway by malignant cells , or by distraction of the lymph vessels by radiotherapy or surgery to that part . Because that Cancer cells are flow across the lymph vessels that eventually enter the bloodstream and may metastasize to distant (away) bones or structures.
Most carcinomas (type of cancer the occur in the breast) occur in the upper lateral quadrant, that (as mentioned) drain into the axillary nodes, in this case axillary nodes and vessels that drain into it must be removed surgically .
Cancer may be spread to the abdominal cavity , neck or other parts caused by the obstruction (blockage) of the lymphatic pathway by malignant cells , or by distraction of the lymph vessels by radiotherapy or surgery to that part . Because that Cancer cells are flow across the lymph vessels that eventually enter the bloodstream and may metastasize to distant (away) bones or structures.
When the tumor is detected, mastectomy
(breast and associated structures removal) or a lumpectomy ( tumor removal) must be done by sergons . Radical Mastectomy is preferable for the chance to best recovery.
In this surgery all associated structures that containing lymph vessels and nodes must be removed entirely.
(breast and associated structures removal) or a lumpectomy ( tumor removal) must be done by sergons . Radical Mastectomy is preferable for the chance to best recovery.
In this surgery all associated structures that containing lymph vessels and nodes must be removed entirely.
Finally, breast cancer has its severe affect on women's lives all over the globe , that may affect their life in several aspects, or in other cases leading them to death. All women must be fully aware of breast cancer causes and what makes it more likely to happen and how to prevent it from happening or at least detecting it in its first stages by periodically checks ; especially for women having a first-degree relatives with breast cancer, that may higher the risk of infection .
Mammography
Sergons use mammography as guide to remove tumors in the breasts, it uses radiotheraphic examination to detect breast masses , that they appear as large density in mammogram
Sergical incision
Incisions commonly created within the inferior quadrants because of the low vascular supply in them compared to alternative quadrants.
Mastectomy is one in all the kinds of incision once the breast is removed as once the tumor has not invaded all surrounding structures, however in additional extensive surgical procedures radical mastectomy is used once the pectoral muscles , fat and connective tissue and plenty of lymph nodes are removed with the breast.
The other incision used is lumpectomy , once only the part that infected of the breast is removed, however the danger of the cancer to come back is at a higher level compared to radical mastectomy.
Mastectomy is one in all the kinds of incision once the breast is removed as once the tumor has not invaded all surrounding structures, however in additional extensive surgical procedures radical mastectomy is used once the pectoral muscles , fat and connective tissue and plenty of lymph nodes are removed with the breast.
The other incision used is lumpectomy , once only the part that infected of the breast is removed, however the danger of the cancer to come back is at a higher level compared to radical mastectomy.
Polymastia , Polythelia and Amastia
Polymastia is when the women or men have more than two breast tissue (accessory breast tissue), it usually consists of rudimentary, undeveloped nipple and areola that may be mistaken for a birthmark (or nevus) until it changes in color with other normal nipples during pregnancy. In some cases glandular tissue may present and develop with lactation.
The place that may they appear in is along a line between axilla and groin .there may be only nipples development that may appear superior or inferior to the normal pair and that called polythelia .
The place that may they appear in is along a line between axilla and groin .there may be only nipples development that may appear superior or inferior to the normal pair and that called polythelia .
Breast cancer in men
It makes about 1.5% of breast cancer, it is basically hard to be detected , secretion from the nipples and some palpable masses may indicate the the tumor.
Breast men cancer tend to infect the pectoralis major muscle and the fascia overlying it ,the apical nodes in the axilla may get infect. In advanced stages of cancer the bones may get infected , in that case serious surgeries should take place .
Breast men cancer tend to infect the pectoralis major muscle and the fascia overlying it ,the apical nodes in the axilla may get infect. In advanced stages of cancer the bones may get infected , in that case serious surgeries should take place .
Gynecomastia
One of the most me breast disorders that affects about 50-65% of male wildwide.
One or both breasts enlargment of male breast that usually occurs after the age of puberty (10 to 12 years).
Gynecomastia may cause due to the some kinds drug
Like diethylstilbestrol (that used to treat prostate cancer ) , imbalance in the hormones or changes in the metabolism of sex hormones in the liver .
Genetic disorders may also be the reason, like less than half of klinefelter Syndrome patients have gynecomastia .
One or both breasts enlargment of male breast that usually occurs after the age of puberty (10 to 12 years).
Gynecomastia may cause due to the some kinds drug
Like diethylstilbestrol (that used to treat prostate cancer ) , imbalance in the hormones or changes in the metabolism of sex hormones in the liver .
Genetic disorders may also be the reason, like less than half of klinefelter Syndrome patients have gynecomastia .
Different times that Gynecomastia occur more than others:
• Newborn babies : many male babies born with enlarged breasts ant their first weeks , and that because of estrogen influence from the mother, after few weeks the breasts return to normal.
• Puberty : large numbers of teenage males have some degree of breast enlargement , low testosterone levels and surges in estrogen, may cause breast tissue to grow. The condition goes away as hormone levels even by a process that takes about half a year or more to complete.
• Adulthood : Enlarged breasts are more common in men over 50. ,as mens grow old, they produce less amounts testosterone. They may also have more body fat, which make estrogen production more in them, thusmake breast tissue grow.
• Newborn babies : many male babies born with enlarged breasts ant their first weeks , and that because of estrogen influence from the mother, after few weeks the breasts return to normal.
• Puberty : large numbers of teenage males have some degree of breast enlargement , low testosterone levels and surges in estrogen, may cause breast tissue to grow. The condition goes away as hormone levels even by a process that takes about half a year or more to complete.
• Adulthood : Enlarged breasts are more common in men over 50. ,as mens grow old, they produce less amounts testosterone. They may also have more body fat, which make estrogen production more in them, thusmake breast tissue grow.
Lymphedema
When the cancer cells interfere with the lymphatic drainage that may cause lymphedema which is excess of fluids in the subcutaneous tissue. That in turn may cause several abnormal cases in the breast, such as leather-like appearance and thickens of the skin, or deviation of the nipple. Orange peel (Peau d’orange) may be on of the causes of lymphedema.
Lymphedema may occur right after surgery of breast cancer or after several months, during the surgery for cancer, nearby lymph nodes are often removed. This disrupts the flow of lymph, which can lead to swelling, And that called lymphedema.
(as mentioned before) women getting mastectomy
are more likely to cure, and that contains removing all nodes that may be infected, thus When many lymph nodes under the arm have been removed, a woman is at higher risk of lymphedema for the rest of her life. Radiation may be one of cases to lymphedema due to the scarring and blockages that may higher the risk of lymphedema.
Lymphedema may occur right after surgery of breast cancer or after several months, during the surgery for cancer, nearby lymph nodes are often removed. This disrupts the flow of lymph, which can lead to swelling, And that called lymphedema.
(as mentioned before) women getting mastectomy
are more likely to cure, and that contains removing all nodes that may be infected, thus When many lymph nodes under the arm have been removed, a woman is at higher risk of lymphedema for the rest of her life. Radiation may be one of cases to lymphedema due to the scarring and blockages that may higher the risk of lymphedema.
REFERENCES
• LAWRENCE E. WINESKI, SNELL'S CLINICAL ANATOMY BY REGIONS (10th Edition) pages 248-255
• Keith L. Moore, Arthur F. Dalley, Anne M. R Clinically Oriented Anatomy (7th Edition) page 104-105
• Inflammatory Breast Cancer, National Cancer Institute January 6, 2016 https://www.cancer.gov/types/breast/ibc-fact-sheet
• Enlarged Male Breast Tissue (Gynecomastia) Last reviewed by a Cleveland Clinic medical professional on 09/08/2021. https://my.clevelandclinic.org/health/diseases/16227-enlarged-male-breast-tissue-gynecomastia
• Keith L. Moore, Arthur F. Dalley, Anne M. R Clinically Oriented Anatomy (7th Edition) page 104-105
• Inflammatory Breast Cancer, National Cancer Institute January 6, 2016 https://www.cancer.gov/types/breast/ibc-fact-sheet
• Enlarged Male Breast Tissue (Gynecomastia) Last reviewed by a Cleveland Clinic medical professional on 09/08/2021. https://my.clevelandclinic.org/health/diseases/16227-enlarged-male-breast-tissue-gynecomastia
IMAGES REFERENCE
• Cover image, Breast Disease Mat-Su Surgical Associates https://matsusurgical.com/breast-disease/
• Fig1 Oedema of the lower quadrants of the operated breast ( peau d'orange sign) Postoperative breast oedema website: https://radiopaedia.org/cases/postoperative-breast-oedema?lang=gb
• Fig2 Breast cancer in images https://www.independentnurse.co.uk/clinical-article/breast-cancer-in-images/63465/
• Fig3 Swollen lymph nodes (illustration) Image source: Scientific Animations, Inc. (CC BY-SA 4.0) health care in Europe website: https://healthcare-in-europe.com/en/home/
• Fig4 mastectomy, mayo clinic https://www.mayoclinic.org/tests-procedures/mastectomy/about/pac-20394670
• Fig5 by @artofdystopia photography by Ketil Born Instagram https://www.instagram.com/p/CGeoMOpAf4J/?igshid=YmMyMTA2M2Y=
• Fig6 Breast cancer The Guardian https://amp.theguardian.com/society/2020/jan/01/ai-system-outperforms-experts-in-spotting-breast-cancer
• Fig7 extra breast in bilateral axillary region ResearchGate, https://www.researchgate.net/figure/Extra-breast-in-bilateral-axillary-region-pair-of-supernumerary-mammary-papillae-in-the_fig1_329188990
• Fig8 Men with overdeveloped breasts can choose a male breast reduction surgery Wellness Kliniek, https://www.wellnesskliniek.com/en/men/breasts-and-nipples/chest-reduction-gynecomastia
• Fig9 External beam radiation uses high-powered beams of energy to kill cancer cells. Beams of radiation are precisely aimed at the cancer using a machine that moves around your body. Radiation therapy for breast cancer, https://www.beaconhealthsystem.org/library/tests-and-procedures/radiation-therapy-for-breast-cancer?content_id=PRC-20212907
• Fig1 Oedema of the lower quadrants of the operated breast ( peau d'orange sign) Postoperative breast oedema website: https://radiopaedia.org/cases/postoperative-breast-oedema?lang=gb
• Fig2 Breast cancer in images https://www.independentnurse.co.uk/clinical-article/breast-cancer-in-images/63465/
• Fig3 Swollen lymph nodes (illustration) Image source: Scientific Animations, Inc. (CC BY-SA 4.0) health care in Europe website: https://healthcare-in-europe.com/en/home/
• Fig4 mastectomy, mayo clinic https://www.mayoclinic.org/tests-procedures/mastectomy/about/pac-20394670
• Fig5 by @artofdystopia photography by Ketil Born Instagram https://www.instagram.com/p/CGeoMOpAf4J/?igshid=YmMyMTA2M2Y=
• Fig6 Breast cancer The Guardian https://amp.theguardian.com/society/2020/jan/01/ai-system-outperforms-experts-in-spotting-breast-cancer
• Fig7 extra breast in bilateral axillary region ResearchGate, https://www.researchgate.net/figure/Extra-breast-in-bilateral-axillary-region-pair-of-supernumerary-mammary-papillae-in-the_fig1_329188990
• Fig8 Men with overdeveloped breasts can choose a male breast reduction surgery Wellness Kliniek, https://www.wellnesskliniek.com/en/men/breasts-and-nipples/chest-reduction-gynecomastia
• Fig9 External beam radiation uses high-powered beams of energy to kill cancer cells. Beams of radiation are precisely aimed at the cancer using a machine that moves around your body. Radiation therapy for breast cancer, https://www.beaconhealthsystem.org/library/tests-and-procedures/radiation-therapy-for-breast-cancer?content_id=PRC-20212907
