Case Study 63 Cancer of the Female Breast女性乳腺癌63例病例研究.ppt

Case Study 63: Cancer of the Female Breast By Robyn Schwartz Case Background 46, premenopausal Dense breasts Has noticed cysts in the past Noticed new lump in upper right quadrant Did not resolve Got bigger Denied lumps in axillary Patient history Happily married for 21 years 3 kids (3, 8, and 10) Does breast self exams Normal pap 2 years ago Has Asthma and hypertension Exercises No tobacco, alcohol or illegal drugs Risk Factors All 3 kids born after the age of 35 First period at 11yr old Dense breasts Cysts already develop regularly Family history of breast cancer Paternal grandmother diagnosed at age 45 before menopause Mother diagnosed at age 45 before menopause. Died at age 73 from reoccurrence of breast cancer Breast Cancer: What is it? Uncontrolled division of abnormal cells in the breast Caused by specific mutations BRCA1 and BRCA2 TP53 Our patient: Mammogram 2.3cm x 2.9cm x 3.2cm mass Irregular borders Skin thickening Enlarged axillary lymph node 6 Y-shaped microcalcifications extended toward nipple Abnormal mass into pectoral muscle Grading vs Staging How abnormal the cells are 1, 2, 3,4 Based on Tubule formation Size and shape of cells Mitotic division Measures the likely aggressiveness of the cells How far the cancer has spread I, II, III, IV Based on Size of tumor Invasive vs non invasive Spread to lymph nodes Spread to other parts of the body Grading tumors Mitotic Score 1: 7 mitoses Score 2: 8-14 mitoses Score 3: 14 mitoses Nuclear (size/shape) Score 1: little variation in size Score 2: moderate variability, open vesicular nuclei Score 3: lots of variability open nuclei Tubular differentiation Score 1: 75% glandular/tubular Score 2: 10-75% glandular/tubular Score 3: 10% Glandular/ tubular Staging Cancer agrdjdytydstasf Stage 0: No Cancer Stage I: IA: Cancer is small, low grade and localized IB: Cancer is large, low grade and localized Stage II: IIA: Tumor is 2-5cm but has not spread IIB: Tumor