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NORMAL BREAST HISTOLOGY]. Breast can be considered a modified skin appendage in

Mammalians producing milk for the nourishment of the newborn. The milk is discharged from a
collection of 10-20 large ducts opening through pores in the nipple during lactation. Each large
duct, also called lactiferous duct, branches out deep into the breast tissue forming what is called
a breast lobe. Thus, a breast consists of about 10-20 inter-anastomosing lobes separated from
each other by varying amounts of fibro-adipose tissue. This photomicrograph shows six (6)
lactiferous ducts (arrows) that run from the nipple to branch down into successive smaller ducts
until the formation of terminal duct lobular unit (TDLU).

Incidence
Breast cancer is the leading cause of death in women over 40 years. Approximately 1
woman in 13 ( nearly 8%) will develop breast cancer during her lifetime. Breast cancer
is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of
cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to
distant areas of the body. The disease occurs almost entirely in women, but men can
get it, too.

Definition of breast cancer: Cancer that forms in tissues of the breast, usually the
ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs
in both men and women, although male breast cancer is rare.
Estimated new cases and deaths from breast cancer in the United States in 2012:

New cases: 226,870 (female); 2,190 (male)

Deaths: 39,510 (female); 410 (male)

Amirah Zainab Binti Mamat@Muhammad

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Etiology- unknown, but there are 2 important factors

1. Genetic factors
2. Hormonal factors
Accordingly breast cancer is either hereditary or sporadic

Pathogenesis
Hereditary breast carcinoma

Associated with family history or germ line mutation

There are multiple mutations including
1.BRCA1& BRCA2( tumor suppressor genes)detected in familial breast cancer
cases
Her 2/neu( C-erB2);this genes is a member of epidermal growth factor receptor
family and its over expression is associated with poor prognosis in patients with
lymph node positive breast cancer.
Rb and p53

Sporadic breast carcinoma

Cause- estrogen plays an important role in the development of breast cancer. There is
an evidence of an increased risk in patient with estrogen producing ovarian tumors .
estrogen stimulates production of growth factors by normal and neoplastic breast
epithelial cells.

Sites

Affects the left breast slightly more than the right, bilateral in 4% cases.
50% of cases arise in upper outer quadrants of the breast because most of
normal glandular tissue of the breast is located in this area.
20% of central area
30% in the remaining three quadrants

Sites of metastasis
About 20% of women are diagnosed at the very earliest stage (before the cancer has
moved beyond a breast duct or ducts to invade surrounding breast tissue). Another 70%
learn of their cancer while it's still contained within the breast or draining lymph nodes.
Both groups have good prospects of avoiding metastasis altogether.
Only 10% are diagnosed after the cancer has already progressed to distant areas,
which for breast malignancies typically includes the bones, lungs, liver or brain.
Metastatic cancer typically develops (if at all) within 3 years of the initial cancer
treatment, often invading lymph nodes near the breast -- located in the armpit and chest
wall -- before traveling to farther sites. But again, much depends on the grade and
aggressiveness of each individual tumor, with some carrying much higher recurrence

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rates. About a quarter of all metastases first appear in the bones. The lungs (at about
20%), liver and brain (the latter two accounting for about 15% each) are next most
common sites for cancer spread.
Metastasis may cause symptoms in the area where the cancer has newly appeared.
Bone metastases (the most common type) can produce bone pain; lung metastases can
produce coughing or shortness of breath; and liver metastases can produce depressed
appetite and weight loss. A brain metastasis may cause neurological symptoms, such
as headaches, blurry vision or a feeling of weakness.

Ways of spread
Breast cancer spreads in three different ways -- through the lymph system, which is the
most common; through the blood; or through tissue, as when a tumor grows into, or
invades, surrounding normal cells. If another tumor forms elsewhere in the body through
metastasis, it's the same kind of cancer as the original tumor. A new tumor in the lung,
for instance, is considered metastatic breast cancer, not lung cancer. However, these
metastasized tumors tend to be more aggressive than the original breast tumor.

References
http://www.breastcancer.org/
http://www.webmd.com/breast-cancer/default.htm
http://www.medicinenet.com/breast_cancer/article.htm
http://en.wikipedia.org/wiki/Breast_cancer
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001911/
http://www.cancer.gov/cancertopics/types/breast
http://www.cancer.org/cancer/breastcancer/index
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Amirah Zainab Binti Mamat@Muhammad

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