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Benign and Malignant Conditions of the Breast

Benign and Malignant Conditions of the Breast. Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg Orlino Bisquera, MD 2014. Overview of the Breast Health Problem Benign Conditions of the Breast. Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg UPM Centennial Professorial Chair (2008)

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Benign and Malignant Conditions of the Breast

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  1. Benign and Malignant Conditions of the Breast Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg Orlino Bisquera, MD 2014

  2. Overview of the Breast Health ProblemBenign Conditions of the Breast Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg UPM Centennial Professorial Chair (2008) Retiree (2014) – Clinical Faculty (2014) 2014

  3. Malignant Conditions of the Breast Orlino Bisquera, MD 2014

  4. Complementary Reading MaterialBenign and Malignant Conditions of the BreastModule – Self-instructional Program Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg

  5. Benign and Malignant Conditions of the Breast General Learning Objectives • To familiarize with the more common benign lesions of the breast, pathophysiology, diagnosis and corresponding treatment. • To familiarize with the different malignancies arising the breast, its diagnosis, and management.

  6. Benign and Malignant Conditions of the Breast Specific Learning Objectives • Enumerate at least 10 more common breast disorders seen in the Philippines. • Classify the breast disorders into benign and malignant conditions.

  7. Benign and Malignant Conditions of the Breast Specific Learning Objectives • Categorize the breast disorders by primary causes • malignant neoplasms • benign neoplasms • aberration of normal development and involution or ANDI • infection

  8. Benign and Malignant Conditions of the Breast Specific Learning Objectives • Identify the most probable breast disorder present in patients presenting with a set of symptoms and signs referable to the breast.

  9. Benign and Malignant Conditions of the Breast Specific Learning Objectives • Enumerate at least 4 more common paraclinical diagnostic procedures being done for patients with possible breast disorders. • Identify the usual indications for the different diagnostic procedures commonly used in patients for possible breast disorders.

  10. Benign and Malignant Conditions of the Breast Specific Learning Objectives • Identify which breast disorders can be monitored and which should be actively treated.

  11. Benign and Malignant Conditions of the Breast Specific Learning Objectives • Given a pretreatment diagnosis of a breast disorder with the stage of the disorder, indicate the usual goal of treatment and its corresponding recommended primary treatment.

  12. Benign and Malignant Conditions of the Breast Specific Learning Objectives • Advice patients with nonspecific mastalgia or mastalgia secondary to hormonal changes. • Identify at least two general indications for referral to a breast specialist.

  13. RJOSON’s Session Are the learning objectivesclear?enough? Want to add more?

  14. OVERVIEW OF BREAST HEALTH PROBLEM

  15. BREAST HEALTH PROBLEM Any condition on the breast that affects the biopsychosocial well-being of an individual can be considered as a “breast health problem”

  16. BREAST HEALTH PROBLEM Three categories: • breast feeding problem • breast sexuality problems • breast disorders

  17. Benign and Malignant Conditions of the Breast Learning Objectives • Enumerate at least 10 more common breast disorders seen in the Philippines.

  18. MORE COMMON BREAST DISORDERS IN PHILIPPINES 1. Breast cancer 2. Fibroadenoma 3. Macrocyst 4. Galactocoele 5. Mastitis and breast abscess

  19. MORE COMMON BREAST DISORDERS IN PHILIPPINES 6. Intraductal papilloma 7. Benign cystosarcoma phyllodes or phyllodes tumor 8. Tuberculosis of the breast 9. Paget’s disease of the nipple (a type of breast cancer) 10. Mammomegaly (virginal hypertrophy in females; gynecomastia in males)

  20. MOST COMMON BREAST CONDITION (NOT DISEASE / DISORDER) IN PHILIPPINES Fibrocystic Breast Condition Fibrocystic Breast Changes Fibrocystic Changes Lumpiness of the breast with / without pain Hormonal changes Normal

  21. Benign and Malignant Conditions of the Breast Learning Objectives • Classify the breast disorders into benign and malignant conditions. • Categorize the breast disorders by primary causes • malignant neoplasms • benign neoplasms • aberration of normal development and involution or ANDI • infection

  22. Classification and Causes – Breast Disorders *ANDI – Aberration of normal development and involution

  23. Classification and Causes – Breast Disorders *ANDI – Aberration of normal development and involution

  24. Classification and Causes – Breast Condition / Disorders *ANDI – Aberration of normal development and involution

  25. Benign and Malignant Conditions of the Breast Learning Objectives • Identify the most probable breast disorder present in patients presenting with a set of symptoms and signs referable to the breast.

  26. CLINICAL PRESENTATION and DIAGNOSIS OF BREAST DISORDERS BREAST DISORDER MANIFESTATIONS (SYMPTOMS AND SIGNS) CLINICAL DIAGNOSIS Processes Pattern Recognition Prevalence

  27. How to formulate a clinical diagnosis using processes of pattern recognition and prevalence Pattern Recognition - realization that patient’s presentation (signs and symptoms) conforms to a previously learned picture or pattern of disease. Prevalence - choice of diagnosis is based on frequency of occurrence of disease in a certain locality, certain age and sex group, and in affected organ and system.

  28. Breast Complete Physical Exam • Inspection • Palpation • Squeezing the nipple for discharge • Axillary palpation

  29. BreastPhysical Exam • Inspection of the breast • Look for gross abnormality!

  30. Gross Abnormalities of the Breast • Unilateral gigantic breast • Erosions of the nipple • Skin retraction • Ulcerations • Fungating mass • Erythema • Nipple discharge

  31. BreastPhysical Exam • Palpation of the breast • Ask before palpating!

  32. Palpation of the Breast • Look for pathologic lumps! • Dominant lumps • Take note of fibrocystic changes! • Hormonal changes • Lumpy breast substance

  33. Pathologic Breast Lump Data needed • Size (in cm in its greatest diameter) • Nature (solid or cystic) • Consistency (hard or not hard – firm/ soft) • Tumor border (well-defined or ill-defined) • Tenderness (presence or absence) • Mobility (movable or fixed – overlying / underlying tissue)

  34. BreastPhysical Exam • Gently squeeze the nipple for any discharge. • Take note of color of discharge!

  35. BreastPhysical Exam • Axillary palpation • Search for palpable lymph nodes

  36. Algorithm for clinical diagnosis of breast mass Signs of Inflammation Positive Negative Signs of Malignancy Positive Negative Signs of Benignity

  37. Diagnostic Process Diagnosis Look for signs of inflammation • Pus • Erythema • Warmth • Tenderness Presence of erythema is enough basis to suspect inflammation! Take note though of “Inflammatory breast cancer”!

  38. Breast Abscess Gram +; Staph aureus Inflammatory breast cancer

  39. Diagnostic Process Diagnosis Look for signs of malignancy • Hard consistency • Ill-defined border • Local invasion • Fixation • Regional spread • Distant spread Presence of ONE sign of malignancy is enough basis to suspect malignancy!

  40. Signs of Malignancy Peau d’ orange Inflammatory carcinoma Carcinoma en cuirasse

  41. Diagnostic Process Diagnosis Look for signs of benignity • Cystic nature of mass

  42. Fibrocystic ChangesMacrocyst

  43. Algorithm for clinical diagnosis of breast mass Signs of Inflammation Positive Negative Signs of Malignancy Positive Negative Signs of Benignity

  44. Breast Abscess

  45. Mastitis

  46. TB of the Breast

  47. Galactocoele

  48. Fibrocystic ChangesMacrocyst

  49. Nipple discharge due to nonspecific cause or fibrocystic changes

  50. Intraductal papilloma Sanguinous discharge No mass

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