Quiz PhD Dissertations Add case

Pathophysiology

Authors: Mia Demant, MD, Mia Wagsmo Steffensen, MD

Breast cancer is the most common cancer affecting women and the leading cause of cancer mortality in women worldwide (1). Risk factors include increasing age, reproductive factors (e.g. early menarche, nulliparity, and later onset of menopause all increase the risk of breast cancer), genetic predisposition (e.g. BRCA1 and BRCA2), personal- or family history of breast cancer, and various environmental factors (excessive use of alcohol, obesity and physical inactivity account for 21% of all breast cancer deaths worldwide (2)). Moreover, exogenous hormone exposure (e.g. estrogen treatment in postmenopausal women) increases the risk significantly (3).  

It is currently estimated that approximately 25% of all women who undergo mastectomy also have breast reconstruction performed, and 25% of these women are primarily reconstructed, the others are reconstructed secondarily (4).

TNM classification of breast cancer (1)

Primary tumor (T)
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
Tis (DCIS)Ductal carcinoma in situ
Tis (LCIS)Lobular carcinoma in situ
Tis (Paget’s)Paget’s disease of the nipple
T1Tumor ≤ 20 mm in greatest dimension
T1miTumor ≤ 1 mm in greatest dimension
T1aTumor > 1 mm but ≤ 5 mm in greatest dimension
T1bTumor > 5 mm but ≤ 10 mm in greatest dimension
T1cTumor > 10 mm but ≤ 20 mm in greatest dimension
T2Tumor > 20 mm but ≤ 50 mm in greatest dimension
T3Tumor > 50 mm in greatest dimension
T4Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules)
T4aExtension to the chest wall, not including only pectoralis muscle adherence/invasion
T4bUlceration and/or ipsilateral satellite nodules and/or edema (including peau d’orange) of the skin, which do not meet the criteria for inflammatory carcinoma
T4cBoth T4a and T4b
T4dInflammatory carcinoma
Regional lymph nodes (N)
NXRegional lymph nodes cannot be assessed (for example, previously removed)
N0No regional lymph node metastases
N1Metastases to movable ipsilateral level I, II axillary lymph node(s)
N2Metastases in ipsilateral level I, II axillary lymph nodes that are clinically fixed or matted; or in clinically detected ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastases
Metastases in ipsilateral level I, II axillary lymph nodes fixed to one another (matted) or to other structures
N2aMetastases only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident level I, II axillary lymph node metastases
N2b
N3Metastases in ipsilateralinfraclavicular (level III axillary) lymph node(s) with or without level I, II axillary lymph node involvement; or in clinically detected ipsilateral internal mammary lymph node(s) with clinically evident level I, II axillary lymph node metastases; or metastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement
N3aMetastases in ipsilateralinfraclavicular lymph node(s)
N3bMetastases in ipsilateral internal mammary lymph node(s) and axillary lymph node(s)
N3cMetastases in ipsilateral supraclavicular lymph node(s)
Distant metastases (M)
M0No clinical or radiographic evidence of distant metastases
cM0(i +)No clinical or radiographic evidence of distant metastases, but deposits of molecularly or microscopically detected tumor cells in circulating blood, bone marrow, or other nonregional nodal tissue that are no larger than 0.2 mm in a patient without symptoms or signs of metastases
M1Distant detectable metastases as determined by classic clinical and radiographic means and/or histologically proven larger than 0.2 mm

References

  1. Shah R, Rosso K, Nathanson SD. Pathogenesis, prevention, diagnosis and treatment of breast cancer. World J Clin Oncol. 2014 Aug 10;5(3):283–98.
  2. Danaei G, Vander Hoorn S, Lopez AD, Murray CJL, Ezzati M, Comparative Risk Assessment collaborating group (Cancers). Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet Lond Engl. 2005 Nov 19;366(9499):1784–93.
  3. Colditz GA, Rosner B. Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses’ Health Study. Am J Epidemiol. 2000 Nov 15;152(10):950–64.
  4. Bjarkam CR, Daugaard H, Houlind KC, Hölmich LR, Borgwardt A, Steinmetz J, et al. Kirurgi. FADL; 2020.

Procedures

Procedures