Breast Tumor: Annisa Bhakti Prativi - 20184010016

BREAST TUMOR
Annisa Bhakti Prativi – 20184010016

SURGEON STAGE CO-ASISSTANCY
RSUD TIDAR MAGELANG
ANATOMY OF THE BREAST
A ducts
B lobules
C dilated section of duct to
hold milk
D nipple
E fat
F pectoralis major muscle
G chest wall/rib cage
Enlargement of the ductus

A normal duct cells
B basement membrane
C lumen (center of duct)
Lymph node areas of the breast
A pectoralis major muscle

B axillary lymph nodes: levels I
mamaria externa
subsclapularis
V. Axilaris
C axillary lymph nodes: levels II
interpectoralis
central
D axillary lymph nodes: levels III
axilaries apical
parasternalis
E supraclavicular lymph nodes
F internal mammary lymph nodes
What Tumor Is??
Tumor is an abnormal lump due

to cell growth that occurs continuously
Classification of Breast Tumor
Fibroadenomas Carsinoma Mammae

Fibroadenoma (FAM)
Benign breast neoplasms
Consists of a mixture of glandular elements and stromal elements
(mesenchymal), the most are fibrous tissue components.
Clinical Symptoms
• The age is usually young decade II-III or even younger
• Lump slowly enlarged
• Often accompanied by pain
• Relationships with menstrual cycles vary greatly
• Bumps are solid-supple, very mobile and borderless
• Can be single or multiple, on one breast or both breasts
Clinical Examination
• This will feel like a small, round, smooth, moving marble
in your breast. No tenderness, can be single or
multiple and no ipsilateral axillary lymph node
enlargement.
CARSINOMA MAMMAE
A condition where the cell has lost control and the normal mechanism, so
experiencing abnormal growth, fast and uncontrollable that lies on breast tissue.
In Situ
Early cancerous. The cancer is confined to the
breast duct or lobule.
Invasive
This is the most serious type of breast cancer.
It is when the cancerous tumors have spread
to other parts of the body.
PATOGENESIS
Hyperplasia Hyperplasia Carsinoma Carsinoma

Ductal Atipic in Situ Invasive
Ca Mammae Stadium
Stadium I
The tumor is still very small
the largest tumor diameter is less than or equal to 2
cm
there is no metastasis to the regional lymph nodes.
Ca Mammae Stadium
Stadium II A
• There are no signs of tumor in the breast, but
there is metastatic mobile lymph node in
ipsilateral aksilar fossa (T0N1M0)
• Tumor diameter < = 2 cm and have been found
mobile lymph node metastasis in
ipsilateral aksilar fossa. (T1N1M0)
• Tumor diameter 2 cm- 5 cm and no metastasis
to the regional lymph nodes . (T2N0M0)
Ca Mammae Stadium
Stadium II B
• Tumor diameter are 2 cm - 5 cm and there is
mobile metastasis of lymph node in ipsilateral
aksilar fossa. (T2N1M0)
• The tumor diameter is > 5 cm, but there is no
regional lymph node metastasis.(T3N0M0)
Ca Mammae Stadium
Stadium III A
Tumor diameter <5 cm or >5 cm
there is lymph node metastasis in ipsilateral aksilar
fossa fixed to other tissues. (T0-3N1-2M0)
Ca Mammae Stadium
Stadium III B
The tumor has spread to the chest wall or causing
swelling can also festering wounds in the breast.
Diagnosed as Inflamatory Breast Cancer.
It may or may not have spread to the lymph vessels
in the armpit and upper arm, but not spread to
other parts of the body organs.
Ca Mammae Stadium
Stadium III C
The tumor has spread to the chest wall or causing
swelling can also festering wounds in the breast.
Diagnosed as Inflamatory Breast Cancer.
It may or may not have spread to the lymph vessels
in the armpit and upper arm, but not spread to
other parts of the body organs.
Ca Mammae Stadium
Stadium IV
The size of the tumor can be anything,

but has spread to distant locations,
namely: bones, lungs, liver, or ribs..
How to Diagnose?
Using TRIPEL diagnostic
1. Clinical
If you notice a lump or other change in your breast, see your doctor right away. He or
she will do a physical exam
2. Mamografi + USG
A mammogram is a special X-ray of your breasts. Your breast will be pressed
between two plates. This spreads out your breast so that a better X-ray
picture can be taken. The X-ray takes 1 or 2 minutes. The entire process
usually takes about 20 minutes.
3. FNA (Fine Neddle Asspiration)

for the Biopsy
BREAST EXAMINATION
Inspection
● Size, shape, discharge
● Skin: peau d'orange (lymphatic obstruction →
tissue edema
● Eritem: inflammation, carcinoma
inflammatory breast
● Dimpling: seeing the phenomenon of
retraction.
BREAST EXAMINATION
Palpation
● Palpate with the first three fingers of the
first segment touched a circular, can be spiral,
zig zag, horizontal-vertical
● Palpate the axillary gland
● Palpate the supraclavicular glands
Risk Factor
Hormonal Ages
1 Estrogen exposure, exogen hormonal
4 Early menarche, late menopouse, giving birth
Non Hormonal Past History

2 Radiation exposure
5 ca. contralateral mammary
tumor surgery (certain dysplasia / fibrocystic)
Genetic Diet
3 a BRCA1 or BRCA2 gene mutation 6 Fatty, smoking, alcohol
Family history
Is an inspection / touch alone to find an
abnormal lump in the breast
Treatment
Lumpectomy – The tumor and a small amount of tissue around it is removed during surgery. Surgery is
the most common treatment for breast cancer.
Mastectomy – If the cancer is widespread in the breast, all of the breast tissue is removed. This is called
a mastectomy. If the cancer has spread to the underarm lymph nodes, the whole breast and most or all of
the lymph nodes are removed. This is called a modified radical mastectomy.
Radiation therapy – High-energy rays are used to kill cancer cells. It may be used after surgery to
destroy any cancer cells that are still there.
Hormone therapy – Lab tests could show that your breast cancer cells have hormone receptors. If they
do, hormone therapy can prevent the cancer cells from using the natural hormones they need to grow.
Chemotherapy – Powerful drugs are used to kill cancer cells. They are given through an IV (directly into
the vein) or in pill form. Chemotherapy can cause unpleasant side effects. These include weakness,
tiredness, and hair loss.
Targeted therapy – Lab tests could show that your breast cancer cells have too much of a proteincalled
HER2. If they do, you can receive targeted therapies. These block the action of the extra HER2 protein
and stop growth. They can be given in an IV or as a pill.
Management Therapy
• Benign Tumor is performed excision biopsy
• Stage I, II and some stage III : BCS (Breast Conserving Surgery) or Radical
Mastectomy Modification, followed by chemotherapy, radiation therapy and
hormonal therapy
• Stage IIIB and IIIC : Neoadjuvant therapy, Surgery, Chemotherapy,

radiation therapy and Hormonal therapy
• Stage IV : palliative therapy (hormonal therapy,

chemotherapy, light therapy)
Thank You

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BREAST TUMOR

Annisa Bhakti Prativi – 20184010016

Enlargement of the ductus

A pectoralis major muscle

Tumor is an abnormal lump due

Fibroadenomas Carsinoma Mammae

Hyperplasia Hyperplasia Carsinoma Carsinoma

The size of the tumor can be anything,

3. FNA (Fine Neddle Asspiration)

Non Hormonal Past History

• Benign Tumor is performed excision biopsy

• Stage IIIB and IIIC : Neoadjuvant therapy, Surgery, Chemotherapy,

• Stage IV : palliative therapy (hormonal therapy,

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