Breast cancer is one of the the most common malignancies in women.
In the early stages, curative treatment may include surgery, radiotherapy, and chemotherapy.
Breast cancer develops in the cells of acini, lactiferous ducts, and lobules of the breast.
Tumor growth and spread depends on the exact cellular site of origin of the cancer.
These factors affect the response to surgery, chemotherapy,and radiotherapy.
Breast tumors spread via the lymphatics and veins,or by direct invasion.
When a patient presents with a lump in the breast,a diagnosis of breast cancer is confirmed by a biopsy and histologic evaluation.
Once confirmed, the clinician must attempt to stage the tumor.
Staging the tumor means defining: .
size of the primary tumor; .
exact site of the primary tumor; .
number and site of lymph node spread; .
organ to which the tumor may have spread.
Computed tomography scanning of the body may be carried out to look for any spread to the lungs, liver,or bone.
Further imaging may include bone scanning using radioactive isotopes, which are avidly taken up by the tumor metastases in bone.
Lymphatic drainage of the breast is complex.
Lymph vessels pass to axillary, supraclavicular, parasternal,and lymphatic lymph nodes as well as the opposite breast.
Subcutaneous lymphatic obstruction and tumor growth pull on connective tissue ligaments in the breast resulting in appearance of an orange peel texture(peau d'orange)on the surface of breast.
Further subcutaneous spread can induce a rare manifestation of breast cancer that produces a hard.
woody texture to the skin(cancer en cuirasse).
Amastectomy involves excision of the breast tissue to the pectoralis major muscle and fascia.
Within the axilla the breast tissue must be removed from the medial axillary wall.
Closely applied to the medial axillary wall is the long thoracic nerve.
Damaged to this nerve can result in paralysis of serratus anterior muscle producing a characteristic 'winged' scapula.