c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Breast Cancer: Background: 13

A D V E R T I S E M E N T

   
 

Infiltrating lobular carcinoma is grossly similar to the more common scirrhous ductal carcinoma and may be difficult to differentiate histologically. The presence of lobular nodules in addition to lines of infiltrating cells (Indian-file) help identify it. It constitutes 5-10% of infiltrating breast cancers, tends to be multicentric and is prone to recur in the opposite breast. This characteristic and its worse prognosis often mitigate for the choice of prophylactic mastectomy of the opposite breast.

While prophylactic mastectomy is highly effective in eliminating the possibility of recurrence because 95% of the breast tissue is gone, it probably does not alter the death rate, since treatment of early stage recurrence is almost equally effective. The anti-estrogen drug Tamoxifen has been shown to reduce the rate of recurrent breast cancer and is now being tested in large clinical trials.   

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Breast Cancer: Background: 14

A D V E R T I S E M E N T

   
 

Cancer cells can spread to distant locations by two types of vascular channels: lymphatics and veins. The lymphatic route is typical of breast cancer. The lymphatic channels drain to structures called lymph nodes, and the first cells to spread in this way are usually trapped in the first node they encounter (sentinel lymph node). Most drainage from the breast goes to the axillary lymph nodes, a significant amount goes to the nodes under the sternum, and a small amount goes to other destinations. If the disease is not arrested at this stage, cells may pass up the lymphatic chain and enter the blood stream and be widely disseminated. Venous spread can carry the cells to any area of the body. Breast cancer cells that spread tend to end up in the bones, lungs, liver, or brain.    

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Breast Cancer: Background: 15

A D V E R T I S E M E N T

   
 

Inflammatory carcinoma of the breast is a rare, aggressive form of breast cancer. It is caused by widespread infiltration of the subdermal lymphatics with poorly differentiated cells whose origin is not clearly identifiable. It presents fairly suddenly with a painful, red, swollen breast and a peau-d'orange surface appearance. It may present in young women, especially with engorged breasts in the post-partum period, and may be hard to differentiate from a breast abscess initially. It carries a grave prognosis. Initial treatment usually involves chemotherapy (neo-adjuvant chemotherapy) to try to control the local manifestations before any surgical treatment is attempted.    

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This page was last modified on 7/9/1999.