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Subscapular
(posterior)
nodes
Latissimus
dorsimuscle
Serratus
anteriormuscle
Apicalnodes
Infraclavicularnodes
Lowerdeep
cervicalnodes
Pectoralismajor
muscle
Internal
mammary
nodes
Lateral
axillarynodes
Central
axillarynodes
PublishedbyAnatomicalChartCompany,Skokie, IL |
Medical illustrationsbyLianaBauman,MAMS, in consultationwithRuthO’Regan,M.D.,WilliamE.Burkel,PhD,UniversityofMichiganMedicalSchool andMonicaMorrowMD,FACS.
•Standbeforeamirror.Comparebothbreasts,
noticing the shapeand size. It isnotunusual
for one breast to be larger than the other.
Check forunusual signs suchaspuckering,
dimpling, scaling of skin, or change in size
orshape.Lookat thesame thingswithyour
arms indifferentpositions.
•Raiseyour leftarm.Using thepads
of three fingersofyour righthand,
feel your left breast firmly,
carefully and slowly. Begin at the
outer edge, pressing in small
circlesmoving slowly around the
breast. Be sure to cover the entire
breast. Also be sure to examine
from your armpit to the collar
bone,aswellasbelowyourbreast.
•Repeat the steps above on your
rightbreast.
•While lyingdown, repeat the steps
above on both breasts. Lie flat on
yourback,withyourarmoveryour
head. Place a pillow or folded
towel under the shoulder of the
breast that you are going to
examine. This position flattens the
breast andmakes it easier to check.
Stage IV
T
(any size)
N
(supra- or infraclavicularnodes)
M
(distantmetastasis)
Stage I
T
(less than or equal to 2cm)
N
(no axillarymetastasis)
M
(nometastasis)
Stage II
T
(5 cm or less in size)
N
(axillarymetastasisnon fixed)
M
(nometastasis)
T
(any size larger than 2cm)
N
(no axillarymetastasis)
M
(nometastasis)
Stage III
T
(greater than 5 cm)
N
(axillarymetastasisnon fixed or fixed)
M
(nometastasis)
Infiltrating (Invasive)DuctalCarcinoma (IDC)
This cancer starts inaduct thenbreaks through the
ductwall,and invades the fatty tissueof thebreast.
IDC is the most common type of breast cancer,
accounting fornearly 80% of cases.
DuctalCarcinoma inSitu (DCIS)
This is breast cancer at its earliest stage.
It is confined to theducts (milkpassage).
Nearly 100%ofwomenat this cancer
stage canbe cured.
Clinical Staging is apart of thepretreatment evaluation and isperformedbased onphysical exam and x-rays studies.The final (pathologic) stage isdeterminedbymicroscopic examination of thebiopsied tissue and
axillary specimen to assess the size of the cancer and thepresence of lymphnode involvement, and thepossibility of systemicmetastasis (spread of cancer outside of thebreast and lymphnodes).Themost commonly
used system is the
Tumor-Nodes-Metastasis system (TNM)
.
T
represents the tumor,
N
the lymphnode involvement, and
M
themetastasis if any.
Thebest time toperforma self-exam isaboutoneweekafteryourperiodends. Ifyou
donothave regularperiods,perform a self-exam on the sameday everymonth.
BreastCancer is themost common formof cancer inwomenand is thenumber2killer (after lung cancer)ofwomenage35 to54. It canalsooccur inmen, though
incidence is rare.The survival ratehas improvedbecauseof earlierdiagnosis and thevarietyof treatmentsnow available.Themost common location forBreast
Cancer is theupperouterquadrant (theupperpartof thebreast closest to thearm),although itmayoccur inanypartof thebreast.The sizeatwhicha cancer can
be felt varies based on its location in the breast and the characteristics of both the cancer and thenormal breast tissue.BreastCancermay spread byway of the
lymphatic system to theunderarm lymphnodesorby thebloodstream to the lungs, liver,bones andotherorgans,ordirectly to the skinor surrounding tissues.
Ductal carcinoma in situ (DCIS) is themost common type of in situ cancer. In situ cancers lack the
ability to spread outside of thebreast. Infiltratingductal carcinoma (IDC) is themost common type
of invasive breast cancer. Invasive or infiltrating cancershave the ability to spread to otherparts of
the body. Others invasive cancers include: infiltrating lobular carcinoma, medullary carcinoma,
tubular cancer andmucinous cancer.
Signs and Symptoms
•A lump ormass in thebreast
•Change in shape or size of thebreast
•Change in the skin, such as thickeningordimpling, scaly skin around thenipple,
an orange-peel-like appearance, orulcers
•Discharge from thenipple that occurswithout squeezing thenipple
•Change in thenipple, such as itching,burning, erosion, or retraction
• Swelling of the arm
•Pain (with an advanced tumor)
•Change in skin temperature or color (awarm,hot, orpink area)
The cause of breast cancer isn’t known, but its higher incidence in women suggests that
estrogen is a cause or contributing factor.Womenwhoareat increased risk include thosewho:
•have a familyhistory ofbreast cancer in close relatives (mother, sister,daughter)
•have a longmenstrualhistory (beganmenstruating at an early age or experiencedmenopause late)
•havehad cancer in onebreast
•havehadbreastbiopsy showing atypicalhyperplasia (increased cellproduction)
•were firstpregnant after age 31
•haveneverbeenpregnant
•were exposed to low-level ionizing radiation
Subareolar
plexus
BSEPatterns
What Is Breast Cancer?
Types of Breast Cancer
Breast Self Examination (BSE)
Risk Factors for Breast Cancer
Suspensory
ligaments
Lactiferousducts
Lobes
Lactiferous sinus
Fat
Teresmajor
muscle
Staging
Understanding Breast Cancer
©2001, 2002, 2006, 2012
OR
ANATOMICAL CHART COMPANY
24
Anatomical Charts & Posters
D.
E.
F.
B.
C.
A.