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Adenocarcinoma of the Breast

Breast Adenocarcinoma

Adenocarcinoma of the breast is a term encompassing several types of tumors such as ductal and lobular carcinomas. An asymptomatic painless mass is usually the only symptom in the early stages, whereas an array of constitutional and localized symptoms may be seen in more advanced disease. Mammography and other imaging studies, such as magnetic resonance imaging (MRI) and ultrasonography, together with biopsy, are used to make the diagnosis.


Presentation

With almost 250,000 new cases in the United states and about 1,380,000 new cases throughout the world, breast cancer is the most common female malignancy, but it is also one of the most lethal tumors (almost 41,000 deaths estimated in the US in 2016) [1] [2]. Countries of the developing world exhibit a much higher mortality rate compared to the Western world, primarily because of a delayed diagnosis and late initiation of treatment [2] [3] [4] [5]. Studies have identified that between 3-8 months may pass from the onset of symptoms to the diagnosis in the developing world, compared to 30-48 days in Western countries [4]. As the majority of breast cancer tumors start as glandular tumors (adenocarcinomas), the term adenocarcinoma of the breast can be used to describe two main types of tumors - lobular and ductal carcinomas [6]. Numerous risk factors have been evaluated in the pathogenesis of breast cancer, but exposure to ionizing radiation, use of exogenous ovarian hormones, and excessive alcohol consumption have emerged as the most important ones [3] [7]. The main symptom of breast cancer is the presence of a lump in the breast, which may be accompanied by edema (either locally or in the armpit, suggesting dissemination of the tumor into the proximal lymph nodes) [6]. In addition, localized pain, inversion or retraction of the nipple, breast tenderness and discomfort are reported [6]. Constitutional complaints (fatigue, malaise, weakness) and distant pain (suggesting metastatic spread) are seen in more advanced stages of the disease [8].

Axillary Lymphadenopathy
  • Abstract Occult adenocarcinoma with clinically apparent axillary lymphadenopathy represents a challenging surgical problem.[ncbi.nlm.nih.gov]
  • Needle biopsy Diff quik Images hosted on other servers: Ductal carcinoma, Figure A Poorly differentiated ductal carcinoma Images hosted on Flickr: 47 year old woman with 3 x 2 cm painless retroareolar mass and ipsilateral axillary lymphadenopathy, courtesy[pathologyoutlines.com]
Pleural Effusion
  • The patient experienced a relapse of right pleural effusion 2 years later and received multimodal treatment. Now, March 30, 2000, the patient is doing well without local recurrence, 8 years after her first admission.[ncbi.nlm.nih.gov]
  • DOI: 10.4103/2278-0513.162246 Background: Pleural effusions are common and devastating complication of advanced malignancies. Lung and breast cancers cause approximately 75% of all malignant pleural effusions.[ccij-online.org]
Nipple Retraction
  • In advanced stages, one may observe the nipple retraction (due to the tumor infiltration of the lactiferous ducts), the "orange peel" aspect of the skin (due to lymphedema induced by tumor emboli in the lymphatics) and the immobility (fixation) of the[pathologyatlas.ro]
  • retraction Gross images Contributed by Mark R.[pathologyoutlines.com]
Breast Mass
  • Extensive evaluation revealed a 1-cm subareolar breast mass, with histopathological features identical to those of the orbital lesion.[ncbi.nlm.nih.gov]
  • She had the left breast mass and cutaneous ulcer. In her past medical history, she had lumbar pain and paresis of limbs culminating in the diagnosis of lumbar mass on 6 th February with pathology report of metastatic adenocarcinoma [ Figure 1 ].[pubs.sciepub.com]

Workup

A detailed patient history and a complete physical examination are considered to be essential steps in the initial workup of breast cancer patients. During the patient interview, physicians should obtain key information about the onset and progression of symptoms and assess whether any of the mentioned risk factors (exposure to ionizing radiation, previous biopsies of the breast, use of oral contraceptives or post-menopausal hormonal supplements, and alcohol consumption are present [3]. A thorough family history, which may identify breast cancer or a history of other malignancies within the family, is also important [3]. The physical examination, however, is essential. A full inspection and palpation of both breasts is necessary in order to confirm the exact site of the mass, exclude enlargement of axillary lymph nodes, and evaluate the appearance of both the nipples (discharge, or anatomical changes such as inversion or retraction) and the surrounding skin (peau d'orange is a highly specific finding in advanced breast cancer where the skin resembles an orange peel) [3] [6]. Once a presumptive diagnosis is made based on clinical findings, imaging studies should be employed. Mammography is by many authors still regarded as the principal method for detection of lesions in the breast, and its use is indicated in all women who present with a palpable mass on physical examination [3] [9]. Additional procedures that can be used are magnetic resonance imaging (MRI) and ultrasonography, both used to assess the exact size and determine the tumor stage [3] [9] [10]. To determine the exact type of the tumor, a biopsy (either fine needle, core needle or excisional) is necessary [9] [11].

Right Pleural Effusion
  • The patient experienced a relapse of right pleural effusion 2 years later and received multimodal treatment. Now, March 30, 2000, the patient is doing well without local recurrence, 8 years after her first admission.[ncbi.nlm.nih.gov]
Pleural Effusion
  • The patient experienced a relapse of right pleural effusion 2 years later and received multimodal treatment. Now, March 30, 2000, the patient is doing well without local recurrence, 8 years after her first admission.[ncbi.nlm.nih.gov]
  • DOI: 10.4103/2278-0513.162246 Background: Pleural effusions are common and devastating complication of advanced malignancies. Lung and breast cancers cause approximately 75% of all malignant pleural effusions.[ccij-online.org]

Treatment

  • The combination of intraarterial infusion chemotherapy and radiotherapy plays a role in successful treatment of extensive local disease of the breast.[ncbi.nlm.nih.gov]
  • One of the three (9%) patients failing treatment had had extensive prior chemotherapy. Five of seven patients over the age of 70 years achieved partial remissions. A sixth had a minor response.[ncbi.nlm.nih.gov]
  • Treatment was repeated every 4 weeks.[ncbi.nlm.nih.gov]
  • After a review of the literature over the same period of time, natural history and treatment of radio-induced angiosarcomas of the breast were analysed. Copyright Harcourt Publishers Limited.[ncbi.nlm.nih.gov]
  • In summary, MCF7 cells show high chemosensitivity to Follistatin and especially GDF8 and both proteins might serve as targets to improve systemic treatment in breast cancer.[ncbi.nlm.nih.gov]

Prognosis

  • Invasive papillary carcinoma is mentioned as a low grade malignancy with good prognosis in most references [ 2, 4, 5, 9 ], but some argued this [ 6, 12 ].[pubs.sciepub.com]
  • If you have breast cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors.[cancer.ca]
  • These differences often affect prognosis. Tumor characteristics, such as hormone receptor status and HER2 status, also affect prognosis. Learn more about factors that affect prognosis.[ww5.komen.org]
  • Excellent prognosis if pure Majority Grade 1 or 2 Mucinous carcinoma of breast Return to top of page[breastpathology.info]
  • More studies need to be done to accurately determine prognosis.[metaplasticbc.com]

Etiology

  • This model is appropriate for studies of the etiology of ovarian hormone independent adenocarcinomas, for identification of therapeutic targets, predictive testing, and drug development.[ucdavis.pure.elsevier.com]
  • The etiology and risk factors of this variant of breast carcinoma is not fully identified. There is a need for discovery of unique biomarkers and targets for diagnosis and treatment of this variant of breast carcinoma.[mdanderson.org]

Epidemiology

  • Definition Epidemiology About 2.5% of all breast carcinomas are of micropapillary type 1. Patients are adult, with a mean age of about 50 years 1.[e-immunohistochemistry.info]
  • NCI, Surveillance Epidemiology and End Results Stat Fact Sheets [On-line information]. Available online at . Accessed on 6/8/08. (2006 May 23). The TAILORx Breast Cancer Trial. NCI [On-line information]. Available online at .[labtestsonline.it]
  • These specific tumor types are defined by their morphology, but are also linked to particular clinical, epidemiological, and molecular features.[karger.com]
  • This can be partly explained by the over-representation of locally advanced cases in Western countries, other epidemiological factors or environmental determinants akin to those observed in the stomach and upper gastrointestinal cancer ( Gill et al, 2003[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • Breast Cancer Pathophysiology Breast cancer is a malignant tumor that starts in the cells of the breast. Like other cancers, there are several factors that can raise the risk of getting breast cancer.[news-medical.net]

Prevention

  • […] and early detection of cervical cancer: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer.[nccn.org]
  • Though not considered hormone therapy, Herceptin is another drug that helps prevent cancer recurrence. Called a biologic, Herceptin attaches itself to cancer cells and prevents them from receiving growth signals.[healthcentral.com]
  • Prevention, early diagnosis, and treatment will become important and further studies are required. The occurrence of multiple primary malignant neoplasms in our case may be explained by microsatellite instability, and increased surveillance.[omicsonline.org]
  • The United States Preventive Services Task Force recommends mammograms every two years for women ages 50 to 74. However, exactly when women should start to get mammograms, and how frequently they should get them, has been debated.[livescience.com]
  • The goal of DCIS treatment is to ensure the abnormal cells in the milk ducts do not spread to the breast tissue and become invasive breast cancer, and to prevent it from returning at a later time.[bcna.org.au]

References

Article

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–2917.
  3. Shah R, Rosso K, Nathanson SD. Pathogenesis, prevention, diagnosis and treatment of breast cancer. World J Clin Oncol. 2014;5(3):283-298.
  4. Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5(3):465-477.
  5. Coleman MP, Quaresma M, Berrino F, et al. Cancer survival in five continents: a worldwide population-based study (CONCORD) Lancet Oncol. 2008;9:730–756.
  6. Sharma GN, Dave R, Sanadya J, Sharma P, Sharma KK. Various Types and Management of Breast Cancer: An Overview. J Adv Pharm Technol Res. 2010;1(2):109-126.
  7. MacMahon B. Epidemiology and the causes of breast cancer. Int J Cancer. 2006;118(10):2373-2378.
  8. Irvin W, Muss HB, Mayer DK. Symptom Management in Metastatic Breast Cancer. Oncologist. 2011;16(9):1203-1214.
  9. Yip CH, Bhoo Pathy N, Teo SH. A review of breast cancer research in malaysia. Med J Malaysia. 2014;69 Suppl A:8-22.
  10. Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008;299:2151–2163.
  11. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008. CA Cancer J Clin. 2008;58:161–179.

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Last updated: 2019-07-11 20:18