Differences Beetwen Bening and Malignant Breast Tumor

Differences between Benign & Malignant Breast Tumor

Sama seperti perbedaan antara tumor jinak & ganas pada umumnya.

Secara klinis:
Characteristic Benign Malignant
Rate of growth Progresif atau lambat Ireguler (bisa lambat hingga cepat), mitosis banyak.
Local invasion Melekat & menyebar, batas2nya jelas Invasif & infiltrasi ke jaringan sekitar.
Kapsul (+) (-)
Mobilitas (+) (-)
Nodul Kecil, ukuran sama. Non-tender, firm.

Secara histopathologis:
Feature Benign Malignant
Differensiasi Well Tidak ada
Anaplasia Masih menyerupai sel awal Atypical, pleomorfisme, hilang polaritas, hiperkromatis, mitosis banyak.
Growth rate Lambat Cepat
Local invasion (-) (+)
Metastasis (-) (+)


Benign Breast Disease

1. Fibrocystic change: lesi payudara yang paling umum. Merupakan gambaran histologist dari fribrosis, pembentukan kista, & hyperplasia epitel. Kista berasal dari lobules & aberasi involusi payudara.
2. Mastalgia: rasa nyeri/sakit pada payudara. Ada 3 macam: cyclic, non-cyclic, & extramammary.
3. Fibroepithelial lesions: fibroadenoma (tumor jinak yang paling sering terjadi, jarang menjadi ganas), multiple fibroadenoma (sering terjadi pada wanita premanopause); & tumor phylloides (tumor fibroepithel yang langka).


Breast Cancer

Etiologi
Ada factor-faktor risiko yang berkontribusi terhadap asal kanker payudara:
1. Gender: kanker payudara lebih sering terjadi pada wanita.
2. Umur: 50% kasus terjadi pada wanita >65 tahun.
3. Nulliparitas atau anak pertama diatas 30tahun.
4. Early menarche & late menopause: terpapar estrogen lebih lama, estrogen dapat bersifat carcinogenic.
5. Menggunakan menopausal hormone replacement therapy.
6. Family history: adanya riwayat penyakit kanker payudara dalam keluarga atau antar saudara.
7. Predisposisi genetic: menurunkan mutasi berupa delesi gen BRCA1 atau BRCA2, 50% pembawa mutasi adalah pria. Bersifat autosomal dominan.
8. Adanya noninvasive carcinoma atau benign proliferative changes with atypical hyperplasia.

Epidemiologi
Penderita breast cancer meliputi 1/3 penderita kanker di dunia & penyebab kematian tertinggi kedua setelah kanker paru-paru pada wanita. Sejak 50 tahun yang lalu, insidensi kanker payudara meningkat, tapi angka kematian menurun sejak 1990.

Sign & Symptoms
• Benjolan pada payudara, yang semakin lama membesar.
• Retraksi nipple & perdarahan.
• Edemapeau d’orange.
• Lymphadenopathy.
• Adanya rasa nyeri dan ketidaknyamanan.

Macam-macam Breast Cancer

Fapet Disease
Pada tahun 1870 Sir James Paget menemukan adanya lesi pada nipple yang menyerupai eczema dan perubahan pada nipple ini berhubungan dengan kanker payudara. Erosi disebabkan oleh invasi sel ke jaringan dengan karakteristik cell besar, nukleus irregular yang disebut Paget Cell. Asal usul dari cell ini masih diperbincangkan oleh pathologist. Tidak ada perubahan yang dapat terlihat pada invasi awal. Gejala yang muncul biasanya adanya nipple discharge yang disertai dengan adanya serum dan darah dari kelenjar-kelenjar yang terlibat.
Treatment:
Inflammatory Carcinoma
Terjadi inflamasi akut yang diikuti dengan redness dan edema. Tanda clinisnya bervariasi mulai dari skin nodule hingga adanya palpasi yang abnormal.

In- Situ carcinoma
Carcinoma ini tidak menginvasi jaringan sekitar dan kekurangan kemampuan untuk menyebar

Lobular Carcinoma in Situ
Bukan merupakan true malignat, tapi merupakan risk factor yang dapat berkembang menjadi Lobular Carcinoma tau Ductal Carinoma. Biasanya disebut lobular neoplasia. Biasanya terjadi pada fase premenopause dan tidak ada gejala dan perubahan yang dapat terlihat.

Ductal Carcinoma in Situ
Biasanya terjadi pada saat postmenopause. Biasanya berupa palpable mass, tapi dapat dideteksi melalui mammograph sebagai sebuah kumpuian dari pleomorphic microcalcification. Intraductal disease tidak akan menginvasi melewati basement membrane. Metastatse pada axilla terjadi pada 5% pasien dengan ductal carcinoma

Breast Cancer in Pregnancy
Breast Cancer menyerang 1 dari 3000 kehamilan. Hanya sedikit kemungkinan ini disebabkan oleh perubahan hormonal. Pasien yang hamil dengan yang tidak tidak memperlihatkan adanya perbedaan.

Table 38.2 Tumor–Nodes–Metastasis (TNM) System for Staging of Breast Cancer
Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
Tis (DCIS) Ductal carcinoma in situ
Tis (LCIS) Lobular carcinoma in situ
Tis (Paget) Paget disease of the nipple with no tumor
T1 Tumor 2 cm or less in greatest dimension
T1mic Microinvasion 0.1 cm or less in greatest dimension
T1a Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension
T1b More than 0.5 cm but not more than 1 cm in greatest dimension
T1C More than 1 cm but not more than 2 cm in greatest dimension
T2 Tumor more than 2 cm but not more than 5 cm in greatest dimension
T3 Tumor more than 5 cm in greatest dimension
T4 Tumor of any size with direct extension to chest wall or skin
T4A Extension to chest wall, not including pectoralis muscle
T4B
Edema (including peau d'orange) or ulceration of the skin of breast or satellite skin
nodules confined to same breast
T4C Both T4A and T4B
T4D Inflammatory carcinoma
Lymph node (N)
Clinical
N X Regional lymph nodes cannot be assessed (e.g., previously removed)
N0 No regional lymph node metastasis
N1 Metastasis to movable ipsilateral axillary lymph node(s)
N2
Metastases to ipsilateral axillary lymph node(s) fixed or matted, or in clinically apparent
ipsilateral mammary nodes in the absence of clinically evident axillary node metastasis
N2a
Metastasis in ipsilateral axillary lymph nodes fixed to one another (matted) or to other
structures
N2b
Metastasis only in clinically apparent ipsilateral internal mammary nodes and in the
absence of clinically evident axillary lymph node metastasis
N3
Metastasis in ipsilateral infraclavicular lymph node(s) with or without axillary lymph
node involvement, or in clinically apparent ipsilateral internal mammary lymph nodes
and in the presence of clinically evident axillary lymph node metastasis; or metastasis
in ipsilateral supraclavicular lymph nodes with or without axillary or internal mammary
lymph node involvement
N3a Metastasis in ipsilateral infraclavicular lymph nodes
N3b Metastasis in ipsilateral internal mammary lymph nodes and axillary lymph nodes
N3c Metastasis in ipsilateral supraclavicular lymph node(s)
Pathologic classification (pN)
pN X
Regional lymph nodes cannot be assessed (e.g., previously removed or not removed for
pathologic study)
pN0
No regional lymph node metastasis histologically, no additional examination for isolated
tumor cells (single tumor cells or small cell clusters not greater than 0.2 mm, usually
detected only by immunohistochemical [IHC] or molecular methods but which may be
verified on H&E stains)
pN0(-) No regional lymph node metastasis histologically, negative IHC
pN0(i+)
No regional lymph node metastasis histologically, positive IHC, no IHC cluster greater
than 0.2 mm
pN0(mol-) No regional lymph node metastasis histologically, negative molecular findings (RT-PCR)
pN0(mol+) No regional lymph node metastasis histologically, positive molecular findings (RT-PCR)
pN1
Metastasis in 1 to 3 axillary lymph node(s), and/or in internal mammary nodes with
microscopic disease detected by sentinel lymph node dissection but not clinically
apparent
pN1mic Micrometastasis (>0.2 mm, none >2.0 mm)
pN1A Metastasis in 1 to 3 axillary lymph node(s)
pN1B
Metastasis in internal mammary nodes with microscopic disease detected by sentinel
lymph node dissection but not clinically apparent
pN1c
Metastasis in 1 to 3 axillary lymph node(s), and in internal mammary nodes with
microscopic disease detected by sentinel lymph node dissection but not clinically
apparent
PN2
Metastasis in 4 to 9 axillary lymph nodes, or in clinically apparent internal mammary
lymph nodes in the absence of axillary lymph node metastasis
PN2a Metastasis in 4 to 9 axillary lymph nodes (at least 1 tumor deposit >2.0 mm)
PN2b
Metastasis in clinically apparent internal mammary lymph nodes in the absence of
axillary lymph node metastasis
PN3
Metastasis in 10 or more axillary lymph nodes, or in infraclavicular lymph nodes, or in
clinically apparent ipsilateral internal mammary nodes in the presence of 1 or more
positive axillary nodes; or in more than 3 axillary nodes with clinically negative
microscopic metastasis in internal mammary lymph nodes; or in ipsilateral
supraclavicular lymph nodes
PN3a
Metastasis in 10 or more axillary lymph nodes (at least one tumor deposit greater than
2.0 mm), or metastasis in infraclavicular lymph nodes
PN3b
Metastasis in clinically apparent ipsilateral internal mammary nodes in the presence of 1
or more positive axillary nodes; or in more than 3 axillary nodes and in internal
mammary nodes with microscopic disease detected by sentinel lymph node dissection
but not clinically apparent
PN3c Metastasis in ipsilateral supraclavicular nodes
Distant metastasis (M)
MX Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
From Greene FL, Page DL, Fleming ID, et al., eds. Breast. In AJCC cancer

Staging
After the diagnosis of breast cancer has been definitively established, the clinical stage
of the disease should be determined. The Columbia Clinical Staging System was used
historically (26) but has been replaced by the tumor–nodes–metastases (TNM)
P.1614
system of the American Joint Committee on Cancer (27). The TNM system allows both
preoperative clinical staging and postoperative pathologic staging to be determined
Table 38.3 Staging of Breast Carcinoma
TNM Classificationa
Tumor Node Metastasis
Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage IIa T0 N1 M0
T1 N1 M0
T2 N0 M0
IIb T2 N1 M0
T3 N0 M0
Stage IIIa T0 N2 M0
T1 N2 M0
T2 N2 M0
T3 N1 M0
T3 N2 M0
IIIb T4 N0 M0
T4 N1 M0
IIIc Any T N3 M0
Stage IV Any T Any N M1
aT1 includes T1mic.