tailieunhanh - Practical Plastic Surgery - part 5

Ung thư vú là nguyên nhân hàng đầu thứ hai tử vong ung thư và ung thư phổ biến nhất ở phụ nữ tại Hoa Kỳ với hơn trường hợp mới được chẩn đoán mỗi năm. Các yếu tố nguy cơ thường gặp nhất là nữ giới, lịch sử gia đình, tuổi tác, lịch sử ung thư vú trước, sinh con live đầu tiên sau tuổi 30 | Chapter 41 Breast Disease and Its Implications for Reconstruction Kristina D. Kotseos and Neil A. Fine Overview of Breast Cancer Breast cancer is the second leading cause of cancer death and the most common cancer among women in the United States with over 200 000 new cases diagnosed each year. The most common risk factors include female gender family history increasing age a prior breast cancer history first live childbirth after age 30 early menarche late menopause previous radiation to the chest wall prolonged use of hormone replacement therapy and genetic mutations such as BRCA1 and BRCA2. Women with a strong family history should be screened according to the National Comprehensive Cancer Network NCCN Genetics Family Screening Guidelines. Risk reduction strategies may then be considered for women with a greater than 5-year risk of breast cancer. High risk women who take tamoxifen for five years reduce their risk of breast cancer by 50 . Abnormalities in proliferation of either ductal or lobular epithelium lead to breast cancer. These abnormalities exist over a proliferative continuum ranging from hyperplasia atypical hyperplasia and carcinoma in situ to invasive carcinoma. Over 85 of breast cancers are ductal in origin and may include several variants such as tubular or colloid carcinomas. Breast Cancer Staging Breast cancer is staged according to the TNM staging system based on tumor size axillary node status and identification of features of locally advanced breast cancer or distant metastases. To conceptualize treatment it is best to categorize breast cancer according to stage. Stage 0 includes the noninvasive carcinomas such as ductal carcinoma in situ DCIS and lobular carcinoma in situ LCIS . Stage I stage II and some stage IIIA breast carcinomas include the primary operable locoregional invasive cancers. Stage I breast cancer is limited to tumors 2 cm in diameter and lack nodal metastases. Stage II breast cancer includes tumors 2 cm without nodal .