SURGERY DEPARTMENT FACULTY OF MEDICINE YARSI UNIVERSITY JAKARTA 2011

Risk FactorsMenarche , 11 years oldNulliparaNon breast feedingHormonal therapyHigh fat diet, alcoholPositive pedigreePrevious benign breast lesion Ovarium tumor Radiotherapy

ANAMNESIS

The chief complain The risk factors The metastasis symptom and sign

MASSFixedUnclear borderUn smooth surfacePeau de orangeDimplingUlcusSatellite nodule

AXILLARY

Palpation of lymph nodes

Mammography

Ultrasonography

MRI

ClinicMammographyFNAB

Concordan benignaConcordan malignaInconcordan

TNM system

TTxT0Tis, DCIS, LCIS

T1 T5cm

T4 a. chest wallb. skinc. bothd. mastitis carsinomatosa

NxN0N1 axilla, mobileN2 axilla, fixedN3a. infraclaviculab. Axilla + mammaria internac. supraclavicula

Mx M0no distance metastasesM1 distance metastases

Ro thoraxUSG abdomenOther clinical picture

Grading

G1 Low gradeG2 IntermediateG3 High grade

SURGERY

Breast Conserving TherapyModified Radical MastectomySimple Mastectomy

RADIOTHERAPY

CHEMOTHERAPYCMFCEFCAFTaxol + DoxoCapecitabine

AdditiveTamoxifen

AblativeBilateral oophorectomyOperativeRadiation

GeneticBiomolecular

P53BRC A1BRC A2HER2/NEUC-erbB-2Cathepsin-D