Snap Shot A 45-year-old woman present with a mass in her right breast. She says it has been there for around a year. Mammography shows a dominant mass with an irregular fibrotically stranded boundary, and some of the strands seemingly to extend toward the nipple. A core biopsy was done and showed the following histology. Introduction Invasive ductal carcinoma is the most common type of breast cancer Commonly in mid 30s to late 50s Forms solid tumor Presentation Symptoms asymptomatic breast lump nipple discharge most often presents in upper/outer quadrant Physical exam firm immobile, painless lump some skin changes (redness, ulcerations, edema, nodularity) skin retraction indicates involvement of Cooper's ligament axillary lymohadenopathy in more advanced cases breast skin edema with dimpling (peau d' orange) is a finding with a poor prognosis represents obstruction of the lymphatics cancer See Breast Cancer General Evaluation Mammography shows mass with an irregular fibrotically stranded bounder Core or excisional biopsy Stage with TMN Staging System Treatment Two treatment options have equivalent outcomes modified radical mastectomy or lumpectomy with post op radiation HER2-neu positivity in breast cancer prompts treatment with trastuzumab Adjuvant tamoxifen (if positive estrogen receptors) or raloxifene can be added to reduce risk of metastasis Prognosis, Prevention, and Complications Tumor size is most important prognostic factor