00:01
To continue the discussion
of breast cancer.
00:04
We’ll now move into invasive.
00:06
The most common invasive breast
cancer is invasive ductal cancer.
00:13
So if you’re thinking
about ductal,
what just happened here that
now resulted in invasion?
Invaded through the
basement membrane.
00:20
Firm, fibrous,
rock hard mass with
sharp margins.
00:26
And here, you would
call this a stellate
type of classic morphology.
00:31
Worst and most invansive
and most common,
76% of all breast cancers
invasive type are the ductal.
00:42
If that’s a ductal, then
we have invasive lobular.
00:45
And, my goodness,
is this dangerous.
00:47
Invasive lobular cancer is the
one that loves to spread.
00:51
Oftentimes, you’d find
this to be bilateral.
00:55
You would find a row of cells.
00:56
You might have heard of
the term “Indian filing”
or a bunch of cells that are
marching in front of the other.
01:03
This is invasive lobular cancer.
01:07
Medullary:
Fleshy, cellular,
lymphocytic infiltration.
01:11
Good prognosis for breast cancer.
01:14
Good.
01:16
Inflammatory:
The opposite of good.
01:19
The 50% survival in 5 years.
01:22
So what is inflammatory?
This is the one that
you have come to know
and you have heard of,
the skin of an orange.
01:29
Peau d'orange in French,
the dermal lymphatics.
01:33
What’s going on here?
Now,
I’m going to bring something
to your attention.
01:37
You’re going to be paying
attention to, when you study,
Paget’s disease of the nipple.
01:43
Inflammatory disease
of breast cancer
and you’re going to be
paying attention to
erythema in general of the breast,
such as your acute mastitis.
01:53
The reason I bring these
to your attention is
because oftentimes, your breast
will then appear as being
red or erythematous.
01:59
But each one’s a little
bit different.
02:01
And inflammatory looks that of a
skin of an orange, literally.
02:04
Breast, what’s happening here?
At least know that the dermal,
lymphatic invasion by
breast cancer, invasive.
02:11
So lymphatics are
being involved.
02:13
Neoplastic cells block
the lymphatic drainage,
resulting in what’s known
as your lymphedema.
02:19
This then looks like exactly
as to what you would expect,
the skin of the orange.
02:25
Here's Paget’s disease.
02:27
Here as well.
02:28
Be careful, the reason I say
that is because this would be –
Well, involvement
of the nipple, you
you would have
reddening as well,
erythema of the breast, but
this reddening or the skin that
you see in Paget’s disease
of the nipple does not look
at all like a skin of orange.
02:46
So what does the
redness and erythema
look like in Paget’s disease?
It will look exactly
like eczema.
02:53
And look for that description.
02:54
As we dive further into
the details of it,
it suggests an
underlying carcinoma.
03:01
"Dr. Raj, I though Paget’s disease
of the nipple was bad enough."
Yes, it is.
03:05
But 50% of the
time, if not more,
there’s an underlying cancer of
the breast that also is involved.
03:12
Oftentimes, it will be
ductal as we shall discuss.
03:15
A brief nice little overview
of what you can expect with
invasive breast cancer.
03:20
With non-invasive, I only talked to
you about ductal carcinoma in situ
and I brought comedocarcinoma
to your attention.