IntroductionEpidemiological informationDiagnostics staging proceduresTopography morphologyStage TreatmentQuality issues Incidence of breast cancer in Europe in 2018females Age specific incidence ID: 938857
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Breast cancerOtto VisserNovember 2019Coding issues IntroductionEpidemiological information(Diagnostics & staging procedures)Topography & morphologyStage TreatmentQuality issues Incidence of breast cancer in Eu
rope in 2018females Age specific incidence of breast cancer Trends in breast cancer incidence Trends in breast cancer mortality 50%55%60%65%70%75%80%85%90%95%100% Lithuania LatviaPolandBulgariaEstoniaSlovakiaC
roatiaCzechiaWalesScotlandSloveniaIrelandEnglandMalta Denmark EUROPE N Ireland AustriaBelgiumSpainPortugal Germany Netherlands Switzerland NorwayItalyFinlandSwedenFranceIceland one year five yearRelative survi
val of breast cancer (2000 Risk factors& symptoms Risk factorsReproductive factorsLife styleHormonal factorsGenetic factors SymptomsPalpable/visible lesion in the breast or axillaDischarge from the nippleNippl
e pain or nipple turning inwardkin irritation (ulceration) or dimplingCancers without symptoms maye detected on a mammogram Topography Anatomy of the breastBreast: mostly glands and fatGlands consist of ducts
and aciniA lobe consists of several glandsAbout 20 lobes per breastThe lactiferous ducts end in the nipple Fat tissue Lactiferous ducts Lactiferous sinus Ligaments Gland lobules Pectoralis muscle Nipple Topogr
aphy codes of the breastNipple (C50.0) Central portion (C50.1) Upperinner quadrant (C50.2) Lowerinner quadrant (C50.3) Upperouter quadrant (C50.4) Lowerouter quadrant (C50.5) Axillary tail (C50.6)Overlapping m
ultiple in anatomically contiguous subsites (C50.8)NOS multiple in anatomically noncontiguous subsites (C50.9) Topography codes of the breastLateralMedialCaudalCranialAll coded as C50.8 Regional lymph nodes of
the breast AxillaryLevel ILevel IILevel IIIInfraclavicular Internal mammary Supraclavicular 5. Intra mammary (=in the breast) ~= level I Morphology Noninvasive breast cancerInvasion means that the cancer inva
des through the basement membrane of the epithelium (the lobe or the duct)Noninvasive cancer (= carcinoma in situ) does not invade the basement membrane and therefore the cancer is limited to the lumen of the
duct or the lumen of the lobe. Within the epithelium there are no lymph or blood vessels and therefore noninvasive cancers cannot metastasize In the breast there are two types of noninvasive cancers:Ductal car
cinoma in situ (DCIS)Lobular carcinoma in situ (LCIS) New morphology codes/terms in ICD CodeTermInvasive breast carcinoma of no special type (C50._)Basal like carcinoma of breast (C50._)Encapsulated papillary
carcinoma Encapsulated papillary carcinoma with invasionInvasive micropapillary carcinoma of breast (C50._)Solid papillary carcinoma in situ (C50._)Solid papillary carcinoma with invasion (C50._)Lobular carcin
oma in situ, pleomorphic (C50._)Anaplastic large cell lymphoma, ALK negativeBreast implantassociated anaplastic large cell lymphoma (C50._) Morphology: main breast cancer typesDuctal carcinoma (breast carcinom
a of NST) 8500/3 (~75%)Lobular carcinoma 8520/3 (~12%)Includes several subtypes:Solid lobularAlveolar lobularPleomorphic lobularTubulolobularMixed lobularucinouscarcinoma 8480/3 (~2%) Morphology: rare types (a
ll 1%)Tubular carcinoma 8211 (~0.8%)Papillary carcinoma 8503 (~0.6%) [8503 has preference over 8260]solid (8509)encapsulated (8504)Micropapillary carcinoma 8507 (~0.6%)Medullary carcinoma 8510 (~0.5%)etaplas
ticcarcinoma 8575 (~0.5%)Apocrine carcinoma 8401 (~0.2%ribriformcarcinoma 8201 (~0.1%) Morphology: very rare types (all 0.1%)euroendocrine carcinoma 8246, 8013, 8041, 8574Lipidrichcarcinoma Glycogenrichcarcino
ma Secretory carcinoma Polymorphous carcinoma Aciniccell carcinoma denomyoepitheliomaEpithelialmyoepithelial carcinoma Metaplastic carcinomaA group of epithelial cancers with differentiation into squamous cel
ls and/or mesenchymallooking (sarcomalike) elementsMay contain e.g. spindle, chondroid, osseous or rhabdomyoidcellsEntirely metaplastic or a mixture of carcinoma and metaplastic areas TermcodeMetaplastic carci
nomaAdenosquamouscarcinomaSquamous cell carcinomaAdenocarcinoma with cartilaginous or osseous metaplasia Adenocarcinoma with spindle cell metaplasia SpindlecellcarcinomaMyoepithelialcarcinoma Mixed cancersDiff
erent elements within 1 tumour multiple primary simultaneous tumours within 1 breast Use the appropriate combination code if it is a mixture with ductal of lobular carcinoma:Other combinations: adenocarcinoma
with mixed subtypes (8255/3)Combinations with SCC or sarcoma are considered metaplastic carcinoma TermInvasiveDuctal (carcinoma of NST) and lobular carcinomaDuctal (carcinoma of NST) and other carcinoma (mucin
ous, tubular, cribriform, etc.)Lobular and other carcinoma (mucinous, tubular, cribriform, etc.) Paget disease of the nippleBreast cancer with presence of malignant (Paget) cells in the squamous epithelium of
the nippleMay extend to the areola and the adjacent skinPaget disease may be invasive (8540/3) or noninvasive (8540/2)Usually associated with high grade DCIS or invasive ductal carcinoma TermNoninvasive PagetI
nvasive PagetPaget disease without underlying tumourPaget disease and DCISPaget disease and invasive duct carcinoma Cancer of the male breastMen have a small amount of glandular breast tissueThe risk of breast
cancer ~=1% of the female risko specific codes for male breast cancer Differentiation grade Code the proper differentiation (BloomRichardson=BR) grade of the invasive tumour In pure DCISlesions (without an in
vasive component) the grade may also be coded Examples:Invasive breast cancer, NST, BR8500/3High grade DCIS 8500/2Invasive breast cancer, NST, BR+ high grade DCIS 8500/3 Nonepithelial cancers of the breastMali
gnant phyllodes tumour9020/3Angiosarcoma 9120/3Mostly due to prior radiotherapySuperficial (in the skin=C44) or in the soft tissue of the breast (C50)Leiomyosarcoma 8890/3Liposarcoma 8850/3Diffuse large Bcell
lymphoma 9680/3MALT lymphoma 9699/3Breast implantassociated anaplastic large cell lymphoma 9715/3 Treatment Treatment for breast cancerThe treatment for breast cancer mainly depends on:size of the tumournumbe
r and site of positive lymph nodesdistant metastasesdifferentiation grade (BloomRichardson grade)tumourfree marginsER/PRstatusHER2statusage & sexpersonal preference of the patient Main treatment modalities for
breast cancer(Sentinel node procedure)SurgeryMastectomyBreast conserving operationBreast reconstructionRadiotherapyStandard after BSOAfter a mastectomy in case of risk factors (e.g. T4, pT3N1, N2, N3) Systemi
c treatment modalities for breast cancerChemotherapyPostoperative (adjuvant; depending on age and risk factors)Preoperative (neoadjuvant; depending on age and risk factors)Hormone therapyFor ER/PRpositive brea
st cancersTargeted therapy (immunotherapy)For HER+ positive breast cancers (trastuzumab, pertuzumabMany other drugs recently introduced or under development (mostly for metastatic breast cancer) EXERCISES www.