MBBS Year
1st Year
Subject
What Is Usually Asked
Blood supply and lymphatic drainage of the breast
ReferenceAll Years (1st-Final)All UniversitiesBreast Cancer
Breast Cancer: Notes, PPT and PYQs for MBBS
Breast cancer (carcinoma breast) is a malignant tumour arising from the epithelial cells of the breast ducts or lobules. It is the most common cancer among women in India. It is examined in Anatomy in 1st Year, Pathology and Pharmacology in 2nd Year, Community Medicine in 3rd Year, and General Surgery in Final Year.
SME-reviewed. Updated 2026.
Open in GeckoMed for PPT slides and notesQuick Summary: What You Need to Know for University Exams
- Most breast cancers are invasive ductal carcinoma (no special type).
- Key risk factors include female sex, age, BRCA1 and BRCA2 mutations, family history and prolonged oestrogen exposure.
- The upper outer quadrant is the most common site, and the classic presentation is a painless, hard, irregular lump.
- Diagnosis uses triple assessment: clinical examination, imaging and tissue biopsy.
- Receptor status (ER, PR and HER2) guides treatment and prognosis.
- Treatment combines surgery, radiotherapy, chemotherapy, endocrine therapy and targeted therapy.
- Axillary lymph node status is the single most important prognostic factor.
Breast Cancer Across MBBS Subjects
| MBBS Year | Subject | What Is Usually Asked |
|---|---|---|
| 1st Year | Anatomy | Blood supply and lymphatic drainage of the breast |
| 2nd Year | Pathology | Classification, morphology, molecular subtypes, prognostic factors |
| 2nd Year | Pharmacology | Tamoxifen, aromatase inhibitors, trastuzumab, anticancer drugs |
| 3rd Year | Community Medicine | Cancer screening, national programme |
| Final Year | General Surgery | Clinical evaluation, staging, surgery, multimodality treatment |
MBBS Year
2nd Year
Subject
What Is Usually Asked
Classification, morphology, molecular subtypes, prognostic factors
MBBS Year
2nd Year
Subject
What Is Usually Asked
Tamoxifen, aromatase inhibitors, trastuzumab, anticancer drugs
MBBS Year
3rd Year
Subject
What Is Usually Asked
Cancer screening, national programme
MBBS Year
Final Year
Subject
What Is Usually Asked
Clinical evaluation, staging, surgery, multimodality treatment
Definition and Classification
Definition: Breast cancer is a malignant neoplasm arising from the epithelium of the terminal duct lobular unit of the breast, with the potential to invade locally and spread to lymph nodes and distant organs.
Pathological Classification
| Category | Types |
|---|---|
| Non-invasive (in situ) | Ductal carcinoma in situ (DCIS); lobular carcinoma in situ (LCIS), now regarded mainly as a marker of increased risk |
| Invasive | Invasive ductal carcinoma, no special type (most common); invasive lobular carcinoma; medullary; mucinous (colloid); tubular; papillary |
| Special clinical forms | Inflammatory carcinoma; Paget's disease of the nipple |
Category
Non-invasive (in situ)
Types
Ductal carcinoma in situ (DCIS); lobular carcinoma in situ (LCIS), now regarded mainly as a marker of increased risk
Category
Invasive
Types
Invasive ductal carcinoma, no special type (most common); invasive lobular carcinoma; medullary; mucinous (colloid); tubular; papillary
Category
Special clinical forms
Types
Inflammatory carcinoma; Paget's disease of the nipple
Key Features of Selected Types
| Type | Key Features |
|---|---|
| Invasive ductal carcinoma | Hard, gritty cut surface; forms most breast cancers |
| Invasive lobular carcinoma | Single-file ("Indian file") pattern of cells; loss of E-cadherin; more often bilateral and multicentric |
| Mucinous carcinoma | Soft, gelatinous tumour; better prognosis |
| Medullary carcinoma | Well-circumscribed, with lymphocytic infiltrate; associated with BRCA1 |
| Inflammatory carcinoma | Red, swollen, warm breast with peau d'orange due to dermal lymphatic invasion; poor prognosis |
| Paget's disease of the nipple | Eczema-like change of the nipple, usually with underlying carcinoma |
Type
Invasive ductal carcinoma
Key Features
Hard, gritty cut surface; forms most breast cancers
Type
Invasive lobular carcinoma
Key Features
Single-file ("Indian file") pattern of cells; loss of E-cadherin; more often bilateral and multicentric
Type
Mucinous carcinoma
Key Features
Soft, gelatinous tumour; better prognosis
Type
Medullary carcinoma
Key Features
Well-circumscribed, with lymphocytic infiltrate; associated with BRCA1
Type
Inflammatory carcinoma
Key Features
Red, swollen, warm breast with peau d'orange due to dermal lymphatic invasion; poor prognosis
Type
Paget's disease of the nipple
Key Features
Eczema-like change of the nipple, usually with underlying carcinoma
Molecular Subtypes
| Subtype | Receptor Profile | Key Points |
|---|---|---|
| Luminal A | ER and/or PR positive, HER2 negative, low proliferation | Best prognosis; responds to endocrine therapy |
| Luminal B | ER positive, higher proliferation, may be HER2 positive | Intermediate prognosis |
| HER2-enriched | HER2 positive, ER and PR negative | Responds to anti-HER2 therapy |
| Triple-negative (basal-like) | ER, PR and HER2 negative | Aggressive; associated with BRCA1; treated mainly with chemotherapy |
Subtype
Luminal A
Receptor Profile
ER and/or PR positive, HER2 negative, low proliferation
Key Points
Best prognosis; responds to endocrine therapy
Subtype
Luminal B
Receptor Profile
ER positive, higher proliferation, may be HER2 positive
Key Points
Intermediate prognosis
Subtype
HER2-enriched
Receptor Profile
HER2 positive, ER and PR negative
Key Points
Responds to anti-HER2 therapy
Subtype
Triple-negative (basal-like)
Receptor Profile
ER, PR and HER2 negative
Key Points
Aggressive; associated with BRCA1; treated mainly with chemotherapy
Aetiology (Risk Factors)
| Category | Risk Factors |
|---|---|
| Non-modifiable | Female sex, increasing age, family history, BRCA1 and BRCA2 mutations, other inherited syndromes (for example involving TP53) |
| Reproductive and hormonal | Early menarche, late menopause, nulliparity, first full-term pregnancy after 30, not breastfeeding, hormone replacement therapy |
| Lifestyle | Obesity after menopause, alcohol, physical inactivity |
| Previous breast disease | Atypical hyperplasia, previous breast cancer |
Category
Non-modifiable
Risk Factors
Female sex, increasing age, family history, BRCA1 and BRCA2 mutations, other inherited syndromes (for example involving TP53)
Category
Reproductive and hormonal
Risk Factors
Early menarche, late menopause, nulliparity, first full-term pregnancy after 30, not breastfeeding, hormone replacement therapy
Category
Lifestyle
Risk Factors
Obesity after menopause, alcohol, physical inactivity
Category
Previous breast disease
Risk Factors
Atypical hyperplasia, previous breast cancer
Protective factors: Breastfeeding, early first full-term pregnancy, multiparity and regular physical activity.
Pathophysiology
Flowchart
- Genetic mutations (inherited or acquired) accumulate in breast epithelial cells
- Hormonal influences, especially oestrogen, promote proliferation
- Atypical hyperplasia progresses to carcinoma in situ
- Tumour cells breach the basement membrane to become invasive
- Spread occurs local
Routes of Spread
| Route | Details |
|---|---|
| Local | Into breast tissue, skin (peau d'orange, ulceration), nipple (retraction), pectoral fascia and chest wall |
| Lymphatic | Axillary nodes most commonly; also internal mammary and supraclavicular nodes |
| Blood | Bone (most common distant site), lung, pleura, liver and brain |
Route
Local
Details
Into breast tissue, skin (peau d'orange, ulceration), nipple (retraction), pectoral fascia and chest wall
Route
Lymphatic
Details
Axillary nodes most commonly; also internal mammary and supraclavicular nodes
Route
Blood
Details
Bone (most common distant site), lung, pleura, liver and brain
Anatomy link: About 75% of lymph from the breast drains to the axillary nodes, making axillary nodes central to staging and surgery.
(Examiner may ask you to draw the lymphatic drainage of the breast.)
Clinical Features
Symptoms:
- Painless lump, most commonly in the upper outer quadrant
- Nipple retraction or discharge (blood-stained discharge is significant)
- Skin changes such as dimpling, redness or ulceration
- Lump in the axilla
- Symptoms of metastasis, such as bone pain, breathlessness or jaundice
Signs on examination:
| Sign | Significance |
|---|---|
| Hard, irregular lump with ill-defined margins | Typical of carcinoma |
| Skin tethering or dimpling | Involvement of suspensory (Cooper's) ligaments |
| Peau d'orange | Dermal lymphatic obstruction |
| Fixity to the chest wall | Locally advanced disease |
| Nipple retraction | Involvement of ducts |
| Palpable axillary or supraclavicular nodes | Lymphatic spread |
Sign
Hard, irregular lump with ill-defined margins
Significance
Typical of carcinoma
Sign
Skin tethering or dimpling
Significance
Involvement of suspensory (Cooper's) ligaments
Sign
Peau d'orange
Significance
Dermal lymphatic obstruction
Sign
Fixity to the chest wall
Significance
Locally advanced disease
Sign
Nipple retraction
Significance
Involvement of ducts
Sign
Palpable axillary or supraclavicular nodes
Significance
Lymphatic spread
Many patients in India present with locally advanced disease, which makes early detection a major public health priority.
Diagnosis
Triple Assessment
| Component | Methods |
|---|---|
| Clinical | History and examination of both breasts and axillae |
| Imaging | Mammography (usually over 35 to 40 years); ultrasound (younger women and dense breasts); MRI in selected cases |
| Pathology | Core needle biopsy (preferred, gives histology and receptor status); fine needle aspiration cytology in some settings |
Component
Clinical
Methods
History and examination of both breasts and axillae
Component
Imaging
Methods
Mammography (usually over 35 to 40 years); ultrasound (younger women and dense breasts); MRI in selected cases
Component
Pathology
Methods
Core needle biopsy (preferred, gives histology and receptor status); fine needle aspiration cytology in some settings
BI-RADS Categories (Imaging)
| Category | Meaning |
|---|---|
| 0 | Incomplete, needs further imaging |
| 1 | Negative |
| 2 | Benign |
| 3 | Probably benign, short-interval follow-up |
| 4 | Suspicious, biopsy recommended |
| 5 | Highly suggestive of malignancy |
| 6 | Known biopsy-proven malignancy |
Category
0
Meaning
Incomplete, needs further imaging
Category
1
Meaning
Negative
Category
2
Meaning
Benign
Category
3
Meaning
Probably benign, short-interval follow-up
Category
4
Meaning
Suspicious, biopsy recommended
Category
5
Meaning
Highly suggestive of malignancy
Category
6
Meaning
Known biopsy-proven malignancy
Receptor and Staging Work-Up
| Investigation | Purpose |
|---|---|
| ER, PR and HER2 testing (immunohistochemistry) | Guides endocrine and targeted therapy |
| Ki-67 | Measures proliferation |
| Blood tests | Complete blood count, liver function, alkaline phosphatase |
| Chest imaging, abdominal ultrasound or CT, bone scan | Detect metastasis in advanced disease or when symptoms suggest spread |
| PET-CT | Selected cases |
Investigation
ER, PR and HER2 testing (immunohistochemistry)
Purpose
Guides endocrine and targeted therapy
Investigation
Ki-67
Purpose
Measures proliferation
Investigation
Blood tests
Purpose
Complete blood count, liver function, alkaline phosphatase
Investigation
Chest imaging, abdominal ultrasound or CT, bone scan
Purpose
Detect metastasis in advanced disease or when symptoms suggest spread
Investigation
PET-CT
Purpose
Selected cases
TNM Staging (Simplified T Categories)
| T Stage | Tumour Size or Extent |
|---|---|
| T1 | 2 cm or less |
| T2 | More than 2 cm but not more than 5 cm |
| T3 | More than 5 cm |
| T4 | Any size with direct extension to the chest wall and/or skin, including inflammatory carcinoma |
T Stage
T1
Tumour Size or Extent
2 cm or less
T Stage
T2
Tumour Size or Extent
More than 2 cm but not more than 5 cm
T Stage
T3
Tumour Size or Extent
More than 5 cm
T Stage
T4
Tumour Size or Extent
Any size with direct extension to the chest wall and/or skin, including inflammatory carcinoma
Nodal (N) and metastasis (M) status complete the stage. The current AJCC system also includes biological factors such as grade and receptor status in prognostic staging.
Management
Management is multidisciplinary and depends on stage, receptor status, menopausal status and patient preference.
Surgery
| Procedure | Key Points |
|---|---|
| Breast-conserving surgery | Wide local excision with clear margins, always followed by radiotherapy |
| Modified radical mastectomy (Patey) | Removes the breast and axillary nodes, preserving pectoralis major |
| Simple (total) mastectomy | Removes the breast without full axillary clearance |
| Sentinel lymph node biopsy | Stages a clinically node-negative axilla |
| Axillary lymph node dissection | For node-positive disease |
| Breast reconstruction | Immediate or delayed, in selected patients |
Procedure
Breast-conserving surgery
Key Points
Wide local excision with clear margins, always followed by radiotherapy
Procedure
Modified radical mastectomy (Patey)
Key Points
Removes the breast and axillary nodes, preserving pectoralis major
Procedure
Simple (total) mastectomy
Key Points
Removes the breast without full axillary clearance
Procedure
Sentinel lymph node biopsy
Key Points
Stages a clinically node-negative axilla
Procedure
Axillary lymph node dissection
Key Points
For node-positive disease
Procedure
Breast reconstruction
Key Points
Immediate or delayed, in selected patients
Adjuvant and Systemic Therapy
| Treatment | Examples and Key Points |
|---|---|
| Radiotherapy | After breast-conserving surgery; after mastectomy in higher-risk disease |
| Chemotherapy | Anthracyclines (doxorubicin), taxanes (paclitaxel), cyclophosphamide; given before surgery (neoadjuvant) in locally advanced disease |
| Endocrine therapy | Tamoxifen (selective oestrogen receptor modulator; used especially before menopause; risks include endometrial cancer and thromboembolism); aromatase inhibitors such as letrozole and anastrozole (after menopause; risk of bone loss) |
| Anti-HER2 therapy | Trastuzumab for HER2-positive disease; can cause cardiotoxicity |
Treatment
Radiotherapy
Examples and Key Points
After breast-conserving surgery; after mastectomy in higher-risk disease
Treatment
Chemotherapy
Examples and Key Points
Anthracyclines (doxorubicin), taxanes (paclitaxel), cyclophosphamide; given before surgery (neoadjuvant) in locally advanced disease
Treatment
Endocrine therapy
Examples and Key Points
Tamoxifen (selective oestrogen receptor modulator; used especially before menopause; risks include endometrial cancer and thromboembolism); aromatase inhibitors such as letrozole and anastrozole (after menopause; risk of bone loss)
Treatment
Anti-HER2 therapy
Examples and Key Points
Trastuzumab for HER2-positive disease; can cause cardiotoxicity
Locally Advanced and Metastatic Disease
- Locally advanced: Neoadjuvant chemotherapy, followed by surgery and radiotherapy
- Metastatic: Systemic therapy based on receptor status, bone-protecting agents for bone metastases, radiotherapy for symptom control and palliative care
Complications
Of the disease:
- Local ulceration and fungating tumour
- Bone metastasis with pathological fractures and hypercalcaemia
- Pleural effusion, liver and brain metastasis
Of treatment:
| Treatment | Complications |
|---|---|
| Surgery | Seroma (most common), wound infection, flap necrosis, lymphoedema of the arm, winging of the scapula (long thoracic nerve injury) |
| Radiotherapy | Skin changes, fibrosis |
| Chemotherapy | Bone marrow suppression, hair loss, nausea |
| Tamoxifen | Endometrial cancer, thromboembolism, hot flushes |
| Trastuzumab | Cardiotoxicity |
Treatment
Surgery
Complications
Seroma (most common), wound infection, flap necrosis, lymphoedema of the arm, winging of the scapula (long thoracic nerve injury)
Treatment
Radiotherapy
Complications
Skin changes, fibrosis
Treatment
Chemotherapy
Complications
Bone marrow suppression, hair loss, nausea
Treatment
Tamoxifen
Complications
Endometrial cancer, thromboembolism, hot flushes
Treatment
Trastuzumab
Complications
Cardiotoxicity
Prevention and Early Detection (Community Medicine Angle)
- Screening in India: Clinical breast examination is part of population-based screening for common cancers for women aged 30 years and above under the national NCD programme.
- Mammography screening is used in many high-income countries for women from about 40 or 50 years.
- Breast awareness: Women should know how their breasts normally look and feel and report changes early.
- High-risk women: Genetic counselling and closer surveillance for those with BRCA mutations or strong family history.
- Risk reduction: Breastfeeding, physical activity, healthy weight and limiting alcohol.
Prognosis
Prognosis depends on stage at diagnosis. Early breast cancer has a good outlook with treatment, while metastatic disease is generally not curable.
Prognostic factors:
- Axillary lymph node status (most important)
- Tumour size
- Histological grade (Nottingham grading)
- Receptor status (ER, PR, HER2)
- Histological type
- Lymphovascular invasion
- Proliferation index (Ki-67)
Quick Viva Questions
Q: What is the most common site of breast cancer? A: The upper outer quadrant.
Q: What causes peau d'orange? A: Obstruction of dermal lymphatics by tumour cells, causing skin oedema around the hair follicles.
Q: Injury to which nerve causes winging of the scapula after axillary surgery? A: The long thoracic nerve.
Q: What is the most important prognostic factor in breast cancer? A: Axillary lymph node status.
Q: How does tamoxifen act? A: It is a selective oestrogen receptor modulator that blocks oestrogen receptors in breast tissue.
How Breast Cancer Appears in MBBS University Exams
Typical question styles (not attributed to specific papers or years):
- "Discuss the aetiology, clinical features, staging and management of carcinoma breast." (Long essay, General Surgery)
- "Classify breast carcinoma. Describe the morphology and prognostic factors of invasive ductal carcinoma." (Long essay, Pathology)
- "Describe the lymphatic drainage of the breast and its applied anatomy." (Long essay or short note, Anatomy)
- "Write a short note on triple assessment." (Short note, Surgery)
- "Write a short note on tamoxifen." (Short note, Pharmacology)
- "Write a short note on modified radical mastectomy." (Short note, Surgery)
More General Surgery Topics
Frequently Asked Questions
What is the most common type of breast cancer?
Invasive ductal carcinoma of no special type is the most common type, forming the majority of invasive breast cancers.
What is triple assessment in breast disease?
It is the combination of clinical examination, imaging (mammography and/or ultrasound) and pathological sampling (usually core needle biopsy) used to evaluate a breast lump.
Can I download the breast cancer PPT for my presentation?
Yes. Use the Download PPT button at the top of this page. The GeckoMed app also gives offline access to the slides and notes.
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