What is Skin Involvement or T4b ?

Edema (including peau d’ orange) or ulceration of the skin of the breast or satellite skin nodules confined to the breast.

What is not Skin Involvement or T4b ?

Dimpling of the skin and nipple retraction is not considered skin involvement.

Skin involvement in breast showing a skin nodule 

surrounded by edema (peau d orange)

How does peau d’ orange appearance develop?

Localised edema (peau d’orange) develops when drainage of lymph fluid from the skin is disrupted by infiltration of lymphatics by metastatic cells.

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Read more about Ca Breast:

WHAT IS THE REASON FOR PUCKERING OR SKIN RETRACTION IN BREAST CANCER?
http://www.worldsurgeryforum.net/2016/05/what-is-reason-for-puckering-or-skin.html

SKIN PUCKERING AND PEAU D ORANGE APPEARANCE IN BREAST CANCER
http://www.worldsurgeryforum.net/2016/05/skin-puckering-and-peau-d-orange.html

WHAT IS THE ACCURACY OF CLINICAL DETERMINATION OF AXILLARY LYMPH NODE METASTASIS IN CA BREAST?
http://www.worldsurgeryforum.net/2016/06/what-is-accuracy-of-clinical.html

MECHANISM OF METASTASIS FROM CA BREAST TO BATSON'S PLEXUS AND LIVER
http://www.worldsurgeryforum.net/2016/06/mechanism-of-metastasis-from-ca-breast.html

6/12/2016 02:39:00 PM

How does metastatic lesion from Ca Breast reach vertebrae?

• The malignant cells from the breast reaches vertebrae via the intercostal veins.
• The intercostal vein will join the vertebral plexus of the veins. This is also called Batson’s plexus of veins. 
• The peculiarity of this plexus is that there are no valves and therefore the malignant cells can freely reach all the vertebrae from the base of the skull to the sacrum.
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How does a metastatic lesion from Ca Breast reach the liver ?

• The liver is involved in 2 ways. 
• The most important route is bloodstream spread. 
• The liver also can be involved by lymphatic route. 
• The lymphatics from the lower inner quadrant of the breast traverse the plexus in the rectus sheath and reach the subperitoneal plexus. From their along the falciform ligament it will reach the liver. 

6/10/2016 07:16:00 PM