1 Breast Cancer Flashcards
List some common presenting symptoms of Breast Cancer
- Lump
- Pain
- Nipple Discharge
- Nipple Retraction
- Change in the breast shape/appearance
- Skin changes
List some questions that could be asked of the patient’s past history
Breast cancer history
- Similar symptoms
- Surgery (remember ovarian surgery)
- Close relatives
- Breast/Ovarian
- History of breast cancer (on the male side)
- Family history
- Gynaecological (Menarche/Menopause - age), parity, breastfeeding, OCP/HRP
- Systemic features (anorexia, weight loss, bone pain, respiratory symptoms)
Describe a common breast examination
Can be done in different positions
- Start in sitting position
- Place patient arms on the side
- Make observations on any obvious signs
- Palpation - in lying down position; use the palm to examine against the chest wall; on the contralateral wall of asymptomatic breast, then move onto symptomatic breast and the quadrant in question
- Examine axilla - (lypmh nodes)
What to look for in a breast lump
- Tenderness
- Size
- Site
- Skin above lump
- Composition
- Fixity (to skin or deeper structures)
- Mobility
What could some differential diagnoses be (if not breast cancer)?
- Asymmetrical dense glandular tissue
- Cyst
- Fibroadenoma/Hamartoma
- Inflammatory/Abscess
- Phyllodes
- Cancer
Describe the information needed on any nipple discharge
- Colour
- Spontaneous or not?
- Uniductal/Multiductal
- Any medications?
- Smoking?
Describe the triple assessment method used in the identification of breast cancer
- History/examination
- Imaging: Mammogram/USS/MRI
- Tissue biopsy: FNAC (fine needle assisted cytology), Core biopsy, vacuum biopsy, punch biopsy
Describe the use of mammography
It is an X-ray of the breast
- Two views of each breast are taken (MLO - mediolateral oblique, and CC craniocaudal view)
Advantages:
- fast, easy processing, can manipulate pictures, easily stored and accessed
What to look for in a mammogram
- Calcifications (micro/macro)
- Mass
- Architectural distortion
Describe how a patient can get into a breast clinic
Different pathways:
- When a patient notices some problem with breast > GP refers to the clinic (symptomatic)
- When a patient attends the national breast screening program (healthy, asymptomatic patients, from 50-70 years, every 3 years > can be referred on
Describe the use of an ultrasound of the breast
Another commonly used modality
- Not used as a screening tool - not used for the whole breast, rather for a targeted assessment in the breast
- Can also be used to assess for lymph glands
- Used for younger patients - younger breasts = denser
A mammogram is the primary imaging tool (as younger, ultrasound is used, which is a smaller proportion)
Describe the use of MRI of a breast
It is selectively used
- Used to see the extent of the cancer (as mammogram may struggle if very dense)
- Assessing implant integrity
- Response to treatment
- Significant disconcordance between imaging/clinical examination
Describe biopsy use in breast cancer identification
- FNAC (fine needle aspiration cytology)
- Core biopsy (most common)
- Vacuum-assisted biopsy (bigger needle - for more tissue)
- Punch biopsy (from skin lesions/surface lesions > very rarely it has to be removed for diagnosis)
List some risk factors of breast cancer
- Females
- Age (older)
- Increased breast density
Hormonal factors
- Increasing levels of oestrogen increases the risk
- Early age at menarche
- Late age at menopause
- Nulliparity
- Late age at first childbirth
What is a mutation in which one can be predisposed to breast cancer
- BRCA1
