7.1 breast cancer Flashcards
what are the diagnostic tests typically used in breast cancer?
mammography
ultrasonography
biopsy
what are the complications of breast cancer?
metastases - commonly to bone, brain, lung and liver
spinal cord compression
hypercalcemia
upper extremity lymphedema
cardiac dysfunction secondary to chemotherapy
infertility in premenopausal patients
how can breast cancer be classified?
TNM staging
what are the clinical presenting features of breast cancer?
physiological swelling and tenderness
nodularity - lumpy/sore
breast pain (not usually associated in malignancy)
palpable breast lump
nipple discharge, including galactorrhoea
breast infection and inflammation, usually associated with lactation
what is pubertal breast development know as?
thelarche
how do symptoms of nodularity link to menstruation?
symptoms are greatest about one week before menstruation and decrease when it starts
if changes are bilaterally symmetrical, they’re rarely pathological. if asymmetrical, review patient after one of two menstrual cycles, seeing her mid cycle
what is the treatment for nodularity?
analgesia
a good, well fitting bra
what are most benign breast lumps found and what are their features?
cysts or fibroadenomas
features include 3D, mobile and smooth shape with regular borders and a solid or cystic consistency
what age group are cysts found in?
35-50 usually
palpable as discreet lumps and cannot be distinguished from solid tumours from clinical examination alone
what are fibroadenomas?
lumps of fiborous and epithelial tissue in women
peak incidence 20-24 years old
benign and commonly found in young women. the most common type of breast lesion.
what differential diagnosis could you think of with unilateral nipple discharge in a non-breastfeeding woman?
galactorrhoea duct estasia breast cancer mastitis tumour in milk duct
what is mammary duct ectasia?
dilation of major ducts, filled with creamy secretions with periductal inflammation
can get nipple discharge, retracted nipple, acute inflammation or recurrent chronic inflammation with abscess formation
what is mastitis?
generalised cellulitis of the breast
treat with antibiotics
what is a breast abscess?
build up of pus in breast due to infection
present with point tenderness, erythema and fever
generally related to lactation
non lactation abscesses more frequent in smokers
caused by staph or strep
what changes should cause you to refer someone to a cancer specialist immediately?
aged >30 and have an unexplained breast lump with or without pain or
- unexplained lump in axilla
aged >50 with any of the following symptoms in one nipple only
- discharge
- retraction of skin (p’eau d’orange)
- other changes of concer
what breast conditions cause mammographic abnormalities?
densities
- invasive carcinomas, fibroadenomas, cysts
calcifications
- DCIS, invasive carcinomas, cysts and other benign changes
how do we improve survival from breast cancer?
early detection neoadjuvant chemotherapy gene expression profiles genetic screening prophylactic masectomies
what are some risk factors for breast cancer?
- age
- BRCA 1/BRCA 2 positive
- family history
- menarche at age 13 or younger
- first child over the age of 30
- later onset of menopause
- drinking
how does breast cancer screening work in the UK?
women age 50-70 come every 3 years for a mammogram
what is ductal carcinoma in situ?
breast cancer in the milk ducts
may not have symptoms but may present with
- breast lump
- nipple discharge
and histologically
- calcification
- central necrosis
what are the common histoloigical types of breast cancer?
adenocarcinoma
DCIS
Invasive
can be classified by histological type
