8: Breast cancer Flashcards
Menstrual hx- risk factors
Early menarche: 55yrs
Age- risk factor
3/4 of all breast cancers seen in pts >50yrs
Pregnancy- risk factors
Late age at first pregnancy: >30yrs
Nulliparity: no pregnancy
Obesity or Overweight- risk factors
- Adult weight gain of 20- 25kg
- Western pattern diet
- Sedentary lifestyle
- Regular, moderate consumption of alcohol
Oral contraceptives & Hormone replacement therapy- risk factors
- Current users of OC-> risk goes down since discontinuance
- Post-menopausal HRT (esp. combination HRT [progesterone+estrogen])
- -Combination HRT is contraindicated in women with prior Hx of breast CA or a strong family Hx**
mammary Paget’s disease- sx
-chronic, eczematous eruption of the nipple
Inspections of the breast- 4 positions
- Arms at sides
- Arms over head
- Hands pressed against hips
- Leaning forward
Palpation
Lateral portion of the breast
-roll onto the opposite hip
-hand on forehead but keeping the shoulders pressed against the bed or examining table
Medial portion of the breast
-lie with shoulders flat against the bed
-hand at neck and lifting elbow until is even with the shoulder
Dx of mass
Best time: day 5-7 of menstrual cycle
- Palpation-> Aspiration/US-> Mammogram-> Biopsy
- palpable mass not visualized on ultrasound must be presumed to be solid
Triple diagnosis
- palpation
- mammogram
- fine needle aspiration
Breast self-exam (BSE)
Best time day 5-7 of menses
- Look at your breast in the mirror
- Repeat step 1 in different positions
- Examine your breasts lying down
- in the shower
Clinical breast exam- screen
- by physican
- at least once per year after 40yrs women with risk factor
- at least every 3yrs for ages 20-39
Screening mammography
-Recommend annual or biannual mammography to women past 40yrs
Breast biopsy- non palpable lesions
-Ultrasound localization: used when mass is present
-Stereotactic localization: used when no mass is present (microcalcification)
Types of biopsy
-Fine needle aspiration biopsy (FNAB- low complication rate, less scarring, low cost)
-Core-needle biopsy & Open biopsy (permit analysis of breast tissue architecture, show if invasive cancer is present-> IMP for management)**
Surgical excision
-Needle (wire) localization biopsy
Breast biopsy- palpable lesions
- FNA is nearly 100% accuracy
- -clinical, radiographic, and pathologic findings should be in concordance*
Staging
-the single most IMP predictor of 10-20 year survival rates in breast CA is the number of axillary lymph nodes involved with metastatic disease
Radical mastectomy
en bloc removal of all breast tissue, draining lymph nodes and pectoralis muscles
Modified radical mastectomy
entire breast is removed, including the skin, areola and nipple, as well as most of the axillary lymph nodes
Simple mastectomy
removes the breast tissue, nipple, areola and skin but not the uninvolved lymph nodes
Lumpectomy
aka breast-conserving or breast-sparing
- Removal of tumor and some surrounding breast tissue
- lumpectomy + radiation: ROC for DCIS
- first rx option for early-stage breast CA
Absolute contraindication for lumpectomy
- pregnancy
- prior irradiation to the breast
- 2 or more gross foci of CA in separate quadrants of the same breast
- mammographic findings suggests of diffuse areas or malignancy
- failure to obtain negative margins despite several surgical attempts
- collagen vascular disease
Relative contraindications to lumpectomy
- tumors larger than 5cm
- small breasts
- fixation to chest wall or skin
- involvement of nipple or overlying skin
SERMs
Tamoxifen
Raloxifene
-lobular carcinoma in situ is rx with SERM for 5yrs followed with careful annual mammography and semiannual physical exams
Adjuvant therapy
Trastuzumab- Ab for HER-2
-with chemotherapy and hormonal therapy
