booby cancer Flashcards
breast cancer risk factors
- Female
- Increased oestrogen exposure – earlier onset of periods + later menopause
- More dense breast tissue – more glandular tissue
- Obesity
- Smoking
- Fam history – first degree relative
- HRT – particularly combined HRT containing bother oestrogen + progesterone
- COCP – gives small increase in risk of breast cancer, but risk returns to normal 10 yrs after stopping pill
breast cancer screening
mammogram every 3yrs to women age 50-70yrs
- bilateral MLO + CC
- suspicious finding go to 1 stop clinic
1 stop clinic = triple assessment
- imaging - US, mammography >40yrs
- pathology - core biopsy, large volume vacuum biopsy
-> scoring 1 to 5
origins of metastatic breast cancer
2Ls 2Bs
Lung
liver
bones
brain
breast cancer imaging
US
- lumps in young (<30)
- helpful distinguishing solid to cystic
mammograms
- more effective for older
- can pick up calcification missed by US
MRI
- screening high risk women
- to further assess size + feature of tumour
mastectomy vs wide local excision
mastectomy
- multifocal tumour
- central tuour
- large lesion in small breast
- DCIS >4cm
- patient choice
wide local excision
- solitary lesion
- peripheral tumour
- small lesion in large breast
- DCIS <4cm
- patient choice
who is radiotherapy offered to post breast cancer surgery
- wide local incision
- T3/T4 tumours + those with 4 or more positive axillary nodes
- palliative breast radiotherapy
for it to be effective should start within 12week
- if also requires chemo, this is delivered first + RT commences 4 weeks after last doses of chemo
hormone treatment in oestrogen receptor positive women
premenopausal = tamoxifen
postmenopausal = aromatase inhibitors (letrozole/anastrozole)
biological therapy in HER2 positive cancers
trastuzumab (Herceptin)
*cannot be used in patients with hx of heart disorders
indications for neoadjuvant chemotherapy
(neoadjuvant = before primary treatment)
downsizing a tumour (inoperable to operable) + coverting to lumpectomy instead of mastectomy
enrolling patients on clinical trial for “indow of opportunity”
locally advanced breast cancers
large primary tumours
indications of adjuvant chemo
(adjuvant = after primary treatment)
risk of relapse
tumour
extent
grade
proliferation
vascular invasion
online prognostic tool of breast cancer
PREDICT v2
- oncotype DX test used mostly in tayside
triple neg early breast cancer
chemo - neoadjuvant/adjuvant
20% of breast cancers
higher risk to develop brain / CNA or visceral mets
inflammatory breast cancer
1-3% of boob cancers
present similarily to breast abscess or mastitis
- swollen, warm, tender breast with pitting skin (peau d’orange)
- does not respond to antibiotics
worse prognosis than other breast cancers
in situ carcinomas
ductal (DCIS)
lobular (LCIS)
in situ carcinoma
- confined within basement membrane of acini + ducts
- cytologically malignant but non-invasive carcinoma
lobular in situ neoplasia
marker of subsequent risk
true precursor lesion - invasive malignancies arise from it
- atypical lobular hyperplasia
- lobular carcinoma in situ`
histology of lobular in situ neoplasia
solid proliferation
intracytoplasmic lumens
ER positive
E-cadherin neg
features of lobular carcnoma in situ
frequently multifocal +bilateral
low incidence - decreases more after menopause
not palpable, not visible grossly
may calcify - mammography
usually an incidental finding
intraductal proliferations risk of going malignant
- Epithelial hyperplasia of usual type – 2x RR
- Columnar cell hyperplasia +/- atypia
- Atypical ductal hyperplasia – 4x RR
- Ductal carcinoma in situ – 10x RR
- (RR = risk of going malignant)
ductal carcinoma in situ
15-20% of breast malignancies
pre/cancerous epithelial cells of breast ducts
localised to a single area
usually nonpalpable, picked up on screening
arises in TDLU
characteristically unicentric -> single duct system
confined within basement membrane of duct
- may involve lobules - cancerisation
- may involve nipple skin - Pagets
ductal carcinoma in situ on imaging + definitive diagnosis
malignant calcifications
shape - linear or branching
distribution - cluster or segmental
pleomorphic (varying) size + density
definitive diagnosis = vacuum assited core biopsy
microinvasive carcinoma
rare
DCIS (high grade) with invasion of <1mm
malignant invasive breast cancer
malignant epithelial cells which have breached the basement membrane
infiltration of normal tissue
risk of metastasis + death
assoc tumours with BRAC1 + BRAC2
BRAC1 - breast, ovarian, bowel, prostate
BRAC2 - breast, ovarian, prostate, pancreatic
which hormone recepter breast cancer carries the worst prognosis
triple neg
- cancers which do not express HER2, progesterone or oestrogen receptor
(progesterone receptor - supports ER, rarely positive is ER neg)
how is histological grade of breast cancers assessed
nottingham grading system
prognostic indicators of breast cancers
nottingham prognostic index
adjuvant! online
NHS predict
invasive ductal carcinoma - NST
(NST = non-specific type)
originate in cells from breast ducts
80% of breast cancers
seen on mammogram, patient usuallt feels mass
invasive ductal carcinoma on imaging
stellate solid mass or pleomorphic microcalcifications
mass may be circular + calcifications may be non-staging
US
- can be helpful in defining a malignant solid mass
- NOT effective in evaluating calcifications
invasive lobular carcinomas
10% of invasive breast cancers
not always visible on mammograms
spreads diffusely with typical histological indian file pattern
- usually not apparent on palpation or by imaging until advanced age
invasive lobular carcinomas
10% of invasive breast cancers
not always visible on mammograms
spreads diffusely with typical histological indian file pattern
- usually not apparent on palpation or by imaging until advanced age
worse vs better prognosis
worse
- basal
- BRACA1 mutation
- HER2 overexpression
better
- luminal A
- ER/PR positivity
