Breast Flashcards
what is breast cancer screening
breast cancer is most common cancer in women
screen 50-70yr women every 3 years
with mammograms (x-rays)
cranial-caudal + mediolateral oblique views
when is urgent 2WW referral done for breast cancer
> 30yr with unexplained breast mass (regardless of pain)
> 50yr with unilateral nipple changes -discharge, retraction
what genes are involved with breast cancer
both BRCA1/2 are autosomal dominant
tumour suppressor genes
BRCA1 chr17 AD = higher lifetime risk of breast cancer as -ve for all receptors (ER, PR, HER2)
BRCA 2 chr13 AD = better prognosis as +ve for ER and PR
where does breast cancer metastasise
bone, brain, liver, lung
what are the types of breast cancer
ductal carcinoma (in situ if not crossed basement membrane)
lobular carcinoma (in situ if not crossed basement membrane)
medullary carcinoma = young pt with BRCA1 mutation, significant lymphocyte infiltration
Paget disease of nipple = red, scaly rash around nipple
how do ductal + lobule carcinoma differ
ductal - most common, picked up on mammogram screening
abnormal proliferation of ductal cells
localised to one area, spreads locally
good prognosis (fully excised, adjuvant treatment)
lobular - not picked up on mammogram screening (incidentally found on biopsy)
abnormal proliferation of lobular cells
not palpable so asymptomatic
usually affects premenopausal women - managed with 6-monthly exams and annual mammograms
how does breast cancer present
hard, irregular, painless breast lump
skin dimpling/oedema - peau d’orange
skin tethering
nipple retraction
if lymphadenopathy - US axilla
what are RF for breast cancer
increased E2 exposure - early menarche, late menopause, HRT
nulliparous
old age, caucasian
obese, smoker
FH - 1st degree relative diagnosed under 40yr, or 2x 1st degree relatives
1st degree male relative with breast cancer
how is breast cancer investigated
triple assessment - history/examination, mammogram imaging, biopsy (core needle, fine aspirate)
when is US breast done
if young pt - as differentiates solid lumps (fibroadenoma) from fluid (breast cyst)
mammogram done for older women
identifies calcifications
MRI done if high risk to identify tumour
how to investigate breast cancer that spread to lymph nodes
US axilla
sentinel lymph node biopsy
how is breast cancer staged
TNM
how is breast cancer managed
chemoprevention for ER+ve breast cancer:
if pre-menopause = tamoxifen (selective E2 receptor modulator, SE: VTE, endometrial cancer)
if post-menopause = anastrozole (aromatase inhibitor)
if HER2+ve = trastuzumab (monoclonal antibody - biologic)
surgery + adjuvant radiotherapy:
WLE - if small/peripheral lesion with enough breast tissue
otherwise mastectomy
monitor with yearly surveillance for >5yr
what to do if breast cancer spread to sentinel lymph nodes
axillary node clearance
increases risk of lymphoedema in arm
how is ER+ve breast cancer treated
chemoprevention:
if pre-menopause = tamoxifen (selective E2 receptor modulator, SE: VTE, endometrial cancer)
if post-menopause = anastrozole (aromatase inhibitor)
