Breast Flashcards
Breast cancer screening
Every 3 yrs 50-70
Explain the triple assessment for breast cancer
- History ad Examination
- Imaging (USS/Mammogram)
- Biopsy (fine needle or core)
Give the 4 common types of breast cancer
- Invasive ductal carcinoma.
- Invasive lobular carcinoma
- Ductal carcinoma-in-situ (DCIS)
- Lobular carcinoma-in-situ (LCIS)
Most common type of breast cancer
- Invasive ductal carcinoma.
6 for breast cancer
- BRAC1, BRAC2 genes
- Nullparity
- Early menarche, late menopause
- COCP
- 1st degree relative with premenopausal breast cancer
- Obesity
When will a pt be 2 week waited for suspected breast cancer ?
- Aged 30 and over and have an unexplained breast lump with or without pain or
- Aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
what is done prior to surgery for breast cancer in women with no palpable axillary lymphadenopathy
- pre-operative axillary ultrasound before their primary surgery
- If negative then they should have a sentinel node biopsy to assess the nodal burden
what is done in patients with breast cancer who present with clinically palpable lymphadenopathy,
axillary node clearance is indicated at primary surgery
when is wide local excision preferred over mastectomy ?
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
when is a mastectomy preferred over wide local excision for breast cancer
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS > 4cm
what further treatment is recommended following wide local excision / mastectomy for T3-T4 tumours / 4 or more +ve lymph nodes
Whole breast Radiotherapy to reduce recurrence
what adjuvant hormonal therapy is used for oestrogen receptor positive breast cancers in pre menopausal women
Tamoxifen = increased endometrial cancer risk
what adjuvant hormonal therapy is used for oestrogen receptor positive breast cancers in post menopausal women
Aromatase inhibitors - anastrozole
Reduce peripheral oestrogen synthesis
What biological therapy can be used for HER2 receptor +ve breast cancers
Herceptin (Trastuzumab)
what is tamoxifen
SERM = selective oestrogen receptor modulator
4 adverse effects of tamoxifen
Increased VTE risk
Increased endometrial cancer risk
Hot flushes
Menstrual disturbance (vaginalbleeding, amenorrhoea)
4 adverse effects of anastrozole
- osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer - hot flushes
- arthralgia, myalgia
- insomnia
Presentation of fibroadenoma
- Tumour of stromal / epithelial breast duct tissue
- Women 20-40
- Mobile, firm, smooth breast lump
- Painless, well defined borders
- Some will shrink, grow or stay the same
Management of fibroadenoma >3cm and >4cm
- > 3cm = excision
- > 4cm = Core biopsy to excluse phyllodes tumour
Presentation of breast cysts
- Aged 30-50
- Small discrete flutuant lump
- Can be painful