Breast

Question 1

Where do most breast cancers arise from?

Answer 1

Duct (75%) or epithelium of the terminal ducts of the lobules aka lobular (25%)

Question 2

What is pagets disease of the breast?

Answer 2

infiltrating carcinoma of the nipple epithelium, rare

Question 3

Two precursor lesions to carcinoma?

Answer 3

Ductal carcinoma in situ- proliferation of malignant cells that lacks the capacity to invade the basement membrane

lobular carcinoma in situ- proliferation of loosely cohesive cells in ducts and lobules

Question 4

What receptors should you look for?

Answer 4

ER
PR
HER2 (herceptin target)

Question 5

RF?

Answer 5

Previous Hx. of malignancy
-Risk increases with age o<5% of cases before age of 35 o<25% before 50 years

• FHx of breast cancer in a first degree relative
• The BRCA1, BRCA2 and TP53 ,mutations carry very high risk but only 3-5% of women are likely to carry them on their chromosomes

oLifetime risk of cancer in BRCA1 carrier is 80-85% with a 60% chance that the cancer will be bilateral

-Never having borne a child, or first child after the age of 30
-Not having breast fed (breast feeding is protective)
-
Early menarche and late menopause
-Use of COP
oCurrent users are around 25% higher risk than never users Decreases to normal if stop
-Continuous combined HRT increases risk
oCould be 55%-100% increased risk
-Radiation to chest
-High alcohol intake
-Weight
oAdipose tissue produces oestrogen

Question 6

Presentation

Answer 6

most have a lump
nipple change
nipple discharge
skin contour changes
pain

Question 7

2ww?

Answer 7

over 30 or any features suspicious, under 30 you can send for non urgent where treatment has failed/low index of suspicion

Question 8

ix in breast C?

Answer 8

triple assessment: exam, imaging, biopsy

Mammography better for less dense breasts, US is effective in younger women mri can be used in difficult cases

non palpable lesion: core needle biopsy, us guided

palpable: fna, core,

Question 9

Staging ix?

Answer 9

ER and PR
HER2
Routine bloods
CXR
CT if mets suspected
Bone scintigraphy if bone pain or distant mets
PET

Question 10

Surgical options?

Answer 10

decision should be made by MDT

Mastectomy
WLE
Sentinel node biopsy

Question 11

Chemo?

Answer 11

doesnt improve survival as neoadjuvant unless HER2 positive

anthracyclines (epirubicin), taxanes

Question 12

Impact of pathology on treatment?

Answer 12

Tamoxifen (teratogenic) can be used to antagonise ER and used in premenopausal women
aromatase inhib used in post menopausal women NOT PRE
neither work if receptor negative

HER2 positive: herceptin (trastuzimab) infusion can cause cardiomyopathy

Question 13

Hereditay breast cancers?

Answer 13

BRCA1 and 2 most common

BRCA1- lifetime risk 65%

BRCA2 45%

Question 14

Prognosis of breast cancer?

Answer 14

based on sized of lesion, LN, grade

if low score, v high survival
high score stil around 50%