Breast Flashcards
Breast Cancer
Affects 1/10 women
20 000 cases/yr in UK
Commonest cause of cancer death in females 15-54
Second commonest cause of cancer deaths overall
Breast Cancer RF aetiology
Family Hx
10% Ca breast is familial
(One 1st degree relative = 2x risk)
5% assoc. c¯ BRCA mutations
BRCA1 (17q) → 80% breast Ca, 40% + ov Ca
BRCA2 (13q) → 80% breast Ca
Oestrogen Exposure Early menarche, late menopause HRT, OCP (Million Women Study) First child >35yrs Obesity
Other RF Proliferative breast disease w atypia Previous Ca breast ↑ age (v. rare <30) Breast feeding is protective
Breast Cancer Types
DCIS/LCIS
Non-invasive pre-malignant condition
Microcalcification on mammography
10x ↑ risk of invasive Ca
Breast Cancer Types Invasive Ductal Carcinoma
Invasive Ductal Carcinoma, NST/NOS
Commonest: ~70% of cancers
Feels hard (scirrhous)
Breast cancer Other subtypes (not DCIS, LCIS, Invasive ductal carcinoma)
Invasive lobular: ~20% of cancers
Medullary: affects younger pts, feels soft
Colloid/mucinous: occur in elderly
Inflammatory: pain, erythema, swelling, peau d’orange
Papillary
Breast Cancer Types
Phyllodes Tumour
Stromal tumour
Large, non-tender mobile lump
Breast Cancer Spread
Direct extension → muscle and/or skin
Lymph → p’eau d’orange + arm oedema
Blood → Bones: bone pain, #, ↑Ca Lungs: dyspnoea, pleural effusion Liver: abdo pain, hepatic impairment Brain: headache, seizures
Breast Cancer Screening
Every 3yrs from 47-73
Craniocaudal and oblique views
↓ breast Ca deaths by 25%
10% false negative rate.
Breast Cancer Presentation
Lump: commonest presentation of Ca breast
Usually painless
50% in upper outer quadrant
± axillary nodes
Skin changes
Paget’s: persistent eczema
Peau d’orange
Nipple
Discharge
Inversion
Mets Pathological # SOB Abdominal pain Seizures
May present through screening
Breast Cancer Skin changes
Cysts
Fibroadenomas
DCIS
Duct ectasia
Triple Assessment Breast Cancer
Any Breast Lump
Hx + Clinical Examination
Radiology
<35yrs: US
>35ys: US + mammography
Pathology Solid lump: tru-cut core biopsy Cystic lump: FNAC (green / 18G needle) Reassure if clear fluid Send cytology if bloody fluid Core biopsy residual mass Core biopsy if +ve cytology
Breast Cancer other Ix
Bloods
FBC, LFTs, ESR, bone profile
Imaging: help staging CXR Liver US CT scan Breast MRI: multifocal disease or c¯ implants Bone scan and PET-CT
May need wire-guided excision biopsy
Breast Cancer Staging
Clinical Staging
Stage 1: confined to breast, mobile, no LNs
Stage 2: Stage 1 + nodes in ipsilateral axilla
Stage 3: Stage 2 + fixation to muscle (not chest wall)
LNs matted and fixed, large skin involvement
Stage 4: Complete fixation to chest wall + mets
TNM Staging Tis (no palpable tumour): CIS T1: <2cm, no skin fixation T2: 2-5cm, skin fixation T3: 5-10cm, ulceration + pectoral fixation T4: >10cm, chest wall extension, skin involved N1: mobile nodes N2: fixed nodes
Breast Cancer Management Surgery
2 options WLE + Radiotherapy (80% treated as such) Mastectomy Typically large tumours >4cm Multifocal or central tumours Nipple involvement Pt. choice Not radical: no longer used Same survival, but WLE has ↑ recurrence rate
Breast Cancer Mx Sentinal Node Biopsy
Gold Standard
Sentinal Node = first node that a section of breast drains to.
If clinically –ve axillary LNs, no need for further dissection
Procedure
Blue dye / radiocolloid injected into tumour
Visual inspection / gamma probe @ surgery to ID SN
SN removed and sent for frozen section
If node +ve → axillary clearance or radiotherapy