Breast Flashcards
Breast cancer screening
a) Who?
b) How? And how often?
c) Success measure
a) Women 50 - 70. Also, women who have had breast cancer, or those with FHxx/ genetic risks
b) No risk factors: mammography. Risk factors: triple assessment - clinical examination, radiology (mammography or USS), FNA biopsy. Every 3 years
c) Number of deaths prevented through early detection per 10,000 women screened
Breast cancer: histology
Ductal adenocarcinoma
Lobular adenocarcinoma
Paget’s disease of breast
Infiltrating malignancy of the nipple epithelium (1% of all breast cancer)
Inflammatory carcinoma
Rapidly growing, sometimes painful mass enlarging the breast and causing the overlying skin to become red and warm
Iatrogenic causes of breast cancer
HRT
COCP
Radiation to chest
Breast cancer: presentation
Usual - painless lump
Other: nipple change, nipple discharge and skin contour changes.
Breast pain/mastalgia alone is a very uncommon presentation.
Breast cancer: two-week referral
Age > 30 with unexplained breast lump
Age > 50 with any of the following symptoms in one nipple only: discharge, retraction or any other changes of concern
Breast cancer: investigations
a) In all
b) Palpable lumps
c) Non-palpable lumps
d) Receptor status
e) Other staging investigations
a) USS (including regional nodes) and mammography
b) FNA biopsy
c) Core needle biopsy (image-guided)
d) ER, PR and HER-2
e) CXR, LFTs, (plus CT and bone scintigraphy if mets suspected)
Breast cancer: management
a) 2 operation types
b) If ER-positive (pre-menopausal) -risk of this drug?
c) If ER-positive (post-menopausal)
d) If HER-2 positive
e) Other adjuvant treatments
f) To manage bone mets
a) Mastectomy or wide-local excision
b) Tamoxifen - risk of endometrial Ca
c) Aromatase inhibitors: Anastrazole (not effective in pre-menopausal women)
d) Trastuzumab
e) Chemo/radiotherapy
f) Bisphosphonates
Features of a malignant vs. benign breast lump
Malignant - Hard, painless, irregular margins, fixed to underlying chest wall or muscle, skin changes, nipple changes
Breast lump differentials:
a) Most common between 35 and 50, cannot be reliably distinguished from malignancy; cyclical pain/lump
b) Most common in 20s, firm, non-tender and highly mobile lumps. Still warrant breast clinic referral
c) Benign warty lesion behind areola causing sticky bloody discharge
d) In obese woman, following trauma
a) Cyst (fibrocystic change)
b) Fibroadenoma
c) Intraductal papilloma
d) Fat necrosis
Breast Ca: referral guidelines
a) Aged > 30 with…? (2 week wait) - if < 30, non-urgent
b) Aged > 50 with unilateral…? (2 week wait)
a) Unexplained breast lump
- also, consider 2 week wait if unexplained axillary lump
b) Nipple changes: discharge, retraction, other changes suspicious of cancer
