Breast Flashcards
Describe the ways in which breast cancer may present
- Discolouration
- Oedema
- Peau d’orange (skin puckering from local invasion)
- Pagets disease (eczematous rash, bloody discharge)
- Nipple retraction
- Discharge
- Assymetry
What are the RF for breast cancer?
- Family hx (first degree relative with bilateral disease)
- Oestrogen exposure including COCP
- Previous benign breast disease
- Smoking/alcohol/obesity
When is USS helpful for breast cancer diagnosis?
Can distinguish between solid and cystic, especially if the lesion is non-palpable
When is MRI helpful for breast cancer diagnosis?
Patients who already have fibroadenomas or excessive lumpiness, in which palpation is very difficult
Used especially in high risk or younger patients (not routine)
When is breast biopsy indicated? Describe the two types
If FNA shows blood, or unsure about diagnosis
- Excisional biopsy - removes entire abnormal area
- Wire excision biopsy
Which tumour marker can be done in breast cancer?
CA-153 - low specificity and sensitivity so not suitable for screening/diagnosis but can be good for risk of recurrence. Also raised in gynae cancers.
Where is the most common location for breast cancer?
Left breast
Upper outer quadrant and retroareolar region
Describe the two non-invasive breast cancers (in situ) and their management
DUCTAL (DCIS) - Premalignant changes, seen as micro calcification on mammography. Manage with breast-conserving surgery eg. lumpectomy (without SLNB) or mastectomy (with SLNB). Offer annual mammography.
LOBULAR - Premalignant, rarer, multifocal
Describe the two invasive breast cancer types
Ductal (70%)
Lobular (10-15%)
Medullary in young patients, colloid/mucoid in elderly
What percentage of breast cancers are oestrogen receptor positive?
60-70% - this implies better prognosis
What percentage of breast cancers overexposes HER2 (growth factor receptor gene)?
30% - this implies more aggressive disease and worse prognosis
What are BRCA1/2? What are the characteristics?
Tumour suppressor genes that have ‘loss of function’ mutations in familial breast cancer. More common in Azhekansi Jews.
- Younger age of onset
- Frequent bilateral occurence
- Worse histological features (aneuploidy, higher grade, proliferation)
These patients get annual screening from age 30
Describe the ER status of BRCA1/2 and what this means?
BRCA1 - ER negative, cant use tamoxifen
BRCA2 - ER positive, can use tamoxifen
How do you determine HER status ?
FISH testing
How do you treat HER positive cancer?
Herceptin
Describe the staging of breast cancer
TNM
or
Stage 1 - confined to breast, mobile
Stage 2 - Confined to breast, ipsilateral lymph nodes
Stage 3 - tumour fixed to muscle, ipsilateral lymph nodes, skin involvement
Stage 4 - tumour fixed to chest wall, distant mets
What investigations should be done:
a) in all patients
b) if suspected mets
a) CXR, USS, bone scan, ER/PR/HER2 status
b) CT, MRI
Where does breast cancer metastasize?
- Bones - do radioisotope scan (main cause of spinal cord compression)
- Brain - do CT/PET (second most common after lung cancer)
- Liver
- Lung