Breast Flashcards
Breast Cancer
Epidemiology (2)
1 in 8
40,000 new cases in UK per year
Breast Cancer Risk factors (6)
Family history
BRCA genes
Age
Past breast, ovarian, endometrial cancer
Uninterrupted oestrogen exposure: nulliparity, delay in age of 1st pregnancy, early menarche, late menopause, HRT, obesity, OCP
Not breastfeeding
Breast Cancer
Pathology (11)
Adenocarcinoma
Non-invasive ductal carcinoma in situ is premalignant (asymptomatic, screening detects)
Non-invasive lobular carcinoma in situ is rare
Invasive ductal carcinoma most common (invasive means extends beyond basement membrane)
Invasive lobular carcinoma 10-15%
Medullary cancers affect the young
Colloid/mucoid cancers affect the elderly
60-70% are oestrogen receptor +ve, better prognosis (ER +ve)
Most ER +ve cancers express progesterone receptors, cancers with both respond to hormone therapy
Approx. 30% HER2 +ve = aggressive disease
Triple -ve (ER -ve, PR -ve, HER2-ve) in BRCA1 mostly
Breast Cancer
Signs + symptoms (9)
Hard and fixed lump/thickening
Discharge/bleeding
Change in breast size/contour
Skin/muscle tethering
Peau d’Orange skin dimpling
Enlarged axillary/supraclavicular lymph nodes
Asymptomatic: NHS screening programme every 3 years aged 50-71
Paget’s: nipple itching, swelling, redness, ulceration, crusting, bleeding/discharge
Mets: bone pain, pleural effusion, anorexia + weight loss, neuropathic pain, headache, seizures, cord compression
Breast Cancer
Spread (5)
Lymph nodes Liver Bone Brain Lungs
Breast Cancer
Investigations (5)
Mammogram Ultrasound MRI FNA cytology Needle core biopsy
Breast Cancer
Sensitivity of tests (3)
Clinical examination- 88%
Mammography- 93%
Ultrasound- 88%
FNA cytology- 94%
Mammography Radiation dose (1)
1mSV
Mammography
Signs of disease (4)
Dominant mass
Asymmetry
Architectural distortion
Calcifications
Mammography Malignant mass (3)
Irregular and ill-defined
Dense
Distortion of architecture
Mammography Benign mass (3)
Smooth
Normal density
Halo
Breast Screening Programme (5)
50-70 Every 3 years Mammography Uptake 80% Recall for further investigations is 5-10% (additional views, clinical exam, ultrasound, FNAC)
Ultrasound Breast
Indications (1)
First line in <35
Ultrasound Breast
Solid benign mass findings (2)
Smooth outline
Oval shape
Ultrasound Breast Malignant findings (3)
Irregular outline
Interrupting breast architecture
Anterior halo
MRI Breast
Indications (4)
Recurrent disease
Implants
Indeterminate lesion following triple assessment (clinical examination + imaging + FNA cytology)
Screening high risk women
Benign (3) vs Malignant (3) Breast Cytology
Benign: Low cellularity Groups of cells (cohesion) Cells uniform in size Malignant: High cellularity Loss of cohesion Crowded cells
Breast FNA
Advantages (2)
Simple and inexpensive
Immediate results
Breast FNA
Disadvantages (2)
False negatives/positives
Can’t assess invasion or grade malignancies
Breast FNA
Complications (3)
Pain
Haematoma
Infection
Breast Cancer Staging investigations (4)
Bloods: FBC, U&E, creatinine, LFTs, serum calcium
CXR: baseline, lung mets
CT chest abdo: baseline, liver and lung mets
Isotope bone scan: baseline, bony mets
Breast Cancer
Staging (9)
T1: 0-2cm T2: 1-5cm T3: >5cm T4: fixed to skin or muscle N0: none N1: nodes in axilla N2: large or fixed nodes in the axilla M0: no mets M1: mets
Breast Cancer
Treatment (7)
Breast conservation: wide local excision, followed by radiotherapy
Mastectomy
Regional control (lymph clearance): sentinel lymph node biopsy, surgical/radiotherapy axillary clearance if sentinel biopsy +ve
Hormone therapy on oestrogen receptor: tamoxifen if pre-menopause (for 5 years- stops ovaries producing oestrogen), aromatase inhibitor if post-menopausal
Chemo: adjuvant or neoadjuvant
Radio: all wide local excisions and post-mastectomy if >4 +ve axillary
Anti-Her2 immunotherapy
Breast Cancer
Who can be a candidate for breast conservation surgery (5)
Tumour size <4cm Breast/tumour size ratio Suitable for radiotherapy Single tumours Patient's wish
