Breast Flashcards
RFs for breast cancer?
- obesity
- smoking
- FH in 1st degree relative
- oestrogen exposure
- increased no of ovulations
- female
outline screening for breast cancer
- mammogram every 3 years from 50-70
- if BRCA gene: MRI every year from 20-49, then mammogram thereafter
outline risks of BRCA gene
- BRCA 1- chromosome 17
- 50-85% risk of breast cancer
- 40-60% ovarian cancer
- BRCA2- chromosome 13
- same risk as above for breast
- 15% risk ovarian cancer
- increased risk for male breast cancer & prostate cancer
Outline benign breast lumps
- cysts
- fibroadenoma
- lipoma
- fat necrosis
- abscess
- phyllodes tumour
outline benign conditions that present w nipple discharge
duct ectasia
intraductal papilloma
Mx of benign breast lumps?
treat conservatively or local excision
apart from cyst / abscess & phyllodes tumour
describe breast cysts + Mx
- benign
- well circumscribed, mobile, fluctuant lump
- Mx: needle aspiration or local excision
describe fibroadenomas + Mx
- most common breast pathology
- epi: 15-35years
- well circumscribed, firm, highly mobile
- 10% disappear every year- excision based on pt preference
describe fat necrosis
- lump formed by degeneration/scarring of fat
- aetiology: often post breast surgery/trauma
- firm, irregular, fixed lump
- radiologically similar appearance to breast cancer
describe lipoma
- benign fat lump
- soft, painless, mobile lump >20cm
mx of abscess?
may require incision and drainage surgically
describe phyllodes tumour and mX
- benign but has potential to become malignant
- Mx: wide local excision/mastectomy if large
describe duct ectasia
- smoking major RF
- nipple discharge that may be blood stained
- nipple inversion/retraction
- may be assoc w subareolar mass
describe intraductal papilloma + Ix
- benign but increased risk of cancer
- subareolar region
- blood stained/sticky nipple discharge
- Ix: ductography
- Mx: excision and vigilant breast screening
what is gynaecomastia?
benign enlargement of male breast
aetiology of gynaecomastia?
- obesity
- anabolic steroids
- cannabis
- prostate/pituitary/testicular cancer
- liver cirrhosis
- medications
what medications may cause gynaecomastia?
- spironolactone
- 5 alpha reductase inhibitors
- PPI
- ACEI
- amiodarone
Mx of gynaecomastia?
- stop precipitating cause
- SERM
- surgery
outline categories of malignant breast lumps
- In-Situ carcinoma: pre-invasive, not detected clinically (on X-Ray)
- ductal
- lobular
- Invasive carcinoma
- ductal - 80%
- lobular - 15%
- Pagets disease
- Inflammatory breast cancer
describe pagets disease
- malignant cells infiltrate into epidermis
- cell proliferation–> skin thickening
- causes a red, eczematous rash on nipple
- discharge & inversion are possible
describe inflammatory breast cancer
- presents as red, swollen, warm, itchy and inflamed breast
- caused by blockage of lymphatic vessels
- increased breast size
epidemiology of breast cancer?
1/8 women in their lifetime will have breast cancer
macroscopic signs of breast cancer
- firm lump
- fixed mass
- tethering/dimpling of skin
what does triple assessment involve? and when does this get done?
w 2ww cancer referral & suspicious lump
- Clinical
- history&examination
- Imaging
- US<35
- Mammogram >35
- Histology
- FNAC
- Core biopsy
mets of breast ca?
2b’s + 2L’s
bone
brain
liver
lung
staging?
TNM
what is the most important prognostic indicator?
node status
Medical Mx of breast cancer?
- hormonal therapy
- ER+ve (80%)
- pre menopausal: tamoxifen (SERM)
- post menopausal: aromatase inhibitors
- PR+ve
- Her-2+ve (assoc w worse prognosis)
- herceptin
- ER+ve (80%)
- bisphosphonate
- reduced risk of recurrence in post-menopausal women
how long is hormonal therapy indicated for?
increasing evidence for 10 years, esp node positive women
surgical Mx of breast cancer?
- Wide local excision
- if tumour <4cm
- Mastectomy
- Sentinel LN biopsy
- if clear –> no further treatment required
- if +ve –> removal of all nodes surgically or w radiotherapy to all nodes
complications of surgical Mx?
- lymphedema
- nerve injury- long thoracic nerve –> winging of scapula
who is chemo indicated for?
- advanced hormone receptor negative cancer
- aggressive disease
outline the follow-up to breast cancer treatment
triple assessment once yearly for 5 years after
