Breast Flashcards
From which cells can breast cancer arise?
Ductal: Epithelial lining of ducts
Lobular: epithelium of terminal ducts of lobules
Where and what nature are most breast cancers?
Invasive ductal carcinoma
Give 2 epidemiological facts about breast cancer
Most common cancer in women (1/7 in UK)
Peak incidence: 50+
What are the 6 main risk factors for breast cancer?
Age Prolonged exposure to oestrogen FH of breast cancer Genetics Previous breast, endometrial, ovarian or bowel cancer Irradiation to the chest wall
List 7 factors contributing to prolonged exposure to oestrogens
Early menarche OCP Late menopause HRT Nulliparity No breastfeeding Obesity
List 5 features a patient may present with in breast cancer
Breast lump (usually painless) Changes in breast shape Skin changes Nipple discharge (may be bloody) Axillary lump
What signs of malignancy may be apparent in breast cancer?
Weight loss
Bone pain
Paraneoplastic syndromes
How does being oestrogen receptor positive influence prognosis? Why?
Improves prognosis
Can be targeted by oestrogen receptor blocker e.g. tamoxifen
How does over expression of HER2 influence prognosis? Why?
Worsens diagnosis, aggressive disease
GF receptor gene: promotes growth of cancer cells
What are the signs of breast cancer on examination?
Breast lump: Hard, Irregular surface, Indistinct borders, Fixed to surrounding structures
Peau d’orange
Skin tethering
Skin ulceration
Nipple inversion
Paget’s disease of the breast: eczema-like hardening of the skin on the nipple
What initial investigations are carried out in suspected breast cancer?
Triple assessment:
Clinical examination
Imaging: US (< 35 yrs) OR Mammogram (> 35 yrs)
Tissue Diagnosis: FNA OR Core Biopsy
What is a Sentinel Lymph Node Biopsy? Why is it performed?
A radioactive tracer is injected into the tumour and a scan identifies the sentinel lymph node
This node is then biopsied to check the extend of spread
Where are the most common sites of metastases in breast cancer?
Lymph nodes
Lungs
Liver
Bone (spine)
After diagnosis, what further investigations are performed in breast cancer?
CXR Bloods inc. LFTs ER + PR status HER2 status CT + Bone scintigraphy if mets. suspected
What are the 4 stages of breast cancer?
1: Confined to breast, mobile
2: Growth confined to breast, mobile, lymph nodes in ipsilateral axilla
3: Tumour fixed to muscle (but not chest wall), ipsilateral nodes matted + may be fixed, skin involvement larger than tumour
4: Complete fixation of tumour to chest wall, distant mets.
