Breast

Question 1

what is breast cancer in situ and what are the 2 types?

Answer 1

Breast cancer in situ is a non-invasive breast cancer that is confined to the duct or lobule in which it originated and does not extend beyond the basement membrane. The cancer does not have access to distant spread through lymphatics or the bloodstream.

Ductal carcinoma in situ (DCIS) is a potential precursor of invasive carcinoma and suggests that cancer will become invasive at that site.

Lobular carcinoma in situ (LCIS) develops in breast lobule(s) and/or terminal ducts and is usually found incidentally.

Question 2

what mutations are associated with breast cancer?

Answer 2

BRCA1 and 2

Question 3

what are the types of breast cancer?

Answer 3

• Invasive ductal carcinoma (75-85%)
• Invasive lobular carcinoma (10%)
• Other such as medullary carcinoma or colloid carcinoma

Question 4

what are the risk factors for breast cancer?

Answer 4

BRCA mutations 
earlier menarche, later menopause
being older at first pregnancy/childbirth
OC use
HRT 
obesity 
denser breast tissue on mammography

Question 5

what features of breast lump suggest cancer?

Answer 5

• Usually painless (unless inflammatory carcinoma).
• Hard and gritty feeling.
• May be immobile (held within breast tissue), tethered (attached to surrounding breast tissue or skin), or fixed (attached to chest wall).
• Ill-defined; irregular with poorly defined edges.

Question 6

what are the nipple signs of breast cancer?

Answer 6

• Nipple may be the prime site of disease (Bowen’s disease), presenting as an eczema-like change.
• Nipples may be affected by an underlying cancer – Destroyed, inverted, Deviated and associated bloody discharge.

Question 7

what are the skin changes associated with breast cancer?

Answer 7

• Carcinoma beneath skin causes dimpling, puckering, or colour changes.
• Late presentation may be with skin ulceration or fungation of the carcinoma through the skin.
• Lymphoedema of the skin (peau d’orange) suggests local lymph node involvement or locally advanced cancer.
• Extensive inflammatory changes of the skin are associated with inflammatory carcinoma (aggressive form).

Question 8

what are the systemic features of breast cancer?

Answer 8

include weight loss, anorexia, bone pain, jaundice, malignant pleural/pericardial effusions, and anaemia.

Question 9

what InV are done in breast cancer?

Answer 9

Clinical examination - inspection in different positions, palpation.

Imaging - ultrasound, X-ray mammography, MRI

Fine needle aspiration cytology, with microscopy of cells recovered

Core biopsy (often guided by imaging), with microscopy of tissue sections.

Excisional biopsy - diagnostic, therapeutic, or both

Hormone receptors and Her2 receptor testing

Question 10

what endocrine therapy can be used in breast CA?

Answer 10

Used in (o)estrogen receptor (ER) +ve patients;
• Anti-oestrogens like tamoxifen or aromatase inhibitors (letrozole).
• Post-menopausal patients—letrozole (caution osteoporosis).
• Premenopausal patients—tamoxifen.

Herceptin (AKA Trastuzumab) —given in Her-2 receptor +ve patients.

Question 11

what are the surgical options for breast CA?

Answer 11

wide local excision
simple mastectomy
axillary node clearance