Breast Cancer

Question 1

Define Breast Cancer

Answer 1

Uncontrolled growth of epithelial cells in the breast

Question 2

Types of Breast Cancer

Answer 2

In-situ carcinoma: ductal or lobular 
Invasive ductal carcinoma
Invasive lobular carcinoma
Medullary cancers
Colloid/mucoid
Paget disease of the nipple

Question 3

Describe the in-situ breast carcinomas

Answer 3

non-invasive
Cells in the basement membrane of the alveoli which grow and replicate uncontrollably

Ductal: tumour cells grow from the wall of the ducts -> can form invasive ductal carcinoma

Lobular: clusters of tumour cells grow within the lobules but do not invade ducts + alveoli enlarge (will NOT form an invasive lobular carcinoma)
3 types: ER +ve HER2 -ve | HER2 +ve ER ± | ER and HER2 -ve

Question 4

Describe the invasive breast carcinomas

Answer 4

Invasive ductal carcinoma = most common (70%)

Invasive lobular carcinoma = 10-15% of breast cancers

Medullary cancers = tends to affect younger patients

Colloid/mucoid = tends to affect the elderly

Paget’s disease of nipple: cancer cells migrate along the lactiferous duct -> skin -> extracellular fluid through skin breaks -> crusting

Question 5

Risk factors for Breast Cancer

Answer 5

Family History 
Older age 
Increased exposure to oestrogen (early menarche or late menopause, oestrogen-containing medications, nulliparity, late first pregnancy, HRT, COCP, obesity)
BRCA1/BRCA2 (autdom)
ERBB2 (-> HER2)
Ionising radiation
Peutz-Jeghers syndrome

Question 6

Epidemiology of Breast Cancer

Answer 6

Second most common cancer in women

2nd leading cause of cancer death in women

Question 7

Symptoms of Breast Cancer

Answer 7

Hard, painless lump or swelling, commonly in the upper and outer part of the breast
Swelling under the armpit (spread to axillary lymph nodes)
Breast is immobile and fixed (due to infiltration into the pectoral muscles)
Dimpling the skin
Nipple retraction (Fibrosis of lactiferous ducts and suspensory ligaments)
Blood-stained nipple discharge

Paget disease - itchy, redness, crusting, rash on nipple-areola

Question 8

Signs of Breast Cancer on exanination

Answer 8

“Peau D’orange” appearance - dimpling

Hard, painless lump or swelling, commonly in the upper and outer part of the breast (Single | non-tender | firm | poorly defined margins | Most common upper outer quadrant)

Nipple changes (Inversion, Bloody discharge)
Swelling under the armpit (spread to axillary lymph nodes)
Breast is immobile and fixed due to infiltration into the pectoral muscles
Dimpling the skin
Fibrosis of lactiferous ducts and suspensory ligaments -> nipple retraction

Paget disease - itchy, redness, crusting

Question 9

What is the triple assessment for breast cancer

Answer 9

For ALL lumps

1. Clinical examination
2. Mammography (>30) /USS + axillary USS
3. Histology/cytology using core biopsy or fine needle aspiration cytology
4. Staging using bloods: FBC, U&Es, LFTs and bone profile if EARLY stages

Question 10

What is the screening programme in the UK for Breast Cancer

Answer 10

mammograms from the age of 50-70 every 3 years

Question 11

Investigations for Breast Cancer

Answer 11

Mammogram: 
(invasive ductal)
Ill-defined or spiculated mass
Parenchymal distortion
Overlying skin thickening
Malignant calcifications
Enlarged axillary lymph nodes 
Invasive lobular carcinoma: Tendency to be bilateral and multi-focal

USS: Ill-defined, hypoechoic mass | distal acoustic shadowing | surrounding halo | abnormal axillary nodes

Core biopsy: grading + hormone receptor status
Sentinel node biopsy: ? spread to lymph nodes