Breast cancer Flashcards
What are the types of breast cancer? (x5)
- Lobular carcinoma in-situ (LCIS): not actually a cancer but described a neoplastic proliferation of cells within the lobules or terminal ducts. A finding of LCIS does not imply that cancer will form at the site. It instead predicts increased risk of breast cancer generally
- Ductal carcinoma in-situ (DCIS): non-invasive, confined to the duct
- Invasive ductal cancer aka. Infiltrating ductal carcinoma: penetrated basement membrane but not spread to other organs
- Invasive lobular carcinoma
- Metastatic breast cancer: when cancer has spread beyond the breast AND ipsilateral lymph nodes (axillary, internal mammary, infra- and supraclavicular)
What are the risk factors for breast cancer? (x6)
- Genetics: BRCA1 and BRCA2
- Reproductive history (increased oestrogen exposure through reproductive events increases risk)
- Early menarche, late first-birth, and late menopause for the same reason
- HRT
What is the epidemiology of breast cancer: Prevalence? Where? Age? Type?
Affects 1 in 8 women and 1 in 1000 men. Higher prevalence in western ethnicities. Median age of diagnosis is 60. Invasive ductal carcinoma is the most common type.
What are the signs and symptoms of breast cancer? (x6)
- EARLY (DCIS and LCIS): usually asymptomatic, unilateral nipple discharge (clear or bloody)
- INCREASING SIZE (IDC and ILC): lump that is hard, tethered and non-tender
- LOCALLY ADVANCED DISEASE: peau d’orange, ulceration, nipple retraction, erythema, itching, inflammatory breast cancer
- PAGET’S DISEASE OF BREAST: red, scaly, painful inflamed nipple (highly specific)
- Axillary lymphadenopathy
- METASTATIC: bone pain, pleural effusion (pleural cavity)
What is the pathophysiology of peau d’organge?
Oedema of the breast or inflammation, while suspensory Cooper’s ligaments tethers skin of breast leading to orange peel appearance.
How do signs and symptoms between invasive ductal and invasive lobular carcinoma differ?
IDC typically grows as cohesive mass (discrete lump). ILC permeates the breast so can escape physical examination. ILC (with glandular origin) may also secrete mucin
What are the investigations for breast cancer? (x5)
- MAMMOGRAPHY: diagnostic; indistinct or spiculated (spikes on surface indicating extension) margins, increased density, calcifications. Note that in DCIS, you will usually just see calcifications. LCIS cannot be often be visualised
- USS: irregular shape, ill-defined margins, height greater than width, calcifications, hypoechoic core (indicating necrosis of cells in tumour core – typical in fast-growing masses as tumour cannot be supported and vascularised sufficiently)
- BIOPSY: definitive diagnosis; core; hyperchromatic nuclei invading stroma
- MRI: when patient has lymph nodes, but tumour not identified on mammography/USS
- SENTINEL LYMPH NODE BIOPSY: assess spread
What are the additional investigations for metastatic breast cancer? (x6)
- FBC, LFTs (liver mets or raised AlkPhos in bony mets), calcium (bone mets)
- CXR for pleural effusions or lung mets
- CT: assess for mets
- Bone scan: bone mets
- Sample pleural fluid in pleural effusion
What is a comedo lesion?
Fast-growing, defined by necrotic core from inadequate vasculature to support fast growth.
What is the UK NHS Breast Screening Programme?
UK NHS Breast Screening Programme offers routine mammographic screening every 3 years to all women from age 50 years
What is the triple assessment in a breast cancer 2-week referral?
Patients with breast cancer need a triple assessment involving EXAMINATION by breast surgeon, SCAN: mammogram if older than 35, USS if under 35 as breast tissue too dense when young, BIOPSY: fine needle cytology destroys tissue architecture, so cannot tell whether invasive or in-situ. Therefore, a core biopsy is used.
