Breast Cancer Flashcards
EPIDEMIOLOGY
Lifetime incidence
1 in 8 woman
EPIDEMIOLOGY
Ranks where in list of most common cancers
Most common cancer
AETIOLOGY
Risk factors
- Female
- Increased oestrogen exposure (earlier onset of periods and later menopause)
- More dense breast tissue (more glandular tissue)
- Obesity
- Smoking
- FH
AETIOLOGY
Common drugs that increase oestrogen exposure so increase risk
- Combined contraceptive pill
- Hormone replacement therapy
AETIOLOGY
Associated genes
- BRCA1 gene
- BRCA 2 gene
What are BRCA genes
Tumour suppresor genes, mutations in these leads to increased risk of breast cancers as well as ovarian and others
Where is BRCA1 and 2 genes located
1 - chromosome 17
2 - chromosome 13
EPIDEMIOLOGY
Lifetime prevalence of breast cancer in BRCA1 an 2 genes
1 - 70% by 80
2 - 60% by 80
EPIDEMIOLOGY
Lifetime prevalence of ovarian cancer in BRCA 1 and 2 genes
1 - 50% by 80
2 - 20% by 80
AETIOLOGY
Other than BRCA genes, what are other rarer mutations associated with breast cancer
- TP53 and PTEN genes
Types of breast cancer
- Ductal carinoma in situ
- Lobular carcinoma in situ
- Invasive ductal carcinoma
- Invasive lobular carcinoma
- Inflammatory breast cancer
- Paget’s disease of nipple
- Rarer
- Medullary breast cancer
- Mucinous breast cancer
- Tubular breast cancer
CLINICAL FEATURES
Presentation
- Lumps that are hard, irregular, painless or fixed in place
- Lumps may be tethered to skin or chest wall
- Nipple retraction
- Skin dimpling or oedema
- Lymphadenopathy, particularly in axilla
CLINICAL FEATURES
Referral criteria
- 2 week wait referral for suspected breast cancer for
- Unexplained breast lump in patients >30
- Unilateral nipple changes in patients >50
- Unexplained lump in axilla patients >30
- Skin changes suggestive of breast cancer
INVESTIGATIONS
Primary investigations
- Triple diagnostic assessment
- Clinical assessment
- Imaging (US or mammography)
- Biopsy (fine needle or core)
INVESTIGATIONS
When is each different form of imaging used
- US
- Aged <30
- Good to distinguish solid lumps from cystic lumps
- Mammogram
- More effective older woman
- Pick up calcifications missed by US
- MRI
- Screening woman of higher risk
- Further assess size and features of tumour
INVESTIGATIONS
Lymph node assessment
- Diagnosis of breast cancer requires US of axilla and US guided biopsy of any abnormalities
- Sentinel lymph node biopsy may be used during breast surgery when initial US shows no abnormalities
3 type of breast cancer receptors
- Oestrogen receptors (ER)
- Progesterone receptors (PR)
- Human epidermal growth factor (HER2)
What is triple negative breast cancer
Cells carry none of the 3 usual receptors, worse prognosis as limits treatment options
Where does breast cancer usually metastasise
- Remember 2Ls and 2Bs
- Lungs
- Liver
- Bones
- Brain
INVESTIGATIONS
What other investigations might be required to stage cancer after triple assessment
- Lymph node assessment and biopsy
- MRI of breast and axilla
- Liver US - for metastasis
- CT thorax, abdomen and pelvis - for metastasis
- Isotope bone scan - for bony metastasis
INVESTIGATIONS
What system is used to stage tumour
TNM system
MANAGEMENT
Treatment options
- Surgery
- Radiotherapy
- Chemotherapy
- Hormone treatment
- Targeted treatment
MANAGEMENT
Surgical options
- Tumour removal
- Breast conserving surgery - usually with radiotherapy
- Masectomy - usually with breast reconstruction
- Axillary clearance
What is possible consequence of axillary clearance with surgery
Chronic lymphoedema
