breast cancer Flashcards
what are the two types of breast cancer
invasive
non-invasive
what are the types of invasive carcinoma
No special type (NST ) includes Invasive Ductal carcinoma Invasive Lobular carcinoma special types (25%)
what are key features of ductal carcinoma
makes up 80% of invasive breast cancers
originates in breast duct cells
what are key features of lobular carcinoma
makes up 10% of invasive cancers
originates in breast lobule cells
what are some special types of invasive breast carcinomas
tubular
cribriform
mucinous
what are some special types of invasive breast carcinomas
tubular
cribriform
mucinous
what are features of ductal carcinoma in situ (DCIS)
pre-cancerous/cancerous cells of breast ducts
localised
good prognosis if fully excised + adjuvant treatment
what are features of lobular-carcinoma in situ (LCIS)
pre-cancerous condition usually in pre-menopausal women usually asymptomatic mammograms are not effective for imaging LCIS - usually diagnosed incidentally on a breast biopsy managed with close monitoring
what are features of inflammatory breast cancer
very poor prognosis
presents similarly to breast abscesses or mastitis
key feature: peu d’orange
what are key features of paget’s disease of the nipple
looks like eczema
erythematous scaly rash
indicated breast cancer involving the nipple
what are risk factors for breast cancer
age (screening for 50-70yrs) early menarche and late menopause BRCA1 BRCA2 family history HRT for 10+ years alcohol increased weight post radiotherapy for hogkin's
what are signs of breast cancer
!usually painless! lumps inverted nipple retracted nipple oedema skin dimpling mastalgia
what are the triple diagnostic assessments for suspected breast cancer
clinical - history + exam
imaging - mammograms, US
biopsy - FNA for cytology and core biopsy for pathology
when is a mammogram not indicated?
what is the alternative?
for lobular cancer - it is not as likely to show up
if breast tissue is denser (usually younger woman <40, pregnant, breast implants)
use MRI
what is the significance of HER2, PR, ER
HER2 is a human epidermal GF receptor so it promotes cell division, in breast cancer it is usually over expressed
what is the significance of PR and ER tumours
some breast cancers have progesterone or oestrogen receptors which makes them divide faster in the presence of the hormones
what is the ‘T’ part of TNM staging in breast cancer
Tx primary tumour cannot be assessed T0 primary tumour not palpable T1 clinically palpable, <2cm T2 tumour 2-5cm T3 tumour size >5 T4a tumour invading skin T4b tumour invading chest wall T4c invading both T4d inflammatory
what is the ‘N’ part of TNM staging in breast cancer
N0 no regional lymph nodes palpable
N1 palpable and mobile
N2 palpable and fixed
what is the ‘M’ part of TNM staging in breast cancer
Mx distal metastases can not be assessed
M0 no distant metastasis
M1 distant metastasis
what investigations are involved in TNM staging
lymph node assessment and biopsy MRI liver US CT of thorax, abdomen, pelvis isotope bone scan
what investigations are done for the sentinel lymph nodes
biopsy of sentinel node using isotope contrast with blue dye to find it
if it is cancerous remove it
what is an NPI score
nottingham prognostic index
uses tumour grade, size, lymph node involvement to give a score
what prognosis does an NPI score >3.4 give
> 3.4 is poorer prognosis, high risk of recurrence
<3.4 is lower risk
what is the difference between adjuvant and neo-adjuvant therapy
adjuvant has treatment after surgery
neo-adjuvant is treatment before surgery
who is given radiotherapy
used as adjuvant treatment for everyone who has had a wide local excision
given is there is significant lymph node involvement
what are side effects of radiotherapy
fatigue local skin and tissue irritation and swelling fibrosis of breast tissue shrinking of breast tissue skin colour changes telangiectasias angiosarcoma radiation pneumonitis osteonecrosis
what are side effects of lymph node removal/breast surgery
chronic lymphoedema
how is chemotherapy given
as neoadjuvant treatment to shrink the tumour before surgery
as adjuvant treatment after surgery to reduce recurrence
as treatment of metastatic or recurrent breast cancer
who is hormone therapy for
for patients with ER breast cancer
disrupts stimulation of cancer cell growth
what are the two main first line options for hormone therapy
tamoxifen for premenopausal women
aromatase inhibitors for post menopausal women (letrozole, arimidex)
what are the two types of surgery
breast conservation using onco-plastic techniques
mastectomy
when is chemo a good option
women <50
increased poor prognostic factors
ER negative
HER2 positive
what is the follow up for breast cancer
clinical examination for 1-5 years
mammogram annually for 3-10 years
patient education so thy can check their own breasts
what is the significance of PR and ER tumours
some breast cancers have progesterone or oestrogen receptors which makes them divide faster in the presence of the hormones
what are side effects of lymph node removal/breast surgery
chronic lymphoedema
what are side effects of lymph node removal/breast surgery
chronic lymphoedema
What is the 1st lymph node breast cancer would spread to?
The sentinel lymph node
