Breast Cancer Flashcards
How common is breast cancer?
Most common cancer in women in the UK
What is the gene that puts you at an increased risk?
What does this gene do?
What other cancer does this gene put you at an increased risk of?
BRCA1 and BRAC2 (br = breast ca= cancer)
Mutations on tumour supressor genes
Ovarian cancer
Explain how screening works in the UK?
All 50-70 year olds is every 3 years
High risk are annually
As are post surgery for 3-5yrs post op
Screening is with a mammogram
How does ductal carcinoma in situ appear on mammogram?
Linear or branching microcalcifications
If a cancer is inpalpable what can radiologists do to assist surgeons?
Insert wires or small magnets so that it easier to fidn
What is the most desirable form of breast surgery?
Breast conservation - no better outcome than a masectomy and helps to maintain as much of a cosmetic appearance as poss with a less invasive surgery
Breast conservation surgery is done with neoadjuvant methods. What are these?
Neoadjuvant = pre-op
Chemo
Endocrine methods
Oestrogen feeds breast cancer as a result endocrine drugs are used to help minimise growth.
What are these?
Why do we use different classes for pre and post menopausal women?
Pre - tamoxifen
Anti-oestrogen which works by targeting the receptor
(In breast it decreases oestrogen in gynae it increases oestrogen)
Post-menopausal - aromatase i - anastrozole, letrozole
Once reached menopause stop producing oestrogen - main source is from aromatase converting androgens into oestrogen in the subcutaneous fat (hence obesity being risk factor)
What are lifestyle risk factors for breast cancer?
Obesity - aromatase is found in subcutaneous tissue
Alcohol
Increased oestrogen exposure
A woman presents with a moderate mobile mass in her breast which she noticed a few weeks ago. She has no FH of breast/ovarian cancer. There are no skin or nipple changes. No nipple discharge.
This is an example of a low risk patient. She most likely has a …
1) How would you invx?
2) How would this appear on invx?
3) How may her history change if she was more likely to have a malignancy?
Cyst/fibroadenoma
1 - USS
2 - Black - this is how you identify a cyst - a mass would be white
High risk patient
- tethered mass
- FH of breast/ovarian cancer
- Previous lumps
- Skin changes e.g. peau d’orange
- Nipple discharge (often bloodstained)
- Axillary mass
- Oedema
What is Paget’s disease in reference to the breast?
Nipple changes e.g. eczema like
Suggestive of cancer found directly below the nipple
What are the methods of biopsy used?
Vacuum assisted and core biopsy
What is meant by oncoplastic breast conservation?
When plastic surgery work with oncology surgeons
This is most common in women with small breasts or large tumours in big tittied ladies
When breast cancer is considered, the axillary nodes are also USS. Regarding axillary node surgery:
1 - what is done for all women if breast cancer is present?
2 - If cancer is found in axillary nodes what is then done?
3 - What is the rare complication of this and why does it occur?
Sentinel node biopsy - node which is first when leaving tumour
2 - axillary node clearance up to level III
3 - lymphoedema - remove nodes from arm and lymph swells
What type of breast cancer is most strongly assoc. with peau d’orange?
Inflammatory
