Breast Cancer Flashcards
What are the risk factors for breast cancer? (11 things)
- family history
- age
- uninterrupted oestrogen exposure
- 1st pregnancy after 30yrs old
- early menarche
- late menopause
- HRT
- obesity
- BRCA genes
- not breastfeeding
- past breast cancer
What is the Triple Assessment method for breast cancer?
- History n examination
- Imaging
- Biopsy
If a patient presents with a breast LUMP, what questions should you ask? (12 questions)
- Previous lumps
- Family history
- Pain
- Nipple discharge
- Nipple inversion
- Skin changes
- Change in size related to menstrual cycle
- First/last/latest period
- Number of pregnancies
- Postnatal
- Breast feeding
- Drugs (eg HRT)
- Consider metastatic disease (weight loss, breathlessness, back pain, abdominal mass?)
If a patient presents with a breast PAIN, what questions should you ask? (6 questions)
- SQITARS
- Bilateral / unilateral
- Rule out cardiac chest pain (radiates to shoulders or arms / relieved by rest / dyspnoea / central crushing pain / sharp pain)
- History of trauma
- Any mass
- Related to menstrual cycle
If a patient presents with a NIPPLE DISCHARGE, what questions should you ask? (6 questions)
- Amount
- Colour
- Consistency
- Any blood?
- Unilateral / bilateral ?
- Smoking? (ductal ectasia)
What are the causes of nipple discharge? (3 things)
- Duct ectasia
- Intraductal papilloma/adenoma/carcinoma
- Lactation
What is the discharge like in Duct Ectasia? (3 things)
- Green / brown / red discharge
- From multiple ducts
- Bilateral
What is the discharge like in Intraductal papilloma / adenoma / carcinoma? (2 things)
- Bloody discharge
- From one duct
What is the management of duct ectasia? (3 things)
- Diagnose cause (mammogram / US / ductogram)
- Treat appropriately
- Cessation of smoking = reduces duct ectasia discharge
When asking about Past Medical History in breast cancer what should you ask? (2 things)
- Any previous lumps / malignancies?
- Previous mammograms / clinical examinations of breast / US / Fine needle aspiration / core biopsies
When asking about Drug History in breast cancer what should you ask? (2 things)
- HRT
- Pill
Both increase risk of breast cancer
What are the features of Stage 1 breast cancer? (2 things)
- Confined to breast
- Mobile
What are the features of Stage 2 breast cancer? (3 things)
- Growth confined to breast
- Mobile
- Lymph nodes in ipsilateral axilla
What are the features of Stage 3 breast cancer? (3 things)
- Tumour fixed to muscle (but not chest wall)
- Ipsilateral lymph nodes matted (fused ) + may be fixed
- Skin involvement
What are the features of Stage 4 breast cancer? (2 things)
- Complete fixation of tumour to chest wall
- Distant metastases
What are the features of TNM staging in breast cancer?
T1 = \<2cm T2 = 2–5cm T3 = \>5cm T4 = fixed to chest wall or peau d’orange (inflamm)
N1 = mobile ipsilateral nodes N2 = fixed nodes
M1 = distant metastases
What are the surgical treatment options for breast cancer? (3 things)
- Wide Local Excision (WLE)
- Mastectomy
- Axillary surgery
What is the most common breast conserving treatment?
Wide Local Excision (WLE)
What is excised in Wide Local Excision (WLE)?
Tumour + 1cm margin of macroscopically normal tissue
What size tumours is Wide Local Excision only suitable for?
Focal smaller cancers
What is excised in Mastectomy?
All tissue from affected breast + some overlying skin
(amount of skin excised dependent on whether a reconstruction is planned)
Are the chest wall muscles touched in Mastecomy?
No they are left intact
What are the indications for Mastectomy? (4 things)
- Multifocal disease
- High tumour : breast tissue ratio
- Disease recurrence
- Patient choice
Why is Axillary surgery performed? (2 things)
- Assess nodal status
- Remove any nodal disease
Which lymph nodes are removed in Sentinal node biopsy?
The FIRST lymph nodes into which tumour drains
How are the nodes identified in Sentinal node biopsy?
By injecting blue dye with associated radioisotope into peri-areolar skin
Sentinal nodes identified by radioactivity detection / visual assessment (bc nodes become blue)
What happens after the nodes are removed in Sentinal node biopsy?
Nodes sent for histological analysis
What is Axillary node clearance?
Removal of all nodes in axilla
Why should you be careful when performing axillary node clearance?
To not damage important structures in axilla
What are the complications of Axillary node clearance? (3 things)
- Paraesthesia (pins n needles)
- Seroma formation (serous fluid accum)
- Lymphedema in upper limb (swelling bc lymph accum)
What is the ANTERIOR border of the axilla made up of? (2 things)
Pectoralis Major + Minor
What is the LATERAL border of the axilla made up of?
Intertubecular groove of humerus
What is the MEDIAL border of the axilla made up of? (2 things)
- Serratus anterior
- Thoracic wall
What is the POSTERIOR border of the axilla made up of? (3 things)
- Scapularis
- Teres major
- Latissimus dorsi
What are the contents of the axilla? (5 things)
- Axillary artery
- Axillary vein
- Axillary lymph nodes
- Brachial plexus
- Biceps brachii (short head) + coracobrachialis
When is Radiotherapy recommended in breast cancer?
For all patients with invasive cancer after WLE
By how much does radiotherapy reduce the risk of recurrence in breast cancer?
10 yr recurrence risk reduced from 30% –> 10%
When should chemotherapy be considered in breast cancer?
All patients except excellent prognosis patients
What is the aim of hormone treatment in breast cancer?
To reduce oestrogen activity
Which age group is Tamoxifen recommended for?
Pre menopausal patients