Breast cancer Flashcards
breast tissue is made up of
glandular tissue arranged multiple lobes made up of lobules
lobules are divided by fibrous ligaments (coopers ligaments)
breast tissue is
mammary gland that lies over pectoralis major muscle
what ribs does breast extends from
2-6 rib
Lymph Nodes of breast
level 1 nodes - low axilla
level 2 nodes - midaxilla
level 3 nodes - apical axilla
supraclavical nodes
internal mammary
genes most commonly affected in hereditary breast cancer
BRCA1
BRCA2
Li fraumeni syndrome (LFS)
BRCA1
85% risk of breast cancer
60% risk of ovarian cancer
BRCA2
60% risk breast cancer
risk of prostate, non hodgkins lymphoma ,pancreas and bladder cancer
LFS
50% risk breast cancer
Family History-Exposure to Oestrogen
Endogenous
Low parity
first born child at less than 30 years
early menarche (under 11 years)
late menopause (after 54)
Family History-Exposure to Oestrogen
Exogenous
hormone replacement therapy - longterm
oral contraceptive treatment
Other risk factors:
western style diet
alcohol consumption
obesity
high breast density and history of atypical hyperplasia
exposure to ionizing radiation
age :75% over the age of 50 and 5% before 35
Signs and Symptoms
1.painless or slightly tender bump
2.abnormal mammography
3.changes in size /shape/skin
4.bloody nipple discharge
5.Axillary Lymphadenopathy (under arm lymph nodes enlarge)
6.symptoms of metastatic disease
a patient with a breast lump
if a discrete lump is found by gp, patient is referred to symptomatic breast clinic
Diagnosis –Triple Assessment
1) clinical assessment (breast exam)
2)radiology
3)pathology
Triple Assessment- Clinical
medical history
examination of breast
may score using 1-5 system for consistency
Radiographic studies
bilateral mammogram
+/- ultrasound
+/- CXR
+/- plain radiographs -symptomatic bone
MRI breast
Screening mammography
two standard xray images of each breast
diagnostic mammogram
spot compression(focuses on small area that was supsicious on first mammogram) and magnifies views
detects tumour 5mm or less
defines status of both breast
Breast Density
unrelated to breast size and not detected on clinical exam
more common in young ,breastfeeding women or those on HRT
Ultrasound
good at differentiating between tumours and cysts
MRI-Breast
recommended…
-uncertainty following standard imaging
-special clinical situations
MRI-Breast
used if patient has
dense breast
breast implants
suspicsion of lobular cancer
familial breast cancer - with or without BRCA mutations
pathology
recommended
if clinical or imaging findings are suspicious or suggestive of malignancy
types of biopsy
fine needle aspiration
core needle
fine needle aspiration biopsy
small bore needle that obtains CELL SAMPLE from breast
minimally invasive and low cost
core needle biopsy
removes multiple cores of solid tissue
uses image guidance /palpations eg MRI or ultrasound
core biopsy
B1 =normal
B2 =benign
B3 =uncertain
B4 =suspicous
B5a =DCIS (ductal carcinoma in situ)
B5b= invasive
excisional biopsy
removal of entire breast mass or a suspicious area
breast cancer is classified by
-whether the cancer started in the lobules or ducts
-if cells invaded thru lobules or ducts
-microscopic appearance of cancer cells
Almost all are carcinomas arising
from wall of ducts
PATHOLOGIC CLASSIFICATION
ductal
lobular
other
ductal
-intra-ductual carcinoma in situ DCIS
-invasive/infilterating
lobular
in situ LBIS
invasive/ infilterating
other
nipple (pagnents disease)
inflammatory
medullary
most common pathogical classification
infiltrating ductal carcinoma 75-80%
infilrating lobular 10%
DCIS 3-5%
Tumour grade:
Scarff-Bloom-Richardson Grade System
GRADE 1
well-differentiated breast cells,
cells appear normal and rapidly growing
SCORE : 3,4,5
Tumour grade:
Scarff-Bloom-Richardson Grade System
GRADE 2
moderately differentiated cells
SCORE 6,7
Tumour grade:
Scarff-Bloom-Richardson Grade System
GRADE 3
poorly differentiated cells
cells dont appear normal
grow and spread more agressively
SCORE: 8,9
Prognostic factors of breast cancer
tumour size/stage
histological grade
lymph node status
lymphovascular invasion
menopausal status
hormone-receptor positive cancer definition
cancer cells have extra receptors that attach to oestrogen and progesterone
type of Breast Cancer Hormone Receptors
ER-positive
PR-positive
hormone receptor- positive
hormone receptor - negative
ER positive
PR positive
have esotrogen receptors
have progesterone receptors
hormone receptor- positive
hormone receptor - negative
if cancer cell has one or both ( e or p)
if cancer cell has no hormone receptor
HER2 stands for
human epidermal growth.
this means tumour cells make high levels of protein called HER2/neu … associated with certain aggressive types of breast cancer
Triple Negative Breast Cancer refers to
cancer cells have no progesterone or estrogen receptors or the HER2 protein
Features of Triple Negative Breast Cancer
poorer prognosis
agressive tumour
limited tx options
Peau d’Orange
orange peel appearance created by
invasion of axillary lymphatics by tumour, producing obstructions and oedema of overlying skin
Inflammatory Breast Cancer:
what is it
patients present w
very aggressive type of locally advanced breast cancer w poor prognosis
onset odema and erythema of breast skin
