breast - cancer Flashcards
most common type of breast cancer
ductal carcinoma
who are ductal carcinomas in situ more common in
elderly
who are lobular carcinomas in situ more common in
<40
most common breast cancers
ductal carcinoma, lobular carcinoma, medullary, lymphoma, inflammatory
symptoms inflammatory breast cancer
cancer cells block drainage –> inflamed breast
symptoms breast cancer
irregular lump // discharge // nipple retraction // pagets // peau d’orange // skin dimpling
genetics breast cancer
BRCA1, BRCA2, p53 gene
RF brest caner
nullparity, first pregnancy >30 // early menarche, late menopause // combined HRT // COCP // obese
definite referral breast cancer 2 week pathway
> 30 with unexplained lump +/- pain // >50 with unilateral discharge, retraction, or changes
who is offered screening for breast cancer
women 50-70 // mammogram every 3 years
best –> worst prognosis hormone receptors
ER+, PR+, HER2- // ER+, PR-, HER2- // ER-, PR-, HER2+ // ER-, PR-, HER2-
where does breast cancer met too
bone, brain, liver, lung
invx breast cancer
triple assessment
who is offered surgery for breast cancer
almost all patients
surgical approach to women with NO palpable axillary lymph nodes
USS before –> if positive sentinel node biospy
surgical approach to women WITH palpable axillary lymph nodes
axillary node clearance
complication of axillary node clearance
lymphedema and arm impairment
what tumours are suitable for WLE
DCIS <4cm // solitary // peripheral // small lesion in large breast
what tumours are suitable for masectomy
central tumour // multifocal // large lesion in small breast // >4cm
what are all women offered after breast surgery
breast reconstruction
who is offered radiotherapy after surgery
WLE: ALL women // mastectomy: if T3-T4 or 4 lymph nodes
where are breast implants inserted
under pec major
where is tissue taken from + what artery in lattimus dorsi breast reconstruction
skin + back // thoracodorsal artery
where is tissue taken from + what artery in TRAM/ DIEP breast reconstruction
tissue from abdomen // TRAM is fat, DIEP is fat + muscle // inferior epigastric
where is tissue taken from + what artery in IGAP breast reconstruction
skin and muscle from buttocks // inferior gluteal artery
SE from radiotherapy
lung fibrosis // IHD // skin fibrosis
when is chemo indicated for breast cancer pre surgery
prior to surgery to shrink a tumour for WLE
when is chemo indicated for breast cancer post surgery
axillary node disease (FEDC used) // advanced stage
which chemo drugs are usually used in breast cancer
5FU, methotrexate, Cyclophosphamide
when is hormal therapy indicated
ER+ive cancer
what hormonal therapy is used for pre vs post menopausal womem
pre = tamoxifen // post = aromatise inhib eg anastrozole OR tamoxifen
when is immunotherapy indicated in breast cancer
HER2+
what immunotherapy is used
trastuzumab (herceptin)
symptoms pagets
eczma like breast change not responsive to steroids, starts in nipple
invx pagets nipple
biopsy, mammogram, USS breast
implication of pagets
90% invasive carcinoma
