Breast Cancer Flashcards
Most common type of breast cancer
Invasive ductal carcinoma
(aka. No Special Type)
4 indications for mastectomy
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
4 indications for wide local excision
Solitary lesion
Peripheral lesion
Small lesion in large breast
DCIS <4cm
Genetic risk factors for breast cancer
BRCA1: 70% lifetime risk
BRCA2: 55% lifetime risk
p53 gene
1st degree premenopausal relative with breast cancer (e.g. mother)
4 risk factors related to oestrogen exposure for breast cancer
Early menarche
Late menopause
Nulliparity, 1st pregnancy >30y
COCP/ combined HRT
3 Non modifiable risk factors for breast cancer
Age (strongest)
Previous breast cancer
Dense breast tissue
2 modifiable risk factors for breast cancer
Obesity
Alcohol
Breast screening programme age and frequency
50-70y
Offered mammogram every 3y
> 70y may still have mammogram, but make own appointments
Patients with one first degree relative with breast cancer should be referred for screening if…
Age of dx <40y
Bilateral breast cancer
Male breast cancer
Ovarian cancer
4 common types of breast cancer
Invasive ductal carcinoma (most common)
Invasive lobular carcinoma (aka Special type)
Ductal carcinoma in-situ
Lobular carcinoma in-situ
What is inflammatory breast cancer?
Where cancerous cells block the lymph drainage resulting in an inflamed appearance of the breast.
Accounts for~1 in 10,000 cases of breast cancer.
What is Paget’s disease of the nipple?
Eczematoid change of the nipple a/w an underlying breast malignancy
Present in 1-2% of patients with breast cancer. In half, is a/w an underlying mass lesion + most have an invasive carcinoma.
30% of patients without a mass lesion will still be found to have an underlying carcinoma. The remainder will have carcinoma in situ.
Which patients should be referred on the 2ww pathway for breast cancer?
> ,30 + unexplained breast lump +/- pain
OR
,50 with discharge, retraction of other changes in 1 nipple only
In which patients should a 2ww referral for breast cancer be considered?
With skin changes that suggest breast cancer
>,30 with unexplained lump in axilla
In which patients should a non-urgent referral be made?
<30 with an unexplained breast lump +/- pain
Prior to surgery describe management of women with no palpable axillary lymphadenopathy at presentation?
Perform pre-op axillary US before their primary surgery
If -ve: sentinel node biopsy to assess nodal burden
Describe management of women who present with clinically palpable lymphadenopathy
Axillary node clearance is indicated at primary surgery
Give 2 complications of axillary node clearance
Arm lymphedema
Functional arm impairment
Describe use of radiotherapy in women who have had a wide local excision
Whole breast radiotherapy recommended
Reduces risk of recurrence by 2/3
Describe use of radiotherapy in women who have had a mastectomy
Ipsilateral radiotherapy offered for T3-4 tumours + for those with >,4 positive axillary nodes
Hormonal therapy for oestrogen receptor positive tumours
Pre/peri-menopausal: Tamoxifen
Post-menopausal: Anastrozole
MOA of Tamoxifen
Selective Oestrogen Receptor Modulator (SERM)
Acts as oestrogen receptor antagonist + partial agonist
4 side effects of Tamoxifen
Increased risk endometrial cancer
Increased risk VTE
Hot flushes
Menstrual disturbance: PV bleeding, amenorrhoea
MOA of Anastrozole and another drug in its class
Aromatase inhibitor
Reduces peripheral oestrogen synthesis (aromatisation accounts for majority of oestrogen production post-menopause)
Letrozole
4 side effects of aromatase inhibitors
Osteoporosis (DEXA on starting)
Hot flushes
Arthralgia, myalgia
Insomnia
Biological therapy for HER2 positive breast cancer
Trastuzumab (Herceptin)
In which patients is Trastuzumab contraindicated?
Hx of heart disorders
Describe use of chemotherapy in breast cancer
Neoadjuvant: to downstage primary lesion
OR
After surgery depending on stage of tumour e.g. if axillary node disease, use FEC-D
How does Paget’s disease differ from eczema of the nipple?
Pagets involves nipple primarily + only latterly spreads to the areolar
(opposite to eczema)
Diagnosis of Paget’s disease of the nipple
US, mammography + punch biopsy
Describe the axilla if there are axillary lymph nodes involving only isolated tumour cells or micrometastases
Axilla is considered clear
BRCA gene mutation inheritence
Autosomal dominant
1 parent with the mutation= 50% chance of passing on to a child.
