Breast Cancer Flashcards
(32 cards)
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
