breast cancer Flashcards
presentation breast cancer
asymptomatic diagnosed during screening 50-70 yrs
painless lump
mastalgia
nipple discharge
nipple changes
change in size or shape of breast
skin dimpling or oedema
lymphadenopathy in axilla
risk factors breast cancer
increasing age
previous breast cancer
BRCA1 BRCA2
increased oestrogen exposure
COCP (risk returns to normal after 10 years of stopping)
HRT
obesity
smoking
fam history
BRCA1 gene is on what chromosome
17
BRCA2 gene is on what chromsome
13
types of breast cancer
invasive- ductal (80%), lobular (10%), other
non invasive - ductal in situ DCIS, lobular in situ LCIS
distant mets of breast cancer
- Contralateral Breast
- Bone
- Lung
- Liver
- Brain
- Bone Marrow
investigations breast cancer
mammogram
ultrasound
FNA cytology
core biopsy in symptomatic cases in other imaging suspicion
features of benign cytology
low moderate cellularity
cohesive group of cells
flat sheets of cells
uniform size
features of malignant cytology
high cellularity
loss of cohesion
hyperchromasia
crowding and overlapping of cells
scoring of cytology
C1-C5
C3 probably benign
C4 suspicious
C5 malignant
screening programme for breast cancer
mammogram every3 years to women aged50 – 70 years
referral criteria breast cancer
2 week wait urgent if
- unexplained breast lump in patients aged 30 or above (non urgent referral for same in under 30)
- Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
breast cancer treatment
breast conservation surgery. wide local excision WLE or mastectomy +/- radiotherapy
radiotherapy after WLE and post mastectomy in higher stage
chemo more beneficial in <50 years and worse prognosis eg grade 3, LN positive, ER negative, HER2 positive
Trastuzumab (Herceptin) may be given to HER2 positive patients
Anastrozole (aromatase inhibitor) for postmenopausal or Tamoxifen (oestrogen receptor antagonist) for premenopausal patients with oestrogen receptor-positive breast cancer.
sentinel biopsy
A sentinel lymph node is the first node to receive lymphatic drainage of the tumour
- Negative SLN = no further treatment
- Positive SLN = surgical removal or radiotherapy to all axillary lymph nodes
management of breast cysts
in most cases aspiration curative
if blood present then examine under microscope
If there is a residual mass after aspiration then the fluid should be examined and the lump aspirated
