Breast Cancer Flashcards
How are breast tumours classified?
Benign, Pre-Malignant, Malignant
Benign:
Fibroadenomas
Intraductal papillomas
Lipomas
Pre-Malignant:
Ductal carcinoma in situ
Lobular carcinoma in situ
Malignant:
Invasive ductal carcinoma (80%)
Invasive lobular carcinoma (10%)
Medullary carcinoma
Mucinous carcinoma
Papillary carcinoma
What is ductal carcinoma in situ?
Pre-malignant condition which is more common in older women. It is a precursor to malignant disease with a latent period >5 years.
It is defined within the ducts and appears as a branching lesion on a mammogram.
What are the different types of DCIS?
Low, medium or high risk
Histological types including comedo (worse prognosis), cribriform (multifocal) and micropapillary (multifocal).
How is DCIS treated?
Usually: wide local excision +/- adjuvant radiotherapy
If widespread: mastectomy +/- sentinel node biopsy +/- tamoxifen (if ER positive)
How is lobular carcinoma in situ managed?
Mammography surveillance in most cases
If there is a significant risk to the individual, mastectomy may be considered
What is Paget’s disease of the nipple?
Eczematous disease of the nipple which is suggestive of an underlying carcinoma
What are the risk factors for breast cancer?
General: age (>50), women, family history, genetics (BRCA1+2 - DNA mismatch repair genes, TP53), previous malignancy
Oestrogen exposure: early menarche, late menopause, nulliparity, unopposed oestrogen
How are breast lumps investigated?
Triple assessment:
Clinical examination
Imaging (mammogram/ultrasound)
Biopsy (FNA or core biopsy)
Investigations for metastases: bloods, CTCAP, liver ultrasound
How is breast cancer staged?
TNM
What is the Nottingham Prognostic Index?
Prognosis predicting tool which uses the size of the tumour, the grade of the tumour, and the presence of positive lymph nodes
What are the other prognostic indicators in breast cancer?
Oestrogen receptor status (better prognosis)
HER2 status (poorer prognosis)
Lymphovascular invasion (poorer prognosis)
What is the HER2 protein?
Growth factor receptor which is associated with a poorer prognosis, but it does respond to chemotherapy and the monoclonal antibody Herceptin
Where does breast cancer most commonly metastasise to?
Bone and lungs
Other sites include liver, brain, adrenals
When is chemotherapy indicated in breast cancer?
Neoadjuvant or adjuvant treatment
When is radiotherapy indicated in breast cancer?
All patients undergoing breast conserving surgery
Axillary radiotherapy can be used when patients have a positive sentinel node biopsy but don’t want axillary clearance surgery
