Breast Cancer Flashcards
Breast cancer
Malignant neoplasma originating from breast tissue.
Most common cancer in the UK.
Risk factors for developing breast cancer
- female
- increased oestrogen exposure
- obesity
- smoking
- family hx. (1st relative)
- genetics (BRCA1, BRCA2)
Causes of increased oestrogen exposure in women
- early menarch
- late menopause
- nulliparity
- HRT
- combined oral contraceptive pill
Gene mutations implicated in breast cancer
- BRCA1
- BRCA2
- Tp53
6 main types of breast cancer
- ductal carcinoma in-situ (DCIS)
- lobular carcinoma in-situ (LCIS)
- invasive ductal carcinoma (NST, most common)
- invasive lobular carcinome (ILC)
- inflammatory breast cancer (worst prognosis)
- pagets disease of the nipple
Most common type of breast cancer
Invasive ductal carcinoma
- also called ‘no special type (NST)’
- 80% of cases
- breast duct cell malignancy
- shows on mammography
Clinical features of inflammatory breast cancer
- cancer that blocks the lymph nodes
- presents similar to breast abscess/mastitis
- swollen, warm breast
- peau de orange (or skin puckering)
Paget’s disease of the nipple
- eczema-like presentation of nipple
- associated with underlying tumour
Clinical features of breast cancer
Local:
- Lump: painless, hard, irregular, non-mobile
- Skin: erythema, peau de orange, ulceration, dimpling
- Nipple: inversion, deviation, eczema-like, bloody discharge
Regional:
- Axilliary lymphadenopathy
- Symptoms of metastatic spread
- General: fatigue, weight loss, anorexia
NICE referral criteria for breast cancer
Urgent 2 week pathway:
- > 30yrs, unexplained breast lump +/- pain
- > 50yrs, nipple changes (discharge, inversion, other)
Consider 2 week pathway:
- > 30yrs, unexplained axillary lump
- skin changes suggestive of breast cancer
Non-urgent pathway:
- < 30yrs, unexplained breast lump +/- pain
Investigating breast cancer
Triple diagnostic assessment:
1. clinical assessment (hx, exam)
2. imaging (USS, mammogram, MRI)
3. biopsy (fine needle, core)
Also sentinal node assessment & biopsy
Receptors implicated in breast cancer
- Oestrogen receptor (ER)
- Progesterone receptor (PR)
- Human epidermal growth factor 2 (HER2)
Triple negative = poor prognosis, reduced treatment options
Differential for breast cancer
Fibroadenoma:
- benign tumour
- round, smooth, mobile
Management of breast cancer
- surgery
- radiotherapy
- chemotherapy
- hormonal therapy
- biologics
Breast cancer surgical treatment
Tumour removal:
1. breast conservation
2. mastectomy
Axillary clearance:
- remove lymph nodes
