Breast Cancer Flashcards
What is the clinical presentation of breast disease?
Lump/general lumpiness Pain/discomfort Nipple change - contraction & discharge Change in breast shape/symmetry Skin changes
How are breast lesions investigated?
Hx & physical exam
Radiology (US/Mammography)
Biopsy (F&A, true tissue)
Diagnosis requires biopsy & pathology
What are 2 common benign breast diseases?
What are some general features of each?
Fibrocystic lesions
- very common, almost physiological
- cyst formation, fibrosis, epithelial hyperplasia, adensosis and apocrine metaplasia
- Asmptomatic or lump
- Mid-late reproductive years
Fibroadenoma
- Most common in younger woman
- solitary, well circumscribed mass, often considered neoplastic
- most removed
How common is breast cancer?
1 in 8 woman will be diagnosed by the age of 85
Most common cancer in woman
What are some predisposing factors to breast cancer?
Age genetics increased oestrogen exposure Environmental & dietary factors Past hx of breast disease
What are some specific genetic factors that predispose to cancer?
Sporadic mutations in p53 gene or HER2 gene amplification
Familial genes - BRAC1/BRAC2
What is the role of HER2 gene in breast cancer?
HER2 gene product is a receptor leading to up regulation of cell growth
Amplification of the gene occurs spontaneously and leads to increased number of receptors, therefore increased/more rapid cell growth & proliferation
What is the role of BRAC1/BRAC2 mutation in breast cancer?
BRAC1/BRAC2 are mutations in DNA repair genes, therefore increase the risk of accumulation of mutations
Autosomal dominant inheritance and 30 - 90% chance of breast cancer
BRAC1 also associated with increased risk of ovarian cancer
How is increased oestrogen exposure a risk factor and factors contribute to increased exposure?
Oestrogen promotes breast growth during puberty, reproductive years and pregnancy, therefore the more cell growth/turnover, the greater chance there is to acquire mutations
Early menarche and late menopause, no or late pregnancies, not breastfeeding, using HRT and obesity post-menopause increase exposure to oestrogen and increase risk of BC
What are the two types of carcinoma in situ of the breast and which is more common?
Ductal carcinoma in situ (DCIS) - most common, frequently associated with calcification
Lobular carcinoma in situ
- usually asymptomatic and incidental finding
- May extend to ducts and nipple’s and present as Paget’s Disease
What are some features invasive carcinoma?
Which type is more common?
Ductal carcinoma more common & generally have poor prognosis than lobular
associated with E-cadherin abnormality & spread locally to skin, nipple, underlying muscle, pleura and most commonly to auxiliary LNs (also supraclavicular and internal mammary LNs)
What are management options for breast cancer and what does the combination depend on?
Variable combinations of therapies that are determined based on the type, characteristics and stage of the tumor
Surgery Radiotherapy chemotherapy anti-eostrogen drugs Herceptin (MAB)
What are some important considerations with surgical management of breast cancer?
Generally breast conserving, complete mastectomy less common
Avoid removal of all LNs - oedema
Need to look histologically before LN removal
Usually remove sentinel LNs
What is the mechanism of herceptin treatment?
Herceptin is a MAB that binds to the receptor expressed by the HER2 gene
In cases of HER2 gene amplification it is predictive of successful use of herceptin treatment
What are some important prognostic features of breast cancer?
Tumour type - ductal have poor prognosis Grade Size Lymphovascular invasion - determines likelihood of LN spread Presence of DCIS Surgical margins Nodes Oestrogen receptors (also predictive) HER2 amplification (also predictive)
