Breast Cancer Flashcards
Risk factors of breast cancer
Age Duration of oestrogen exposure Obesity Ionising radiation Family history esp if under 50 Brca 1 and 2 associated with early onset
Epidemiology of breast cancer
Lifetime risk in women?
Most common female cancer
1 in 12 women will develop cancer in their lifetime
Histology of Breast cancer
Infiltrating ductal carcinoma - 70-80%
Lobular carcinoma - 10%
ER and PR positive have a better prognosis and can be treated with tamoxifen
Her2 worse prognosis but can be treated with herceptin
H
What is triple assessment?
History and exam
Bilateral mammogram/ultrasound
FNAC, needle, incisional, excisional
How is stage assessed in metastatic breast cancer
MRI, bone scan, or ct
What is the TNM staging of breast cancer
T1 less than 2cm T2 2-5cm T3 greater than 5cm T4 skin No N1 mobile axillary nodes N2 fixed axillary nodes N3 internal mammary nodes M1 distant mets
Management of localised breast cancer
Wide local excision and post op radiotherapy
Mastectomy
Sentinel node biopsy
When is radiotherapy used in the management of breast cancer
Following wide local excision
Following mastectomy if high risk
NOT usually after axillary dissection - except if increased risk of local recurrence
How is endocrine therapy used in adjuvant treatment of breast cancer
Tamoxifen if ER positive for 2-5 years
Then
Aromatase inhibitors- anastrozole letrozole in post menopausal women
Ovarian ablation in premenopausal women- oophorectomy, radio induced
Trastuzumab if her2 positive, in metastatic or localised disease
How is endocrine therapy used in metastatic disease
One third respond to endocrine therapy
Ovarian ablation with lhrh agonists, oophorectomy
Antioestrogens - Chlomiphene
How is chemotherapy used in the management of localised and metastatic disease?
Adjuvant to decrease recurrence, greater effect if less than fifty
To palliate in metastatic disease
Who should be urgently referred within 2 weeks for suspected breast cancer?
Breast lump with features of cancer
Breast lump in post menopausal woman
Breast lump in woman over 30 without features of cancer, persisting after her next period
Spontaneous nipple discharge
Skin change on breast not responding to treatment
