Breast cancer Flashcards
what does the screening programme consist of and who is it for
biplanar digital mammography every 3 years in women aged 50-70
where do the majority of breast cancers arise from
the epithelial cells of the milk ducts
most common pattern of infiltration: infiltrating ductal carcinoma
non invasive breast cancer
ductal cancer in situ
lobular cancer in situ
invasive cancer
infiltrating ductal cancer infiltrating lobular cancer mucinous cancer papillary cancer tubular cancer
what do 10% of women with breast cancer have detectable mutations in
BRCA 1 and 2, and TP53
symptoms and signs breast cancer
painless increasing mass
nipple discharge
skin tethering
inflam cancers: oedema and erythema
investigation breast cancer
triple assessment:
palpation
radiology (mammography, US & MRI scan)
fine needle aspiration cytology
prognositic factors breast cancer
size of primary tumours
the histological subtype (most are infiltrating ductal carcinomas)
histological grade/ differentiation
oestrogen & progesterone receptor (ER, PR) status
Age
menopausal status
expression of HER2 like ER & PR is predictor of rx response
poor prognostic factors for breast cancer
young age premenopausal large tumour size high tumour grade oestrogen & progesterone receptor negative positive nodes
local rx breast cancer
wide local excision
segmental mastectomy and breast conservation
axilla surgery if spread to nodes
radiotherapy to breast to reduce local recurrence
how many people have progesterone and oestrogen receptors
what rx do they have after surgery
1/3
tamoxifen
rx for pts w HER2 overexpression
IV trastuzumab further to chemo
bisphosphonate rx in breast cancer
bone metastases are a common problem in the management of breast cancer
bisphosphonates reduce the incidence of osteolytic deposits
fibroadenomas
benign tumours characterised by a mixture of stromal and epithelial tissue
unlike typical lumps from breast cancer, fibroadenomas are easy to move with clearly defined edges
signs and symptoms fibroadenomas
painless
firm
solitary
mobile
slowly growing lump in the breast of a woman of child-bearing years
partially hormone related and regress after menopause
where do fibroadenomas arise?
terminal duct lobular unit of the breast
diagnosis and treatment
diagnosis through clinical examination, US or mammography and needle biopsy
most are left in situ & monitored by dr
some surgically removed or cryoablation
fibrocystic breast changes
30-60% women affected
characterised by non cancerous breast lumps which can sometimes be uncomfortable - often related to hormonal influence from the menstrual cycle
signs and symptoms fibrocystic breast changes
fibrous tissue and a lumpy cobblestone texture in the breasts
smooth and have defined edges
free moving in relation to adjacent structures
no rx
intraductal papilloma
benign lesions with incidence of 2-3%
central - near nipple and solitary, menopausal W
peripheral - multiple, younger W - higher risk of malignancy
what does intraductal papilloma cause
bloody nipple discharge
dont show up on mammography as too small
