Breast Cancer Flashcards
What are the risk factors for breast cancer?
MAIN
- Gender
- Age
HISTORY
- FHx
- PHx breast cancer
- PHx DCIS
REPRODUCTIVE HISTORY
- Early menarche (avr. 13 yrs)
- Late menopause (avr. 51 yrs)
- First birth >30yrs / nulliparity
- No breastfeeding
MEDICATION (oestrogen exposure)
- Combined Pill
- HRT
- IVF
LIFESTYLE High BMI Poor diet/exercise Alcohol consumption Night shifts Ionising radiation exposure
How does breast carcinoma present?
- Lump*
- Nipple retraction/discharge
- Skin changes - rash, peau d’orange
- Skin tethering
- Axillary/supraclavicular lymph node
OTHER
- 30% found on NHSBSP
- Incidental CT finding
What is the cell histology of breast caricnomas?
ADENOCARCINOMAS
- Invasive ductal = 85%
- Invasive lobular = 15%
DUCTAL CARCINOMA IN SITU
-microinvasion = just broken through the basement membrane
What is the receptor histology in breast carcinoma?
ER - positive in 70%
=depends on oestrogen for growth
=can use TAMOXIFEN (anti-oestrogen) for treatment
PR - positive for progesterone receptor
=less important than ER
HER2 Receptor - 15-20% +ve
=poorer prognosis
=can treat w/ TRANSZUTAMAB
What is Ki67 marker?
- Cell cycle antigen prolieferative marker
- Higher % means more cells dividing
- Means good response to chemotherapy
How is breast cancer investigated?
TRIPLE ASSESSMENT
1. Clinical Examination (w/ history) E1 – Normal (no lump) E2 – Benign lump E3 – A lump E4 – A suspicious lump E5 – Probable cancer
2. IMAGING R1: Normal R2: Benign R3: Indeterminate R4: Suspicious R5: Malignant
3. CYTOLOGY C1: Inadequate C2: Benign C3: Atypia, probably benign C4: Atypia, probably malignant C5: Malignant
Which imaging techniques are used and when?
MAMMOGRAM
- Symptomatic >40yrs
- 35-40yrs & E4 or E5 = mammogram
- Under 35yrs + proven malignancy
- Strong FHx + after positive genetic mutation find
UTLRASOUND
- Initial exam for <35yrs
- 35-40yrs +
What are the views used in mammograms?
Breast compressed
- Keeps still
- Spreads tissue
- Less radiation dose needed
NORMAL VIEWS
Craniocaudal view + mediolateral oblique view
ADDITIONAL VIEWS
- Coned compression = assymetry and distortion
- Magnification = for calcification
- Extended CC for lesions in posterior lateral breasts
How are mammograms interpreted?
1) Masses
2) Calcification
3) Architectural distortion
4) Symmetry/asymmetry
SHOWS: Lesion position, borders, calcification
NOT SHOW: internal composition, is bad in dense breast tissue
How are breast US interpreted?
LOOKING FOR:
- Borders
- Internal echoes (fluid does not echo)
- Shape
- Edge shadows
- Posterior shadows
- Vascularity
USEFUL
- Dense breast
- Differentiates solid vs cystic mass
- Size and variability assessment good
- Can evaluate axilla
What are the advantages and diadvantages of fine needle aspiration for cytology?
+Quick and easy to perform
+Rapid processing
+Low cost
+Few complicaitons
- Need highly trained pathology for identification
- Can’t classify invasive vs. non-invasive
- No receptor status
- Does not provide same amount of tissue as core
What are the advantages and disadvantages of core biopsy?
+Method of choice if malignancy suspicious on exam + imaging
+Classifies invasive vs non-invasive
- Several days to process
- Expensive
What are common metastatic sites for breast cancer?
Bone
Liver
Lung
Brain
OTHER
-Adrenals, ovaries, chest wall
What are surgical management options for breast cancer?
- Breast conservative surgery
- Mastectomy
- Sentinal lymph node - axillary node clearance
What are the indications for mastectomy?
- Patient choice
- Multicenteric tumours
- Local recurrence
- Invasive >4cm tumour
- Prophylatic from +ve genetic mutation
