Breast Cancer Flashcards
what is the tripple assessment
- clinical - history + exam
- radiological - mammogram/USS
- cytopathological– FNA/core biopsy
breast screening in Scotland
offered 3 YEARLY to women 50-70
what % of breast cancers are picked up by screening
50%
most common symptom of breast cancer
lump
genes associated with breast cancer
BRCA1 BRCA2
risk factors for breast cancer
increased age previous breast cancer \+ve family hirsotyr early menarche late menopause no pregnancies HRT alcohol consumption obesity
most common breast cancer
ductal carcinoma
presentation of ductal carcinoma
firm, defined lump
2nd most common breast cancer
lobular carinoma
presentation of lobular carcinoma
softer, ill defined lump
what is a ductal carcinoma in situ
malignant changes present in epithelial cells but basement membrane remains intact
- no invasion is seen
presentation of ductal carcinoma in situ
majority are non-palpable
- detected by mammogram
ductal carcinoma in situ appearance on mammogram
micro calcifications
types of ductal carcinoma in situ
high grade: malignant cells with abundant cytoplasm, marked pleomorphism and increased mitoses
low grade: small, regular cells which form micropapillary strucutres
intermediate: in-between these two stages
what is pagets disease of the nipple
high grade DCIS that has spread into nipple
appearance of pagets disease of the nipple
‘eczema of nipple’ inflammatory changes
itchiness, burning, bleeding
what are the 2 forms of lobular in situ neoplasia
atypical lobular hyperplasia
lobular carcinoma in situ
what is atypical lobular hyperplasia
<50% of lobule involved
what is lobular carcinoma in situ
> 50% lobule involved
what does ER positive mean?
grows in response to oestrogen
what is HER2
member of human epidermal growth factor receptor family
encodes a transmembrane tyrosine kinase receptor
how is HER2 tested for
FISH
what drug is given for HER2 +ve tumours
herceptin
what drug is given to premenopausal women who are ER +ve
tamoxifen
what drug is given to post menopausal women who are ER +Ve
letrozole
what type of drug is letrozole
aromatase inhibitor
why is letrozole only given to post menopausal women
increases risk of osteoporosis
lymph node staging
stage 1: nodes -ve
stage 2: 1-3 nodes +ve
stage 3: >4 nodes involved
surgery options for breast cancer
wide local excision
mastectomy
axillary node clearance/ sampling/ sentinel node biopsy
what is given after surgery
radiotherapy
types of flap in mastectomy
latissimus dorsi pedicled flap
deep inferior epigastric artery perforator free flap (DIEP)
inferior gluteal artery perforator free flap (IGAP)
arteries used in flaps
deep inferior epigastric
inferior gluteal
