Breast cancer Flashcards
3 parts of triple assessment
1) palpation
2) mammogram (>40) or US (<40) - younger women have more dense breasts
When a woman complains of a breast lump US is always performed even if the woman has had a mammogram/ always scan axilla too
3) needle biopsy
Imaging always performed regardless of whether or not there is a clinically palpable abnormality
what is the 1-5 scale used for triple assessment
1) normal 2) benign 3) inderterminante / probably benign 4) suspicious 5) malignant
what features of a lump make you suspicious of malignancy
hard
irregularly
non tender
tethering
risk factors for breast cancer
F age earlier menarche HRT use older age at menopause FH - how many, 1st/2nd degree, age affected BRACA1/2 not having children obese alcohol physical inactivity sex hormones breast density older age at first birth OCP
How to describe a breast lump
size
shape
location - most breast cancer occurs in upper outer quadrant (approx. 50%)
margin
skin tethering? - lump is attached to skin, can be moved in an arc without moving skin but if the lump if pulled outside the arc the skin indents
skin fixation - lump cannot be mpved without moving skin
Breast anatomy
1) chest wall
2) pectoralias muscles
3) breast lobules
4) nipple
5) areola
6) milk ducts
7) fatty tissue
8) ski
Breast history questions?
lump?
pain if so SOCRATIES
skin changes
nipple discharge
nipple indrawn/inverted
abscess
deformity
what age they started periods
menopause?
smoker?
drinks alcohol?
DH- HRT or OCP now or previously
any children - age at 1st pregnancy? breast fed?
FH - 1st degree, 2nd degree, none, age
previous breast problems?
hysterectomy? ovaries removed?
previous mammogram? and when it was
explaning a mammogram to a patient
- uncomfortable but not painful
- two xrays of each breast
- all mammographers female
- cant tell which quadrant the lump is in without a CC view
what can you see on a mammogram
pectoralis major
fibroglandular tissue
axillary lymph nodes
if you feel a lump on palpation but US and mammogram come back negative what do you do
NEEDLE BIOPSY
Types of breast cancer
Invasive ductal carcinoma -most common
invasive lobular carcinoma - second most common
Treatment for breast cancer
MDT and sentinel node biopsy always
accurate diagnosis and staging
Surgery - mastectomy vs wide excision and radiotherapy
tamoxifen if oestrogen positive
if HER2 postive (human epidermal growth factor receptor 2) - anti HER2 therapy e.g. tastuzumab
when to do masectomy over wide excision and radiotherapy
multifocal
local recurrence
DCIS or invasion >4cm
If sentinel node biopsy comes back positive for cancer
axillary node clearance and radiotherapy
When is chemotherapy used in breast cancer
mainly after breast surgery if increasing number of lymph nodes, increasing grade of cancer, increasing size of tumour
to eradicate micro metastatic disease
sometimes offered neoadjuvant mainly for larger or inoperable tumours to shrink and allow surgery
