Breast Cancer Flashcards
Premalignant stage of carcinoma
DCIS
Invasive Ductal carcinomas account for what %?
- also known as what?
Invasive Lobular Carcinomas a account for what %?
70% - now called No Special Type (NST)
10-15%
Associations with which gene lead to poorer prognosis and aggressive disease?
in what % of pts?
HER2 - growth factor receptor gene
30%
Paget’s disease of the nipple?
How does it differ from eczema?
eczematoid change of the nipple associated with an underlying breast malignancy and it is present in 1-2% of patients with breast cancer.
Paget’s disease differs from eczema of the nipple in that it involves the nipple primarily and only latterly spreads to the areolar (the opposite occurs in eczema)
RF for Breast cancer
o ^age is a risk factor for breast cancer.
o Majority are over the age of 50.
o Female is a greater risk factor due to ^oestrogen exposure.
o Having a pre-menopausal 1st degree relative (mum, sister, daughter) with breast cancer will ^risk by 25%.
o Smoking isn’t a risk factor.
o Early menarche is accepted as being at 12 years old in the UK.
- late menopause
- HRT
- OCP
- Late first pregnancy
- nulliparity (no children)
- not breastfeeding
where does breast cancer metastasise to?
what other questions are good to ask?
Lungs
Bones
Abdomen
weight loss
bone pain
jaundice
breathlessness
All lumps should go undergo triple assessment - what is it?
- History/examination
- Mammography/US (just US if <35, but both if over 35)
- Histology/cytology
Part 3 of Triple Assessment:
Histology and cytology - what two things do you do?
what is best for new lumps?
Histology and Cytology involves either fine needle aspiration cytology (FNAC) or core biopsy. Both of these require imaging guidance with ultrasound scanning.
Core biopsy is best for new lumps
Other Ix for Breast carcinoma
- CXR – lung mets
- Blood tests – FBC (anaemia), LFT (liver mets), serum calcium (bone mets)
- CT thorax/abdo: lung + liver mets
- Bone scan – bone mets
Tx for cystic lump?
Tx for solid lump?
Cystic lump aspirate: if clear fluid then discard fluid and provide reassurance if bloody fluid: cytology if mass left over: core biopsy
Solid lump
Core biopsy:
if clear fluid then discard fluid and provide reassurance
if malignant: start Tx
how do you measure prognosis in breast cancer
mainly based on what factor?
Notttingham Prognostic Index can be used to predict the probability of long-term survival based on these factors.
Less weight on tumour size and more on lymph node involvement.
o NPI <3 = good prognosis
o NPI >6 = poor prognosis
Breast surgery:
difference between indications for wide local excision and mastectomy?
Wide Local Excision (WLE) Solitary lesion Peripheral tumour Small lesion on breast DCIS <4cm
Mastectomy Multifocal tumour Central tumour Large lesion in small breast DCIS >4cm Required in at least 1/3 of all women presenting in UK.
when is radiotherapy used?
in ALL patients after WLE
recurrence rates drop from 40 to 10% when added.
Hormone Manipulation Therapy
1) Tamoxifen?
2) risk of w/ tamoxifen?
1) oral anti-oestrogen
2) endometrial cancer, menopausal symptoms and risk of thromboembolic episodes in pre-menopausal women.
Hormone Manipulation Therapy
1) Anastrozole?
2) only use in what patients?
3) advantage to tamoxifen?
1) aromatase inhibitors - prevents conversion of androgens to oestrogens.
2) post-menopausal women
3) better at preventing disease relapse
