Breast cancer Flashcards
What is breast screening?
50-70 year old women invited through GP practice to attend mammogram every 3 years
What ae the pathological types of breast carcinoma?
In situ carcinoma
Invasive carcinoma
What are the types of carcinoma in situ?
Ductal carcinoma IS
Lobular carcinoma IS
What is the % chance of developing cancer from a ductal CIS annually?
2-4%
What is the % of developing cancer from a lobular CIS annually?
2%
Not necessarily in area of CIS
What are the types of invasive carcinoma?
Cancers of no special type- ductal, lobular
Cancers of special type- tubular, cribriform, medullary
What % of breast cancers are ductal?
70%
What % of breast cancers are lobular?
20%
What type of breast cancer has the best prognosis?
Cancers of special type
What are the risk factors for breast cancer?
Older age Younger age at menarche Older age at menopause Older age at first pregnancy FH Previous benign breast disease Cancer in other breast Radiation Obesity Alcohol OCP HRT
What is done in triple assessment?
History and exam
Imaging
Biopsy
Why is triple assessment done?
Eliminate the risk of missing anything
What imaging is done for breast cancer?
Mammogram
US
What biopsies can be done for breast cancer?
FNA cytology Core biopsy Image guided cytology or core biopsy Open biopsy Sentinel node biopsy
What investigations are done to stage breast cancer?
FBC, U&Es, LFTs
CXR
Isotope bone scan- if thee is lymph node spread
Others as clinically indicated
Where does breast cancer spread to locally?
Skin
Pectoral muscles
What lymph nodes does breast cancer typically spread to?
Axillary
Internal mammary
Where does breast cancer most often metastasise to?
Bone
Liver
Lungs
Brain
What causes Paget’s disease of the nipple?
Intraepithelial spread of intraductal carcinoma
What are the signs and symptoms of Paget’s disease of the nipple?
Pain or itching Scaling Redness Mistaken for eczema Ulceration or crusting Serous or blood discharge
What are the T stages of breast cancer?
1- 0-2cm
2- 2-5cm
3- >5cm
4- fixed to skin or muscle
What are the surgical management options of breast cancer?
Breast conservation surgery
Mastectomy
What are the types of breast conservation surgery?
Wide local excision
Quadrantectomy
Segmentectomy
What patients are suitable for breast conservation surgery?
<4cm Breast:tumour ratio Suitable for radiotherapy Single tumour- or rarely multiple Patients wishes
What are the options for treating lymph node spread in breast cancer?
Surgical clearance or radiotherapy
What are the possible complications of lymph node treatment?
Lymphoedema Sensory disturbance Decrease ROM of shoulder Nerve damage Vascular damage Radiation induced sarcoma
What are the options fr treatment of micrometers?
Hormone therapy
Chemotherapy
Targetted therapy
What is the hormonal treatment in premenopausal women?
Tamoxifen for 5 years
What is the hormonal treatment in postmenopausal women?
Excellent prognosis= tamoxifen
Others= anastrozole for 5-10 years
When is chemo given?
If nodes + or grade 3
What targeted therapy is available for some breast cancers?
Anti Her2 therapy
What increases the risk of disease recurrence?
Lymph node involvement Tumour grade Tumour size Absence of oestrogen receptors Her2 receptors Lymphovascular invasion
