Breast Cancer Flashcards
What are possible risk factors for breast cancer?
Genetics - BRCA1/2 Nullparity/late first pregnancy Early Menarche + Late Menopause Not breastfeeding Obesity - post menopause COCP >4years before 1st pregnancy HRT with unopposed oestrogen Exposure to ionising radiation
How are patients with BRCA1/2 mutations treated when asymptomatic?
Prophylactic bilateral mastectomy
Annual MRI scans
What are the types of breast cancer?
Ductal Carcinoma In Situ (DCIS)
Lobular Carcinoma In Situ (LCIS)
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
What is DCIS?
Atypical proliferation of ductal epithelium that eventually plugs the duct.
It is maintained within the basement membrane
How would DCIS present?
Often no palpable lump so shown as an area of microcalcification on screening
How is LCIS found?
Where does LCIS spread to?
Incidentally during a biopsy since it is not palpable and won’t show as microcalcification
The contralateral breast
Which is the most common type of breast cancer?
75% are invasive ductal cell carcinomas
How do Invasive Ductal Carcinoma’s spread?
Regional nodes (internal mammary or axillary)
Systemically spread to bone, lung, pleura, liver, skin and the CNS
How is Invasive Ductal Carcinoma graded?
Histologically based on:
Tubule formation
Nuclear Pleomorphism
Mitotic frequency
Where can invasive Lobular Carcinoma’s spread to?
Peritoneum, meninges and uterus
What is Pagets disease?
eczematoid change in the nipple associated with an underlying invasive carcinoma in 90% of cases
What nipple changes are seen in Pagets?
Roughened Red Ulcerated Itchy Yellow Discharge Painful Flattened
How can Pagets and Eczema be differentiated?
Eczema spares the nipple
What are ER + tumours and what prognosis do they have?
Dependent on oestrogen to control tumour growth
Good prognosis
What are HER2 + tumours and what prognosis do they have?
Dependent on HER2 which is a growth factor receptor gene
Aggressive behaviour with risk of lymphatic and haematogenous spread
How are HER2 + treated pharmacologically?
Herceptin (trastuzumab)
How are ER+ tumours treated pharmacologically?
Tamoxifen if pre-menopausal
Anastrazole - aromatase inhibitor if post-menopausal
What is a triple negative cancer? How are they treated?
ER, PR and HER2 negative tumours
Respond to chemo
What is done in a triple assessment?
History and Breast Examination
Mammogram/Ultrasound (<35/male)
Histology - core biopsy/fine needle aspiration (rare)
What criteria can lead to referral to a breast clinic?
New lump Unilateral persistent pain in post menopausal women Pain that interfere with life Nipple discharge >50yo Bloody/persistent/bilateral nipple discharge Nipple retraction, distortion or eczema Breast contour change Abscess not settling after abx Recurrent cyst
What are the surgical management options for breast cancer and when would these be indicated?
Wide Local Excision - <4cm, peripheral, solitary mass
Mastectomy - >4cm, central, small breasts, multifocal mass
What is done in a wide local excision of a breast cancer?
Excise tumour with 1cm margin of macroscopically normal tissue
What are complications of axillary surgery?
lymphoedema long thoracic nerve damage - winging of scapula arm pain shoulder stiffness skin numbness
What 3 ways can breasts be reconstructed?
Lat Dorsi
TRAM - uses abdominal fat, muscle and skin
DIEP - uses abdominal fat and skin but leaves muscle meaning don’t lose as much strength
