Breast cancer

Question 1

How common?

Answer 1

• about 1 in 8 women are diagnosed with breast cancer during their lifetime.
• commonest cause of death in women ages 35-55.

Question 2

Types?

Answer 2

DCIS = ductal carcinoma in situ: not spread through the walls of the ducts - cannot metastasise.

IDC = invasive ductal carcinoma - through milk duct into breast tissue: most common.

Question 3

Risk factors:

Answer 3

Female sex,
GENETICS: BRACA1 & BRCA2
increasing age,
early menarche and late menopause,
Older age at first full-term pregnancy.
obesity and high fat diet - loose weight and have low fat diet.
Radiation - limit radiation exposure and regular check-ups if have radiation exposure.
Family history
benign breast disease
Combined OCP/ hormone replacement therapy.

Question 4

Presentation and symptoms

Answer 4

Symptoms:

• Change to the site/shape of one or both breasts
• Lumps in breasts or armpits
• Nipple discharge
• Dimpling on the skin of the nipple/ inverted nipple
• Painless rash

Signs:

• Nipple retraction
• Peau d’orange (indicative of inflammatory breast cancer).
• Tethering when patient moves arms.
• lump felt
• Swollen lymph nodes, lump under arm or around collar bone.
• skin change

Question 5

Differential diagnosis

Answer 5

Fibrocystic change

Ductal papilloma

Question 6

Investigations

Answer 6

Triple assessment:

• Palpation
• Radiology: mammogram, ultrasound, MRI.
• Biopsy: fine needle aspiration.

Question 7

Treatment

Answer 7

Surgery – wide local excision, mastectomy (can be prophylactic),

Radiotherapy – recommended after conservative therapy (surgery)

Chemotherapy

Hormone therapy – e.g. tamoxifen binds to oestrogen receptors competitively causing cells to remain in G0 G1 phases of cell cycle
Targeted cancer drugs – e.g. Herceptin (monoclonal antibody for HER2 receptor positive breast cancer – binds to HER2 receptors causing cells to undergo arrest so there is reduced cell proliferation)