Breast Cancer Flashcards
How many women are said to develop BC?
1 in 8
What are RF
- Age
- FHx - 1st degree relative premenopausal w bc
- Nulliparity, having 1st child <30yrs
- BRCA genes
- Early menarche, late menopause
- HRT (combined oral)
- Obesity
- Alcohol - even a small amount causes a considerable risk increase
When are women invited for breast screening?
50 -70 every 3 years but is being expanded to 47-73
How Many women are invited back for further assessment after initial mammogram?
1 in 25
How is a diagnosis made?
Triple assessment:
history + examination, imaging, and histology
When are women referred for a triple assessment?
- by GP if signs or sx that meet the breast cancer “2 week wait” referral criteria, or
- if there has been a suspicious finding on their routine breast cancer screening mammography
What are possible sx of breast cancer?
- Painless lump - irregular, hard, fixed
- Nipple discharge
- Nipple in-drawing
- Pain and tenderness not common
- Peau de l’orange
- Skin tethering
- Indrawn nipple
How may metastatic cancer present?
back pain, pathological fracture etc.
What indicates BC in mammogram
fluffy edge of mass - speculation
speckles of calcium - cancerous change
when is MRI used?
assessment of implants
when is US used?
to guide biopsies
What are the surgical options for breast canceR?
- breast conservation
2. Mastectomy
when is breast conservation recommended?
small tumour relative to breast size
not underneath nipple
no prev radiotherapy
DCIS<4cm
When is mastectomy recommended?
large tumour tumour underneath or indrawn of the nipple multi cancer in same nipple BRCA carrier (double m) DCIS >4cm
When is full axillary clearance indicated?
if glands clinically involved
What is a SE of axillary clearance?
can cause lymphoedema
How can breast cancers be classified? which is the most common type?
Ductal (70%) or lobular
Further subdivided into:
i. In situ - hasn’t spread beyond local tissue
ii. invasive - has spread
Explain the TNM staging for breast cancer
TNM = tumour, nodes, metastasis T0 = no evidence T1 = <2cm T2 = 2-5cm T3 = >5cm T4 = extends to chest wall, skin, inflammatory N0 = no nodes N1 = mobile nodes N2 = fixed/matted nodes N3 = internal mammary nodes M0 = no metastases M1 = metastases
What criteria is used to give prognosis of bc?
Nottingham Prognostic Index
Grade + LN +0.2xsize
When is radiotherapy recommended?
ALWAYS after wide local excision to reduce rate or recurrence
after mastectomy if T3-4 or 4 or more +ve axillary nodes
When is hormonal therapy offered?
if tumours are positive fore oestrogen receptors
Which hormone therapies are recommended for who? why?
Tamoxifen - pre/perimenopausal women, inhibits oestrogen receptor Aromatase inhibitors (anastrozole) on post-menopausal women
Why are aromatase inhibitors used in treatment?
aromatisation accounts for majority of oestrogen production in post-menopausal women
What are important SE of tamoxifen?
increased risk of endometrial cancer, VTE and menopausal symptoms
What biological therapy is offered to women? when is it indicated and contraindicated?
Trastuzumab (perception) - used in HER2 positive tumours CI: hx of heart disorders
When is chemotherapy indicated?
if a tumour needs down staging or after surgery depending on stage of tumour
What are the advantages of immediate reconstruction?
- options for skin preservation and better objective cosmesis
reduced physiological trauma from disfigurement
What are disadvantages of immediate breast reconstruction?
May delay chemo or radio if complications
Radio may spoil result
What are advantages of delayed reconstruction?
Minimal risk of delays in other adjuvant therapies from complications
Can excise irradiated tissue
What are disadvantages of delayed reconstruction?
- limited sin preservation options
- loss of inframammary fold
- period w/o breast, may never have reconstruction or face delays as no longer urgent
What are complications of breast implants?
capsule formation infection rupture shape changing w age hamper sensitivity of mammograms
What is adjuvant therapy in metastatic disease?
Bisphosphonates and denosumab
