Breast Cancer Flashcards
what different types of invasive carcinomas can you get in breast cancer?
> cribriform > medullary > tubular > lobular > ductal
what is a carcinoma in situ?
cell have malignant appearance but are contained in the basement membrane
what is the commonest type of carcinoma in situ?
ductal
what are the risk factors for breast cancer?
> family history > pregnancy > older age at menopause > younger age of menarche > previous benign or malignant disease > radiation (hodgkins disease) > obesity > alcohol > HRT/OC
how can breast cancer present?
> lump > thickening > discharge > change in - size - contours - areola colour and appearance > peau d'orange - redness - pitting
what does peau d’orange presentation suggest?
inflammatory breast cancer (bad prognosis)
what are the 3 main investigations of breast cancer?
> clinical examination
mammography
ultrasound scan
when would you do a mammography?
> over 40 yrs old
> less than 40 but family history or any increased suspicion of breast cancer
what might be seen on mammography with benign disease?
> lobulated
halo
normal density
what might be seen on mammography with metastatic disease?
> irregular
spiculated
dense
distortion of architecture
what might benign disease look like on the ultrasound?
> smooth outline
oval shaped
acoustic enhancement
what might malignant disease look like on the ultrasound?
> interrupted breast architecture
anterior halo
irregular outline
acoustic shadowing
when would you do an MRI?
> recurrent disease
implants
indeterminant lesion after triple assessment
what are the limitations of cytology?
> invasion not assessed
grading not done
false positives and negatives
what information can a core biopsy give you?
> confirmation of invasion
tumour typing and grading
immunohistochemistry
what on cytology of a FNA suggests benign disease?
> low cellularity
cohesive groups
bipolar nuclei in background
what on cytology of a FNA suggests malignant disease?
> high cellularity
nuclear dysmorphism
absence of bipolar nuclei
loss of cohesion
what are some complications of FNA?
> pain
haematoma
fainting
(pneumothorax, infection)
what investigations would you carry out to stage breast cancer?
> LFT's > Hb > FBC > U+E'S > isotope bone scan
describe the T stages in the staging of breast cancer?
- 0-2cm
- 2-5cm
- more than 5cm
- fixed to skin or muscle
what patients are suitable for breast conversion?
> patients wish
single tumour
suitable for radiotherapy
what is the management of micro-metastasis?
> hormone therapy
chemotherapy
anti-HER2 therapy
what hormone therapy is available?
> tamoxifen (pre and post menopausal women) for 5 years
aromatase inhibitors
(can only work if oestrogen receptors are present)
what is carried out to determine if chemo will benefit?
21 gene assay
when is chemo offered?
> node positive
> grade 3
what is anti HER2 therapy?
a monoclonal antibody against a HER2 receptor used in patients with over expression of HER2
name ANTI HER2 therapy
trastuzumab
what are the effects of anti HER2 therapy?
> 33% increase in survival of 3 years
> 50% decrease risk of recurrence
what is the follow up of breast cancer?
> mammogram of breast at 1 year intervals for 10 years
> clinical examination 6 monthly for 3-5 years
how are the lymph nodes investigated?
sentinel node biopsy: first node to receive drainage from the cancer
what is the treatment for spread to the axillary nodes?
axillary node clearance
what are the complications of axillary node clearance?
> decreased movement of the shoulder > nerve damage (brachial plexus, thoracodorsal, long thoracic) > vascular damage > sensory disturbance > lymphadenopathy
