Breast Cancer Flashcards
What is the lifetime risk of developing breast cancer in women?
1 in 8 women will develop breast cancer
(It is 1 in 868 in men so it is much rarer for breast cancer to develop in women?
What are some modifiable risks for breast cancer?
Smoking Obesity (Adipose tissue produces oestrogen) Alcohol consumption OCP use HRT use Fewer pregnancies Late first pregnancy Radiation exposure- e.g. previous radiotherapy for breast cancer
What are some non-modifiable risks for breast cancer?
Female gender
Inherited gene mutations- BRCA1 and BRCA2
Age of first menarche
Late menopause
Increasing age
Family History (having one first degree relative with breast cancer doubles the risk)
Presence of precancerous lesions- DCIS
What are some signs and symptoms of breast cancer?
Many are asymptomatic and are picked up on screening Breast lump Axillary lump Change in breast consistency Breast asymmetry Puckering of the skin/ Peau d'orange Bleedings/Discharge from the nipple Inversion of the nipple
Non-specific sx- Weight loss, fatigue, bone pain, liver capsular pain
What is inflammatory breast cancer?
This is a form of breast cancer which can easily be missed. Malignant cells block the lymphatic vessels and there are inflammatory symptoms. For example: Itching, pain, redness, nipple inversion, skin puckering. This can progress to Paget’s disease of the breast which eczema like changes around the nipple (redness, pain, tenderness, flaking skin) sometimes with bloody discharge of the nipple
What is paget’s disease of the breast?
Form of breast cancer that causes eczema like features around this nipple- itching, redness, pain. May be bloody discharge from the nipple.
What are the features of inflammatory breast cancer?
Redness Tender breast Firm or hard to the touch Swelling of the breast May be hot to touch
It is due to malignant cells blocking the small lymphatic channels in the breast. It is often misdiagnosed for mastitis and should be one of the differentials if suspecting breast cancer
Who is mastitis rare in and if presenting in these groups it should raise the suspicion of inflammatory breast cancer?
Women who aren’t pregnant
Women who aren’t breastfeeding
Women who have had their menopause
What is the NHS breast cancer screening programme?
Women aged 50-70 are invited for a mammogram every three years
Note- in some parts of england this have been extended to 47-53
Why are mammograms not great in younger patients?
The breast tissue of younger patients is much denser and means a mammogram is less useful at identifying any lesions. USS may be better
What are the tumour markers that can be investigated for in breast cancer, their presence will indicate the need for some different treatment options?
Oestrogen Receptor Positive
Progesterone Receptor Positive
HER2 Positive
What is HER2?
HER2 is a gene that causes over-expression of human EGFR which drives tumour cell growth and division. It can be targeted using trastuzumab/ herceptin
When should an urgent 2 week wait referral for suspected breast cancer be considered?
Anyone aged 30 or over with an unexplained breast lump with or without pain
Anyone aged 50 or over with discharge, retraction or any other changes of concern to the breast or nipple
Consider if any skin changes that could indicate breast cancer or an unexplained lump in axilla of patients over 30.
What is carried out for a 2WW referral for breast cancer?
Triple assessment-
Clinical Assessment/Examination by a breast surgeon
Radiological Assessment- Mammogram/USS
Pathological Assessment- FNAC or Core Biopsy
How is breast cancer staged?
TNM Staging (Live every other cancer)
What is a DCIS?
This stands for ductal carcinoma in situ, it is a premalignant lesion that has not invaded beyond the basement membrane. A large proportion do not develop into cancer.
What are they types of breast cancer?
Lobular
Ductal
Special Type/Mixed
All breast cancers are adenocarcinomas as they arise from glandular tissue
What guides the treatment decisions for breast cancer?
TNM staging guides the treatment options. For example surgery is possible in more localised disease but not for metastatic disease.
Outline the treatment categories for breast cancer
Surgery- Wide local excision, Mastectomy, Axillary node clearance
Chemotherapy- Adjuvant/Neoadjuvant
Radiotherapy
Targeted therapies if ER/PR/HER2 positive
What are the surgical treatment options for breast cancer?
Wide local excision with sentinel node biopsy
Mastectomy
Axillary node clearance- if sentinel node positive for metastatic cells
Why is a sentinel node biopsy carried out?
A sentinel node biopsy checks for the presence of malignant cells in the lymph node that drains the tumour. The presence of malignant cells in the sentinel nodes indicates nodal involvement and so an axillary node clearance + chemotherapy is indicated
The sentinel lymph node is identified by injected dye into the tumour
What is the role of chemotherapy in the treatment of breast cancer?
Neoadjuvant chemotherapy may be done before surgery to shrink the tumour bulk. This can make surgery a more suitable option.
Adjuvant chemotherapy- Used after surgery to reduce the risk of micro-metastases and recurrent disease. Indicated is there is any spread to the lymph nodes.
Chemotherapy is also indicated in metastatic disease where surgery may not be suitable.
Palliative- to reduce the symptoms created by tumours but with no curative intent
What chemotherapy agents are mainly used in breast cancer?
Anthracyclines- e.g. Epirubicin. Intercalate between the base pairs of DNA and therefore prevent replication
Taxanes- e.g. Docetaxel. Binds and stabilises microtubules so prevents mitosis.
What is the role of radiotherapy in the treatment of breast cancer?
Adjuvant radiotherapy may be offered after breast surgery if there has been spread to lymph nodes or to reduce the risk of cancer returning locally.
Palliative radiotherapy may be carried out to shrink tumours to relieve symptoms
