Breast Cancer Flashcards
How does a fibroadenoma present?
Commonest under 35 years
‘Breast mice’: discrete, non tender, highly mobile
If >3cm, surgical excision
What is fibroadenosis?
Also called fibrocystic disease or benign mammary dysplasia
Lumpy painful breasts in middle aged women, most commonly before menstruation
What is mammary duct ectasia and how does it present?
Dilatation of the large breast ducts causing the walls to fall in on themselves, blocking the ducts.
Presents with a tender lump around the areola and green nipple discharge
What is the triple assessment for breast cancer?
Examination
Imaging (USS and mammography)
FNA
What are the NICE guidelines on the investigations of breast cancer?
Following triple assessment;
MRI should be used if there is high tissue density on mammography, when planning breast conserving surgery, or if there is discrepancy between clinical assessment and mammography
All women with cancer should have an USS of the axilla.
If the USS is positive = lymph node biopsy. If the USS is negative = sentinel node biopsy
What are the indications for mastectomy?
Multifocal tumour Central tumour Large lesion in small breast DCIS >4cm Patient choice
What are the indications for wide local excision?
Solitary lesion Peripheral tumour Small lesion in large breast DCIS <4cm Patient choice
When is radiotherapy offered to women?
Offered to
All women who have had wide local excision (reduces risk of recurrence)
Women who have had mastectomy with T3/T4 cancer/4+ axillary nodes
What are the three important outcomes following breast surgery?
Psychological morbidity
Local recurrence
Mortality
Where does bone typically metastasise too?
Breast Bronchus Thyroid Kidney Prostate
What is the guidance on giving chemotherapy to breast cancer patients depending on whether they have positive or negative lymph nodes?
Node positive = chemotherapy recommended
Node negative = 21 gene test. If you are high risk = chemotherapy. Low risk = no chemotherapy.
What additional treatments can be offered to ER positive pre-menopausal and post-menopausal women?
Pre-menopausal: tamoxifen
Post-menopausal: aromatase inhibitor (anastrozole) and bisphosphonates
What are the side effects of tamoxifen?
Increased risk of endometrial cancer, VTE and menopausal symptoms
When is Herceptin (trastuzumab) used?
25% of women with breast cancer over express human epidermal growth factor type 2 (HER2) on the surface of tumour cells.
Herceptin blocks the binding of oestrogen to this cell therefore blocking cell growth/division.
CI in women who have heart disorders as it can cause CCF and cardiomyopathy
What artery is involved in breast reconstruction?
Deep inferior epigastric artery
How do you identify the sentinel node?
The sentinel node is the first node which drains an area of tissue
Injection of vital blue dyes plus technetium labelled colloids allow identification
If positive = axillary lymph node clearance or axillary radiotherapy
How does tamoxifen work?
SERM (selective oestrogen receptor modulator) with mixed agonist and antagonist properties.
Blocks breast receptors (therefore causes hot flushes, dryness etc but stimulates bones and endometrium).
How does anastrozole work?
Selective aromatase inhibitor
Blocks conversion of androgen to oestrogen in peripheral tissue only so only use in post-menopausal women
When should you refer people using 2WW if you suspect breast cancer?
> 30 with any unexplained lump
>50 with either retraction, discharge or other changes of concern in one nipple only
What are the risk factors for breast cancer?
Nulliparity BRCA1/BRCA2 early menarche/late menopause COCP not breast feeding
What is the management of breast cysts?
Cysts should be aspirated
Those which are bloodstained or persistently refill should be biopsied/excised
What is the management of fat necrosis?
Imaging and core biopsy
How does periductal mastitis present and what is it’s management?
Patients are at a younger age than in duct ectasia
Inflammation, abscess, mammary duct fistula
Associated with smoking
Treat with ABx, abscess will require drainage
Where does breast cancer metastasise too?
Lungs
Liver
Bones
Brain
