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
