Breast cancer Flashcards
Incidence of breast cancer
Affects one in eight women
Risk Factors for breast cancer
- Age: Increased incidence
- Previous breast cancer
- Genetic: BRCA1 and BRCA2 (5%)
- Early menarche and late menopause
- Late or no pregnancy
- HRT
- Alcohol (>14 units per week)
- Weight
- Post Radiotherapy treatment for Hodgkin’s disease
Presentation of breast cancer
Asymptomatic: breast screening (50-70 years)
Symptomatic: outpatient clinic
-Lump
-Mastalgia (persistent unilateral pain)
-Nipple discharge (blood-stained)
-Nipple changes (Paget’s disease, retraction)
-Change in the size or shape of the breast
-Lymphoedema (Swelling of the arm)
-Dimpling of the breast skin
Breast clinic
Clinic: history and examination Radiological: bilateral mammograms / USS Cyto-pathological: -FNA -cells only (cytology) -Core biopsy -tissue (histopathology)
Breast cancer clinical assessment: history
- presenting complaint
- previous breast problems
- family history
- hormonal status
- drug history
Breast cancer clinical assessment: examination
- both breast
- axilla
- SCF
Pathological types of breast cancer
Invasive -80% Ductal Carcinoma -10% Lobular Carcinoma -10% Others Non-Invasive DCIS (Ductal Carcinoma In Situ) LCIS (Lobular Carcinoma In Situ)
Management of Cancer steps
1) Diagnose the disease
2) Staging of the disease
3) Definitive treatment
Staging breast cancer
- FBC, U&Es, LFTs, Ca2+/PO2-
- Chest x ray
TNM classification: T primary tumour
Tx Primary tumour cannot be assessed T0 Primary tumour not palpable T1 Clinically palpable tumour -size < 2 cm T2 Tumour size 2-5 cm T3 Tumour size > 5 cm T4a Tumour invading skin T4b Tumour invading chest wall T4c Tumour invading both T4d Inflammatory breast cancer
TNM classification: N regional lymph nodes
N0 No Regional lymph nodes palpable
N1 Regional lymph node palpable- mobile
N2 Regional lymph node palpable- fixed
TNM classification: M regional lymph nodes
Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
Treatment of breast cancer
Surgery
+/- Radiotherapy
+/- Chemotherapy
+/- Hormonal Therapy
Two main types of surgical breast procedure
- Breast conservation surgery
- Mastectomy
Patients suitable for
breast conservation surgery
- Tumour size clinically<4cm -but depends on size of breast
- Breast/Tumour size ratio
- Suitable for radiotherapy
- Single tumours
- Patient’s wish
Sentinel lymph node biopsy
- first node to receive lymphatic drainage
- first node the tumour spreads to
- if negative, rest of nodes in lymphatic basin are negative
- only performed when preoperative axillary USS normal/benign
Treatment of the axilla
- If SLN is negative - no further treatment required
- If SLN contains tumour - either remove them all surgically or give radiotherapy to all the axillary nodes
Complications of axillary treatment
- lymphoedema (10-17%)
- sensory disturbance (intercostobrachial n.)
- decrease ROM of the shoulder joint
- nerve damage (long thoracic, thoracodorsal, brachial plexus)
- vascular damage
- radiation-induced sarcoma
Factors associated with increased risk of breast cancer recurrence?
- Lymph node involvement
- Tumour grade
- Tumour size
- Steroid receptor status (negativity- ER/PR neg)
- HER2 status (positivity- HER2 pos)
- LVI- lymphovascular invasion
Prevention/adjuvant breast cancer treatment
LOCAL -Radiotherapy SYSTEMIC -Hormone therapy -Chemotherapy -Targeted therapies
HER2 positivity and Anti-Her2 therapy
Trastuzumab
- Monoclonal antibody against Her-2 receptor
- Given to patients with over-expression of Her2 and chemotherapy
- 50% decrease risk of recurrence
- 33% increase in survival at 3 years
