Breast cancer Flashcards
What are the types of breast cancer?
Ductal carcinoma Lobular carcinoma Cancers of special type: -tubular -cribriform -medullary
What is the most common type of breast cancer?
Ductal carcinoma
What is the second most common type of breast cancer?
Lobular carcinoma
What is the precursor to ductal carcinoma?
Ductal carcinoma in situ
Malignant, but non invasive, doesn’t cross basement membrane
What is the risk and management of ductal CIS?
2-4% risk of developing to invasive cancer annually
Excise
What is lobular carcinoma associated with?
Lobular carcinoma in situ- not a precursor but makes woman high risk for breast cancer
What is the management of lobular carcinoma in situ?
Annual mammogram for screening
High risk of cancer developing anywhere in breast
What type of cancer has the best prognosis?
Tubular- almost 100% cured
What are the risk factors for breast cancer?
FH= breast and ovarian cancer at young age, men with breast cancer BRCA 1 and 2 Oestrogen exposure: -early menarche, late menopause -combined OCP -late age 1st pregnancy -oestrogen HRT PMH breast/ovarian cancer Obesity
What is the presentation of breast cancer?
Lump or thickening, usually painless Discharge- blood stained Skin changes= redness, pitting, contractures Abnormal contour, asymmetry Change to nipple Paget's disease of nipple Lymphadenopathy
What are some red flags for cancer?
Blood stained discharge
Strong FH
BRCA +
What is Paget’s of the nipple?
Intraepithelial spread of ductal carcinoma
What is the presentation of Paget’s?
Pain, itching, scaling and/or redness of nipple
Serous/bloody discharge
How is breast cancer assessed?
Triple assessment:
- history and exam
- imaging
- biopsy
What is the benefit of triple assessment?
Negates the change of missing anything
How sensitive is history and exam?
88%
What imaging is first line in <35s?
US
What imaging is first line in >35s?
Mammogram
What investigations are used to stage breast cancer?
Sentinel node biopsy Biopsy of lymphadenopathy CXR CT Isotope bone scan
What are the principles of management of breast cancer?
Surgery Node clearance Hormone therapy Targeted therapy Chemotherapy
What are the surgical options in breast cancer?
Breast conserving surgery -wide local excision -segmentetomy -quadrantectomy Mastectomy
What patients are suitable for breast conserving surgery?
Tumour <4cm
Single tumour
High breast : tumour ratio
Suitable for radiotherapy
When are axillary lymph nodes clearance?
Sentinel or any lymph node biopsy +
What are the options for axillary node clearance?
Surgery= more common
Radiotherapy
What are the complications of axillary node clearance?
Lymphoedema of arm and breast
Damage to long thoracic nerve= supplies serrates anterior –> winged scapula
When can hormone therapy be used?
Oestrogen receptor + breast cancer
What hormone therapy is used in premenopausal women?
SERM= tamoxifen
What hormone therapy is used in post menopausal women?
Aromatase inhibitor= anastrazole
What are the complications of hormone therapy?
Osteoporosis risk
Endometrial cancer risk
When is targeted therapy used in breast cancer?
HER2 + cancer
What breast cancer has the worst prognosis?
Triple negative
What is the breast cancer screening?
Women aged 50-70 and registered with GP practice invited to attend for mammogram every 3 years
What is the scoring system used when examining, looking at imaging and biopsy in breast issues?
1= normal 2= benign 3= indeterminate 4= suspicious 5= malignant
