Breast Cancer Flashcards
Define:
Malignancy of Breast tissue
Most common type is invasive ductal carcinoma
60-70% are positive for oestrogen receptors which have a better prognosis
30% have HER2 receptors which has a worse prognosis
Aetiology:
Genetics (BRCA1/2) and environment
Risk factors:
Increased exposure to oestrogen (early menarche, nulliparity, first pregnancy >30 years, late menopause)
Age
OCP
Obesity
HRT
Not Breast feeding
FHx of Breast cancer or previous breast cancer
Epidemiology:
1/9th of women in the UK
Rare in men
Peaks ages 40-70yrs
Symptoms:
Breast lump:
- Painless
- Irregular
- Indistinct border
- Hard
- Immobile
- May be fixed to structures
Changes in breast shape
Nipple discharge - may be bloody
Axillary lumps
Malignancy symps - weight loss, bone pain and paraneoplastic syndrome - rare to get systemic symptoms unless further along
Signs:
Breast lump:
- Firm
- irregular
- fixed
Lymphadenopathy
Peau’ d’orange
Paget’s disease - eczema like hardening of the nipple and flaking usually due to DCIS
Nipple inversion
Skin tethering/ulceration
Investigations:
Triple assessment
If <35 years = ultrasound >35 = Mammogram
FNA or core biopsy for cytology and histology
Sentiel lymph node biopsy
Staging – commonest sites of metastasis are chest, lungs, bone and brain
o CXR
o Liver contrast-enhanced ultrasound/CT/MRI
o Imaging of axial skeleton and long bones (bone scintigraphy or plain radiograph) and blood tests for serum calcium, phosphate and ALP.
o CT (brain/thorax)
• Bloods: FBC, U&Es, calcium, bone profile, LFTs, ESR
Treatments available:
Local: surgery or radiotherapy
Systemic: chemotherapy, hormonal therapy, monoclonal antibodies (Herceptin)
Hormonal therapy is given for tumours that are ER or PR positive–> decreases oestrogen synthesis (aromatase inhibitors e.g. exemestane) or selectively blocks oestrogen receptors (tamoxifen)
