Breast cancer Flashcards
What are the most common forms of breast cancer?
Ductal carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS)
What are the risk factors of breast cancer?
(Increased estrogen exposure)Early menarche, late menopause, Nulliparity
(Cancer history)
(BRCA1 or BRCA2 gene mutations)
What are the clinical features of breast cancer?
Asymmetrical breast
Palpable firm mass, poorly defined border, usually upper outer quadrant
Retraction and dimpling due to tightening of Cooper ligaments
(Peau d’orange) Lymphatic obstruction
(Nipple changes) Inversion, bloody discharge
What is Pagets disease of the breast?
Ductal carcinoma (usually adenocarcinoma- either in situ or invasive) that infiltrates the nipple and areola (eczematoid change of the nipple associated with an underlying breast malignancy)
What are the clinical features of Pagets disease?
Erythematous, scaly, or vesicular rash affecting the nipple and areola
Pruritus, burning sensation, nipple retraction
What is inflammatory breast cancer?
Rare form of advanced, invasive carcinoma, characterised by dermal lymphatic invasion of tumor cells. Most commonly a ductal carcinoma.
What are the clinical features of inflammatory breast cancer?
Tenderness, burning sensation, blood-tinged nipple discharge
Axillary lymphadenopathy
Peau d’orange
How is breast cancer diagnosed?
(<30 years) Ultrasound,
(> 30 years) Mammography
Biopsy (via core needle biopsy or fine needle aspiration)
Then, if positive, (Receptor testing for oestrogen, progesterone and HER2), tumour markers, tests for bone and liver metastasis, axillary lymphadenopathy (leading to either sentinel node biopsy or axillary node clearance)
What is the treatment for DCIS and LCIS
(DCIS) Lumpectomy or mastectomy with sentinel node biopsy
(LCIS) Surveillance + Chemo-prevention therapy (e.g. tamoxifen) / aromatase inhibitors such as anastrozole used in post-menopausal women
What is the treatment for invasive ductal carcinoma?
(Early stage) Lumpectomy followed by radiation therapy
+ Sentinel lymph node biopsy + adjuvant therapy if ER/PR+ or HER2+
(Locally advanced) Adjuvant systemic therapy + surgical resection (BCT or mastectomy) + axillary lymph node dissection
Followed by adjuvant systemic therapy ± radiation therapy
(Advanced metastatic disease)Systemic treatment + Palliative or radiation therapy
What are the targeted hormone therapies in treating breast cancer?
(Progesterone or Oestrogen receptor positive) Tamoxifen = Selective estrogen receptor modulator (SERM) that acts as an antagonist on the estrogen receptors of the breast
Raloxifene = a SERM that is particularly beneficial in post-menopausal patients with osteoporosis
Aromatase inhibitors, e.g., anastrozole, letrozole, exemestane used in post-menopausal women
(HER2 positive) Trastuzumab
