Breast cancer Flashcards
Incidence
Classification: Preinvasive vs invasive
1 in 8 women
Pre-invasive
- no invasion below basement membrane, clinically undetectable, no mets
Invasive:
- beyond basement membrane, may have mets
Types of preinvasive [2]
Types of invasive [5]
Preinvasive
- DCIS
- Lobular CIS
Invasive:
o Invasive ductal carcinoma non-special type (NSV): 85%
o Invasive lobular carcinoma: 10%
o Special type: 5% (tubular, medullary, mucinous etc)
o Inflammatory: cancerous cells block lymph drainage causing inflamed breast appearance
o Paget’s disease of the nipple
Where does breast ca mets to? Describe by the 3 mechanisms of metastases: local, lymphatic and blood
o Local: skin, pectoral
o Lymphatic: axillary and internal mammary lymph nodes
o Blood: lungs, liver, bones, brain
RF [9]
- previous breast, ovarian or endometrial cancer
- FHx, known BRCA1/2
- early menarche and/or late menopause
- delay in 1st age of pregnancy
- OCP or HRT
- ionising radiation
- P53 mutation
- obesity
- previous surgery for benign disease
Protective factors of breast ca
• Protective factors: several pregnancies, breastfeeding
Presentation [5]
- hard and fixed lump or thickening
- discharge or bleeding, change in breast size or contour
- skin or muscle tethering
- peau d’Orange skin dimpling
- enlarged axillary or supraclavicular lymph nodes
Presentation of metastatic breast ca [6]
- bone pain
- pleural effusion
- anorexia and weight loss
- neuropathic pain, weakness
- headache, seizures
- spinal cord compression
NHS screening program for breast ca
When to do urgent referrals (within 2 weeks) [4]
NHS screening programme every 3 years for women aged 47-73y/o
Refer people using suspected cancer pathway (apt within 2w) if
- > 30y/o and unexplained breast lump
- > 50y/o and any one of
- discharge
- nipple retraction
- or any other changes of concern
- also consider if skin changes suspicious of breast cancer or >30 and unexplained axilla lump)
When are non urgent referrals indicated?
What is triple assessment of breast lumps
<30y/o unexplained breast lump with or without pain
• Triple assessment of breast lumps: clinical examination, imaging, cytology
Mammogram
Sensitivity
Indications [3]
Findings [4]
93% sensitivity
• Ind: >35y/o or <35y/o and strong suspicion or FHx risk >40%
• Findings:
- dominant mass, asymmetry
- architectural distortion, parenchymal contour
- calcified fibroadenomas (most benign but small % cancerous or pre-cancerous)
- irregular or ill-defined, spiculated
USS
Specificity
Indications [2]
Findings [4]
88% specificity
• Ind: <35y/o or to differentiate between solid and cystic masses
• Findings: irregular outline, interrupted architecture, acoustic shadowing, anterior halo
MRI with gadolinium contrast
Indication [6]
- problem solving
- implants
- indeterminate lesion after triple assessment
- dense breast,
- screening of high risk women
- lobular disease for multifocality
Fine needle aspiration and cytology Sensitivity How to do Findings Cons Complications [4]
a 23G needle is used to aspirate cells under XR or US guidance; 94% sensitivity
Unspecified adenocarcinoma vs benign lesion, grading of cancer
High rate of false -ves so best to do core needle biopsy as well
Cx: pain, haematoma, fainting, infection, PTX
Findings of FNAC that differentiate unspecified adenocarcinoma from benign
- UNSPECIFIED ADENOCARCINOMA: high cellularity, loss of cohesion, cell crowding, nuclear polymorphism, hyperchromasia, absence of bipolar nuclei
- Benign: low or moderate cellularity with flat sheets of cells of uniform size and bipolar nuclei in the background
Needle core biopsy definition
Indications [3]
Findings [4]
14G needle used to obtain intact tissue strand which is fixed in formalin using XR or USS guidance
Ind:
- all cases of suspected radiological or cytological suspicion
- architectural distortion and micro calcification OR breast screening
Findings:
- invasive or non-invasive
- histological subtype and grade
- immunohistochemistry
- commedo necrosis (high grade DCIS)
