Breast Cancer

Question 1

Define breast cancer

Answer 1

Ductal carcinoma in situ (DCIS) –confined to ducts and has not invaded the basement
membrane; potential precursor for invasive ductal carcinoma; 80% found on mammography

Invasive ductal carcinoma – 70%

Invasive lobular carcinoma – 15%

Paget’s disease of the breast – 1-4% of breast cancer cases; Paget’s cells in epidermis of
nipple; can be seen in DCIS or invasive ductal carcinoma

Phyllodes tumour – 0.5% of all breast tumours; fast growing tumour of periductal stromal
and epithelial cells; can be benign, borderline or malignant, premenopausal (40-50 years)

Question 2

What are the causes/risk factors of breast cancer?

Answer 2

• Family history of breast or ovarian
cancer (more significant if <40)
• Increasing age
• Radiation
• Alcohol
• Smoking
• Oestrogen exposure
- Early menarche
- Late menopause
- Nulliparity
- 1st pregnancy >30
- No breastfeeding
- OCP >5 years
- HRT

Question 3

What are the symptoms of breast cancer?

Answer 3

DCIS – asymptomatic, itching

Question 4

What are the signs of breast cancer?

Answer 4

• Irregular lump
• Skin changes (locally advanced or inflammatory breast cancer)
- Peau d’orange
- Eythema
- Ulceration
• Nipple changes
- Nipple discharge (DCIS)
- Eczema (Paget’s)
• Axillary lymphadenopathy

Question 5

What investigations are carried out for breast cancer?

Answer 5

Triple assessment
• History and examination
• Imaging
- USS <35 years
- Mammography >35 years
• Biopsy
- FNA (fluid-filled)
- Core biopsy (solid)