Breast Cancer Flashcards
(40 cards)
What is carcinoma in situ and what are the main types?
Malignancies that are contained within the basement membrane tissue
Seen as ‘pre-malignant’
Typically found on imaging, rarely symptomatic
Two main types in breast:
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
What are the features of DCIS?
Malignancy of the ductal tissue of the breast, confined within the basement membrane
20-30% will develop into invasive disease if untreated
How is DCIS diagnosed?
Detected during screening:
- mammography shows micro calcifications, either localised or widespread
- confirmed on biopsy
How is DCIS managed?
If localised –> wide local excision
If widespread or multifocal –> complete mastectomy
What are the features of LCIS?
Malignancy of the secretory lobules, contained within the basement membrane
Much rarer than DCIS
But greater risk of developing invasive disease
Usually diagnosed before menopause
How is LCIS diagnosed?
Incidental finding on biopsy of the breast
doesn’t show up on mammography
How is LCIS managed?
Low grade LCIS –> monitoring
If patient possesses BRCA1 or BRCA2 genes –> bilateral prophylactic mastectomy
How are invasive carcinomas of the breast classified?
Invasive ductal carcinoma (75-85%)
Invasive lobular carcinoma (10%)
Other subtypes e.g. medullary or colloid
What are the risk factors for breast cancer?
Female sex Age BRCA1 + BRCA2 Family history in first degree relative Previous benign disease Obesity Alcohol Developed country Exposure to unopposed oestrogen: - early menarche, late menopause, nulliparity, first pregnancy age > 30, oral contraceptives or HRT
What are the clinical features of invasive carcinoma?
Asymptomatic via screening (esp for lobular carcinoma)
Breast lump, asymmetry or swelling
Abnormal nipple discharge
Nipple retraction
Skin changes: dimpling/peau d’orange or Paget’s like changes
Mastalgia
Palpable lump in axilla
How is suspected breast cancer investigated?
TRIPLE ASSESSMENT:
- history + examination
- imaging
- core biopsy
Which imaging is done during triple assessment?
Mammography
- detects mass lesions or microcalcifications
USS
- for women age < 35 and men due to density of breast tissue
- also used to guide core biopsy
What is the single most prognostic factor in breast cancer?
Nodal status (number of axillary lymph nodes involved)
0 nodes = 1
1-4 nodes = 2
> 4 nodes = 3
How is prognosis calculated for breast cancer?
Nottingham Prognostic Index (NPI):
(size x 0.2) + nodal status + grade
Vascular invasion + receptor status also influence prognosis
Which receptor statuses should breast malignancies be checked for?
Oestrogen receptor (ER) Progesterone receptor (PR) Human epidermal growth factor receptor (HER2)
How is breast cancer screened for in the UK?
Women aged 50-70 invited for mammogram every 3 years
- if any abnormality, referred to breast clinic for triple assessment
What is Paget’s disease of the nipple?
Rare condition
Roughening, reddening and slight ulceration of the nipple
97% have an underlying neoplasm
What are the clinical features of Paget’s?
Itching or redness of nipple and/or areola with flaking and thickened skin
Often painful and sensitive
Flattened nipple +/- yellow or bloody discharge may also be present
How can Paget’s be distinguished from nipple eczema?
Paget’s always affects the nipple, only involving the areola as a secondary event
Eczema usually only involves the areola and spares the nipple
How is Paget’s investigated?
Biopsy
+ complete breast and axilla examination
Imaging may also be warranted
How is Paget’s managed?
Surgical removal of at least the nipple + areola
How does the triple assessment grade suspicion of malignancy?
Examination score (P) Imagining score (mammography - M, ultrasound - U) Histology score (B)
1 = normal 2 = benign 3 = uncertain/likely benign 4 = suspicious of malignancy 5 = malignant
What are the different options for surgical management of breast cancer?
Breast conserving:
- wide local excision (WLE)
Mastectomy
Axillary surgery
Who might be suitable for WLE?
Localised operable disease with no evidence of metastatic disease
Focal, small cancers
Also dependent on location and relative size of breast
