Breast Cancer

Question 1

Definition

Answer 1

· Malignancy of breast tissue

o Most common type: invasive ductal carcinoma

Question 2

Aetiology

Answer 2

· Genetics (e.g. BRCA-1 and BRCA-2 genes)

· Environmental factors

Question 3

Risk factors

Answer 3

o Age

o Prolonged exposure to oestrogen
· Nulliparity (not having kids)
· Early menarche
· Late menopause
· Obesity
· COCP
· HRT

o Family history of breast cancer

Question 4

Epidemiology

Answer 4

· Most common cancer in women (1/9 women in the UK)

· Peak incidence: 40-70 yrs

Question 5

Presenting symptoms

Answer 5

· Breast lump (usually painless)

· Changes in breast shape

· Nipple discharge (may be bloody)

· Axillary lump

· Symptoms of malignancy:
o Weight loss
o Bone pain
o Paraneoplastic syndromes

Question 6

Signs on physical examination

Answer 6

· Breast lump
o Firm
o Irregular
o Fixed to surrounding structures

· Peau d’orange

· Skin tethering

· Fixed to chest wall

· Skin ulceration

· Nipple inversion

· Paget’s disease of the nipple - eczema-like hardening of the skin on the nipple
o Usually caused by ductal carcinoma in situ infiltrating the nipple

Question 7

Investigations

Answer 7

· TRIPLE ASSESSMENT

o Clinical examination

o Imaging:
· Ultrasound (< 35 yrs)
OR
· Mammogram (> 35 yrs)

o Tissue Diagnosis:
· Fine Needle Aspiration
OR
· Core Biopsy

· Sentinel Lymph Node Biopsy
o A radioactive tracer is injected into the tumour and a scan identifies the sentinel lymph node
o This node is then biopsied to check the extend of spread

· Staging
o CXR
o Liver ultrasound
o CT (brain/thorax)

· Bloods: FBC, U&Es, calcium, bone profile, LFTs, ESR