Breast cancer

Question 1

Define

Answer 1

DEFINITION: malignancy of breast tissue

Most common type: invasive ductal carcinoma

Question 2

Causes

Answer 2

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

Environmental factors

Question 3

Risk factors

Answer 3

Age

Prolonged exposure to oestrogen

• Nulliparity (not having kids)
• Early menarche
• Late menopause
• Obesity
• COCP
• HRT

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

Symptoms

Answer 5

Breast lump (usually painless)

Changes in breast shape

Nipple discharge (may be bloody)

Axillary lump

Symptoms of malignancy:

• Weight loss
• Bone pain
• Paraneoplastic syndromes

Question 6

Signs

Answer 6

Breast lump

• Firm
• Irregular
• 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

• Usually caused by ductal carcinoma in situ infiltrating the nipple

Question 7

Investigations

Answer 7

TRIPLE ASSESSMENT

Clinical examination

Imaging:

• Ultrasound (< 35 yrs)
• OR
• Mammogram (> 35 yrs)

Tissue Diagnosis:

• Fine Needle Aspiration
• OR
• Core Biopsy

Sentinel Lymph Node Biopsy

• A radioactive tracer is injected into the tumour and a scan identifies the sentinel lymph node
• This node is then biopsied to check the extend of spread

Staging

• CXR
• Liver ultrasound
• CT (brain/thorax)

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