Breast cancer

Question 1

Define breast cancer-

Answer 1

Cancer of the breast-
precursor lesions: ductal carcinoma and lobular carcinoma
DC predicts increased risk of malignancy from the area of the DC
LC predicts increased risk of malignancy of DC and LC in either breasts
LC in situ is technically not cancer but neoplastic proliferation. cancer doesn’t always evolve in same place

they then evolve to primary invasive cancer-
invasive lobular carcnioma, invasive carcinoma of no special type, invasive ductal carcinoma
and 2 billion other ones

Question 2

Aetiology and risk factors of Breast cancer

Answer 2

Ductal carcinoma Is a tumour of epithelial cells-in situ if they have not broken BM-precusor lesion-r
LC-not cancer but if present high risk of metastatic disease

Invasive types-invasive lobular carcinoma, invasive carcinoma of no special type, invasive ductal carcinoma mainly

Risk factors;
Women
age peak-75
white women
BRCA1-BRCA2
Anything increasing oestrogen-HRT, oral contraceptive pill, 
FHx of breast cancer
Older age of menopause, older 1st pregnancy
no children/pregnancy (null parity)

Question 3

Epidiemology of duct ectasia and intraductal papilloma

Answer 3

50000 cases in US in 2020-
85% are DC, and 15% are LC
Breast cancer is the most common woman malignancy
-300 000 cases a year in US

most DC if untreated will become malignant
diagnosis of LCIS increases that risk by 10x

Invasive ductal is also the most common, followed by NST and then lobular

Question 4

Signs and Sx of Breast cancer

Answer 4

BC in situ-precursors and usually asympto-and picked up on screening

Invasive breast cancers are often asymptomatic but show signs on exam
Most common-
breast mass-non mobile, non painful
irregular edges, without fibrous capsules around

nipple change in shape

Nipple discharge
axillary masses
skin thickening and discolouration around nipple-eg peak d’orange, scaling of nipple, inversion
always look at asymmetry of nipples, breast, axilla

but physical examination isn’t great-so always use imagine

Question 5

Investigations of breast cancer

Answer 5

Mammogram Is first line-esp for screening
USS also can be useful to separate cyst from masses
MRI also

discharge cytology can reveal cells