Breast Carcinoma

Question 1

Epidemiology

Answer 1

1/10 people
2nd most common cancer in women
18% 2/1000

Question 2

Pathology

Answer 2

Almost all adenocarcinoma

• 75% ductal
• 10% lobar
• 12-15% special, better prognosis

Question 3

In situ carcinoma

Answer 3

Cancer in side the basement membrane
30-50% of ductal CIS become invasive
10-37% of lobular

Question 4

Tumour grade

Answer 4

Graded 1-3
Oestrogen receptor status
HER2 receptor status

Question 5

Padgetts disease of the nipple

Answer 5

Epidermis becomes infiltrated by neoplastic cells from underlying ductal carcinoma

Question 6

Clinical features

Answer 6

Unpredictable, takes 8y to become palpable
Non cyclical pain 
Hard irregular lump
Skin dimpling
Tethering
Peu d'orange
Redness 
Ulceration 
Recent nipple inversion 
Persistent eczema 
Blood stained discharge

Question 7

Risk factors

Answer 7

Age >50 rare under 35
Family history breast, ovarian, prostate
Western birth
Previous history 
Early menarche
Late menopause
Late/nulliparity >30
Hormone therapy 
Previous cancer
Radiation at young age

Question 8

Triple assessment

Answer 8

Clinical
Breast USS/mammography
Biopsy
Accuracy of 99.6%

Question 9

Mammography

Answer 9

Rarely done under 35
-mass
-micro calcification 
-architectural distortion
-asymmetry 
Carcinoma-speculated mass lesion 
Detects non palpable tumours

Question 10

Ultrasound

Answer 10

Distinguish solid from cyst
100% specific
Benign from malignant 85%
Size 
Biopsy guide

Question 11

Biopsy

Answer 11

All image detected masses
Fine needle aspiration-> immediate grading c1-5
Core biopsy -> diagnosise invasion

Question 12

Staging

Answer 12

FBC, LFT's
CXR
Abdo USS
Isotope bone scan 
TNM

Question 13

Breast conservation surgery
What
Criteria

Answer 13

Remove tumour margin and lymph node biopsy then radiotherapy 
Criteria:
-single lesion 
-2cm 
-low grade

Question 14

Mastectomy
What
Criteria

Answer 14

Remove breast
May spare skin 
\+\- reconstruction 
Criteria:
-invasive
-locally advanced

Question 15

Axillary surgery

Answer 15

Most important prognostic factor
Defined in relation to pec minor
Varies between sampling and dissection
Setinel node biopsy

Question 16

Radiotherapy

Answer 16

Reduces tumour recurrence by 65%

External bean radiation for 3-5w

Question 17

Adjuvant treatment

Answer 17

Aim to destroy micromets
Chemotherapy:
-high grade
-axillary node spread 
-premenopausal

Hormonal therapy:

• ER+ tumours
• post menopausal

Biological therapy:

• herceptin
• HER2+

Question 18

Prognosis

Answer 18

Follow up for 3-5 years
50% die from another disease
Mets can remain dormant for up to 35y
5y 41%

Question 19

Spread

Answer 19

Local:

• adjacent breast
• overlying skin
• pectoral muscle

Lymphatic spread:

• local-> per d’orange
• axillary lymph nodes

Vascular:

• bone
• lung
• ovary