Breast Carcinoma Flashcards

1
Q

How many people are affected

A

1 in 9 females

40,000 new cases per year

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2
Q

What causes it

A
  • Non-invasive ductal carcinoma in-situ = premalignant
    (seen as microcalcification on mammography)
  • Non-onvasive lobular = rarer + multifocal
  • INVASIVE DUCTAL CARCINOMA = 70%
  • Invasive lobular carcinoma = 10-15%
  • Medullary cancer = 5%
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3
Q

What are the risk factors

A
  • FHx
  • Age
  • uninterrupted oestrogen exposure
  • 1st pregnancy >30
  • Early menarche
  • Late menarche
  • HRT
  • Obesity
  • BRCA genes
  • Not breast feeding
  • Past Hx
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4
Q

What is the clinical presentation

A
  • Stage 1 - confined to breast, mobile
  • Stage 2- growth confined to breast, mobile, lymph nodes (in ipsilateral axilla)
  • Stage 3 - tumour fixed to muscle (not chest wall), ipsilateral lymph nodes, skin involvement
  • Stage 4 - complete fixation of tumour to chest wall, distant mets
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5
Q

What type of staging do you use

A

TNM staging:

  • T1 <2cm
  • T2 2-5cm
  • T3 >5cm
  • T4 fixity to chest wall or peau d’orange
  • N1 mobile ipsilateral nodes
  • N2 fixed nodes
  • M1 distant mets
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6
Q

What investigations do you perform

A
  • 60-70% breast cancers = OESTROGEN receptor +ve (best prognosis if +ve)
  • 30% over-express HER2 –> worse prognosis, aggressive disease + poorer prognosis
  • TRIPLE ASSESSMENT (clinical examination + histology/cytology + mammography/ultrasound)
  • Sentinel node biopsy from axillary
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7
Q

What is the treatment for stage 1/2 breast carcinoma

A

Surgical

  • removal of tumour by wide local excision (WLE)
  • mastectomy ± breast reconstruction ± axillary node sampling/surgical clearance
  • sentinel node biopsy

Radiotherapy

  • recommended following surgery
  • risk of recurrence 30% -10%
  • increase overall survival

Chemotherapy
- adjuvant chemo is for all except excellent prognosis pts

Endocrine agents:

  • aim to lower oestrogen activity or progesterone +ve tumours
  • ER blocker TAMOXIFEN is widely used
  • Ovarian ablation or GnRH analogues lower recurrence + ^ survival.

Reconstruction options:
tissue expanders, implants, latissimus dorsi flap, TRAM (transverse rectus abdominis myocutaneous) flap.

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8
Q

How do you treat stage 3/4 carcinoma

A
  • Long term survival possible + median survival >2 yrs
  • Staging involves: CXR, bone scan, liver USS, CT/MRI or PET-CT + LFTs & Ca2+
  • Radiotherapy to painful bony lesions (bisphosphonates may reduce pain + fracture)
  • Tamoxifen (for ER +ve)
  • Trastuzumab should be given for HER2 +ve, in combo w/ chemo
  • CNS surgery for solitary mets
  • Get specialist help for arm lymphoedema.
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