Breast Carcinoma Flashcards
1
Q
How many people are affected
A
1 in 9 females
40,000 new cases per year
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%
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
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
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
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
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.
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.