Breast Carcinoma Flashcards
What is the most comomn presentation of breast cancer?
The most common presentation of breast cancer is a palpable lump i.e. investigate all
(the most common presentation of breast cancer is a lump but not all lumps are breast cancer)
What are the 3 stages of triple assessment of breast cancer and why do we do this?
triple assessment allows pre-operative diagnostic accuracy of ~99%
- Clinical assessment = Hx and exam
- radiological assessment = US +/- mammogram
- Pathological assessment = FNA (Cytology) and or/core biopsy
The first stage of triple assessment is the clinical assessment Hx and exam.
What signs of breast cancer O/E maybe found?
- Skin tethering,
- nipple changes,
- asymmetry,
- hard, irregular lump
The first stage of triple assessment is the clinical assessment Hx and exam.
What are the tumour markers for breast cancer?
Commonly used tumour marker:
CA15-3 (produced by cancer cells)
or CA27-29
The 2nd part of the triple assessment for breast cancer is radiological assessment = US +/- mammogram.
When is a mammogram used & what can be seen?
if > 35 y/o = mammography
=> identifies microcalcifications and densities
- DCIS (pre-cancer): white micro-calcifications
- Benign: circumscribed, regular contours
- Malignant: speculated masses (needle shaped)
A patient > 35 y/o has a mammogram as part of her triple assessment for her breast lump.
What does it mean if on the mammogram there is white micro-calcifications?
DCIS aka Pre-cancer!
A patient > 35 y/o has a mammogram as part of her triple assessment for her breast lump.
What does it mean if on the mammogram there is lesion with circumscribed, regular contours?
= benign
A patient > 35 y/o has a mammogram as part of her triple assessment for her breast lump.
What does it mean if on the mammogram there is speculated masses (needle shaped)?
A malignant breast lump
What would a mammogram of DCIS aka Pre-cancer show?
white micro-calcifications
What would a mammogram of a woman with a benign breast lump show?
a lesion with circumscribed, regular contours
What would a mammogram of a woman with a malignant breast lump show?
speculated masse(s) (needle shaped)
The 2nd part of a triple assessment is radiological assessment - US +/- mammogram
When is an USS used / what is seen?
USS is used in ALL AGES
as esp. if younger, the breast tissue maybe too dense for mammography (when older the breast tissue becomes more fatty than glandular)
USS is good for distinguishing solid & cystic lesions
USS can be used to guide needle biopsy
The 3rd stage of the triple assessment is pathological assessment w/ FNA (cytology) and/or core biopsy
What are the differences?
FNA
- uses a smaller needle
- may need to repeat (as can miss the floating cells)
- no LA needed
Core biopsy
- LA needed
- nick made in skin
- larger needle
A patient undergoes pathological assessment for a breast lump as part of the triple assessment, her lump is diagnosed as C3. What does this mean and what does the “C” mean?
C3 is c for Cytology 3 and it is the same grading as B3 = core biopsy 3 but just shows that the cells were looked at in a different way.
the scale of pathological assessment goes from C1/B1 - C5/B5
C3/B3 equates to the lump being equivocal as to if it is cancerous/not but actually that it favours benign.
(C4/B4 also = equivocal but favours malignant)
A patient undergoes pathological assessment for a breast lump as part of the triple assessment, her lump is diagnosed as B1.
What does this mean and what does the “B” mean?
B1 = core biopsy 1 and is the same grading as C1 but just shows that the cells were looked at in a different way. as 3 is c for Cytology 1
the scale of pathological assessment goes from C1/B1 - C5/B5
C1/B1 equates to the lump sample being inadequate or NOT diagnostic
- C1/B1
- Inadequate or not diagnostic
- C2/B2
- Benign e.g. fibroadenoma, fibrocystic change
- C3/B3
- Equivocal, favours benign
- C4/B4
- Equivocal, favours malignant
- C5/B5
- Malignant (DCIS is included in this)
A patient undergoes pathological assessment for a breast lump as part of the triple assessment, her lump is diagnosed as B2.
What does this mean and what does the “B” mean?
B2 = core biopsy 2 and is the same grading as C2 but just shows that the cells were looked at in a different way as the C is for Cytology 2
the scale of pathological assessment goes from C1/B1 - C5/B5
C2/B2 = equates to the lump sample being benign e.g. fibroadenoma, fibrocystic change
- C1/B1
- Inadequate or not diagnostic
- C2/B2
- Benign e.g. fibroadenoma, fibrocystic change
- C3/B3
- Equivocal, favours benign
- C4/B4
- Equivocal, favours malignant
- C5/B5
- Malignant (DCIS is included in this)
Age impacts DDx (order) for breast lumps.
What is the order for ddx of breast lumps in young patients?
1 fibro adenoma,
(in older: 1) carcinoma, 2) fibrocystic change , 3) fibro adenoma e.g. order reverses)
Age impacts DDx (order) for breast lumps.
What is the order for ddx of breast lumps in older patients?
OLDER:
- # 1 carcinoma,
- # 2 fibrocystic change,
- # 3 fibro adenoma
[YOUNG: #1 fibro adenoma,#2 fibrocystic change, #3 carcinoma much less common]
What is the most common age group for breast cancer to affect?
- 40-70 yrs
- may occur at any age but rare
- rare <25y/o
breast cancer = 2nd commonest form of cancer to affect women in the developed world; lifetime risk 1 in 9 ; 1 in 8 women in UK;
–> Mortality decreasing; incidence increasing (more detected by screening, RFs)
What is the national breast screening programme protocol?
2-view mammography
every 3yrs
for women 47-73
in UK has ↓breast cancer deaths by 30% in women >50yrs
what is the aim of the 2-view mammography every 3yrs for women 47-73 in UK (national breast screening programme)?
- Aims to identify DCIS (pre-cancer, microcalcifications) & small invasive carcinomas at an early stage before symptoms & signs
- –> Reduce morbidity & mortality of cancer
- Women 47-73yrs invited for screening mammogram every 3yrs (range currently being extended to from 50-70yrs)
- IF Suspicious features → further assessment (imaging e.g. US, exam, FNA/core biopsy)
nulliparity decreases the risk of breast cancer true or false
False it increases the breast cancer risk
due to (unnoposed?) oestrogen exposure so other factors include:
- Oestrogen exposure
- Obesity (peripheral aromatisation androgens to oestrogen)
- Late menopause, early menarche
- Nulliparity, no breast feeding
- Exogenous oestrogen -
- COCP/coil,
- HRT >10yrs
Besides oestrogen exposure what ae the other RF’s for breast cancer?
- Age: >50yrs high risk
- Gender: females 100x more likely than men, but male not impossible
- Genetics: 5-10% breast cancers familial
- BRCA1/2 - tumour suppressor gene, AD, 80-90% chance developing breast cancer, also ovarian cancer risk . B1 with uterine, B2 w/ prostate (e.g. male at risk!) and pancreatic
- P53 - Li-Fraumeni syndrome, germinline mutation, less common
- PMH breast cancer/ previous breast conditions (AHD, LCIS)
- Age at first pregnancy: >30yrs high risk
- Irradiation
- Alcohol consumption
What are protective factors against breast cancer?
- being physically active
- breastfeeding
- diet
- aspirin
- NSAIDs
Where is the most common place on the breast to have a breast cancer?
50% are in the upper outer quadrant