Breast conditions and cancer Flashcards
describe the incidence and mortality of breast cancer over time
incidence is increasing as mortality is decreasing
what % of breast cancer patients are asymptomatic
50
common symptoms of breast cancer
lump in breast bleeding or non physiological discharge from nipple pain in breast altered shape/contour or skin change lumpy breast
what happens at a triple assessment clinic?
clinical exam by hx and exam
radiology by USS or mammogram
core biopsy - cytology is rarely used so core or vacuum core biopsy for histopathology
grading of needle core biopsy?
B1 - unsatisfactory/normal B2 - benign B3 - atypical but probably benign B4 - suspicious of malignancy B5a - CIS B5b - invasive carcinoma
what is the intermediate paradigm of breast cancer
breast cancer is a potentially systemic disease and so early detection through screening and local control prevents metastatic spread
treatment for early breast cancer - local
radiotherapy
surgery
treatment for early breast cancer - systemic
chemotherapy
hormonal - tamoxifen, aromatase inhibitors, GnRH, oophorecotmy
where may later of advanced breast cancer present and management?
bone or soft tissue
systemic therapy to improve QOL or symptom control
what is an ANDI
alternations in normal development and involution
anything thats not cancer
fibrocystic change, cyst, papilloma
example of a hormonal change leading to breast condition
gynaecomastia
example of inflammatory benign breast conditions
mastitis
abscess
describe the physiology of lactation
babies cries heard in higher centres and removes prolactin inhibition and stimulates oxytocin release
prolactin stimulates milk secretion and oxytocin stimulates smooth muscle contraction and ejection of milk
ejection partly triggered by mechanoreceptors in nipple from suckling
NPI <3?
excellent prognosis
NPI<3.4?
good prognosis
NPI 3.41-5.4?
moderate prognosis
NPI >5.41
poor prognosis
methods of breast conservation surgery?
wide local excision
image guided local excision
oncoplastic surgery
what is the alternative to breast conserving surgery
mastectomy
chemotherapy given as neoadjuvant?
FEC and taxane ±herceptin
true/false - mastectomy is more effective than breast conserving surgery + radiotherapy
false, they are just as effective
what is WLE used for, what is the margin and where is cut
palpable symptomatic cancers
just below skin to pectoral fascia
aim for >1cm
when is image guided local excision used, margin and method?
asymptomatic cancers detected on screen
1mm margin
clips, RF wave, magnetic seed