Breast Disease Flashcards
Epidemiology of breast cancer
Second most common cause of death from cancer in the uk
Risk factors for breast cancer
Increased hormone exposure (early menarche, late menopause, nuliparity or late first pregnancy, oral contraceptives) Susceptibility,it’s gene mutations (most commonly BRCA1 or 2 Advancing age. Caucasia Obesity Alcohol and tobacco use Past history of breast cancer Previous radiotherapy
Who gets screened for breast cancer
All women aged 50-70
Every 3 years
Invited for mammogram and results may lead to triple therapy
Benefits of breast sceeening
Early detection of cancers
Reduction in relative risk of death
Referral for triple assessment
Risks of breast screening
Mammograms are painful and felt to be undignified
False negatives and positives
Indications for urgent referrals for triple assessment
Over 30 with an unexplained mass regardless of pain or not
Older than 50 with nipple discharge, retraction or other concerning symptoms
Mass in Axilla, 30 years or older and skin changes suggestive of cancer
Presentation of breast in breast cancer
New lump or mass Swelling of the affected breast Peau d orange Breast or nipple pain Nipple retraction Dry red flaking or thickening around area Nipple discharge Swollen lymph nodes
Histological subtypes of breast cancer
Ductal carcinoma
Lobular carcinoma
Medullary carcinoma
Phyllodes tumour
Ductal carcinoma features
Most common breast cancer
Ductal cells proliferate
Cells lose their acinar structure and arrange themselves into rows
If basement in tact then considered ductal carcinoma in situ
Lobular carcinoma presentation
Make sup 15% of breast cancers More likely to be bilateral and multi centric Arrange themselves into single rows Cells are small bland and uniform Sparse distribution so often impalpable
Medullary carcinoma features
More common in younger patients with BRCA1 mutation
Composed of solid sheets of anaplastic cells with large pleomorphic nuclei and frequent mitoses
Significant lymphocytic infiltration
Better prognosis
Phyllodes tumour features
Rare
Grows a leaf like pattern
Genetic pathophysiology
BRCA 1 and 2 are TSGs and their mutations can be inherited
BRCA 1 found on chromosome 17 and increases the rfx of breast ovarian colon pancreatic and prostate cancer. Autosomal dominant inheritance
BRCA2
Chromosome 13 same as before minus prostate and throw in stomach. Pr positive tumours
Which 3 receptor types are checked for in breast. Cancer
Oestrogen ER
PROGESTERONE PR
HER 2 (human epidermal growth factor)
Absence of ER or PR is a bad prognostic indicator
Triple negative is associated with younger age and poorest outcome
In terms of hormonal therapy how is ER positive cancer treated if the patient is premenopausal? (-55)
Tamoxifen (oestrogenreceptor antagonist)
In terms of hormonal therapy how is ER positive cancer treated if the patient is postmenopausal? (55+)
Anastrazole (aromatase inhibitor)
SE of tamoxifen
Hot flushes Nausea Weight gain Increased risk of DVT Tetragenic (danger to foetus)
Trustumumab (herceptin) indication in breast cancer
Hormone therapy in HER2 receptor positive cancers
What is a mastectomy and why would you do one?
Multi focal tumours or central tumours, diameter of incision greater than 4cm
What is a WLE and why do one
Take less than 4cm with the diameter of incision , depends on there being enough breast left for aesthetic appearance after
So,Italy tumours
Peripherally located
Radiotherapy
Almost all patients with a WLE should be offered adjuvant radiotherapy as it reduces reoccurrance
Mastectomy shahid be offered to patients with higher cancer stages
How are breast cancers staged
TNM
Which treatment could you give to a 70 year old who is her2 negative, er positive and pr negative
Anastrazole
Which treatment to a 49 year old her 2 negative er positive and pr negative woman
Tamoxifen
Fat necrosis of the breast
Benign and common in obese patients
Can be a fi4m round lump or soft and uneven
Usually found following trauma to the breast
Overlying coin changes show bruising and inflam
Puerperal mastitis
Inflammation of the breast associated with lactation in postpartum women
Clinical diagnosis based on the following-
Localised symptoms- painful, tender, red hot breast
Systemic symptoms- fevers, rigours, myalgia, fatigue, nausea and headache
