Breast disease Flashcards
What is the triple assessment?
Clinical assessment: symptoms, risk factors, family history particularly age, HRT and medications
Imaging assessment - if <40 USS, if >40 mammogram
Needle biopsy : core biopsy allows you to test for receptors etc as big chunk, fine needle aspiration of lymph nodes allows you to check for malignancy to see if axillary node clearance is indicated.
what are lobules and ducts of the breast?
The lobules are the glands that produce milk.
The ducts are tubes that carry milk to the nipple.
What is the most common overall breast cancer?
Invasive ductal carcinoma (no special type)
breast cancer screening program
The NHS Breast Screening Programme is offered to women between the ages of 50-70 years.
Women are offered a mammogram every 3 years.
After the age of 70 years women may still have mammograms but are ‘encouraged to make their own appointments’.
do people need referred if they have a first degree relative with breast cancer?
If the person concerned only has one first-degree or second-degree relative diagnosed with breast cancer they do NOT need to be referred unless any of the following are present in the family history:
age of diagnosis < 40 years
bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in a relative younger than age 45 years
glioma or childhood adrenal cortical carcinomas
complicated patterns of multiple cancers at a young age
paternal history of breast cancer (two or more relatives on the father’s side of the family)
or three first-degree or second-degree relatives diagnosed with breast cancer at any age
inheritance of BRCA 1 and BRCA 2
autosomal dominant
2ww referral criteria for breast cancer
aged 30 and over and have an unexplained breast lump with or without pain or
aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
consider if:
skin changes that suggest breast cancer or
aged 30 and over with an unexplained lump in the axilla
where does breast cancer metastasise to
L – Lungs
L – Liver
B – Bones
B – Brain
can go anywhere though
when is axillary node clearance indicated?
if lymphadenopathy
if no lymphadenopathy but a postive sentinal node biopsy on first surgery
when is wide local excision indicated?
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
when is mastectomy indicated
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS > 4cm
when is radiotherapy indicated for breast cancer? type?
Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds.
For women who’ve had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes
management of estrogen receptor positive breast cancer?
Tamoxifen for premenopausal women
Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)
Pharamcology tamoxifen
Tamoxifen is a selective oestrogen receptor modulator (SERM).
It either blocks or stimulates oestrogen receptors, depending on the site of action.
It blocks oestrogen receptors in breast tissue, and stimulates oestrogen receptors in the uterus and bones.
This means it helps prevent osteoporosis, but it does increase the risk of endometrial cancer.
adverse effects of tamoxifen
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer
pharmacology aromatase inhibitors such as Anastrozole
Aromatase is an enzyme found in fat (adipose) tissue that converts androgens to oestrogen. After menopause, the action of aromatase in fat tissue is the primary source of oestrogen. Aromatase inhibitors work by blocking the creation of oestrogen in fat tissue
