Breast Disease Flashcards
What are the risk factors for breast cancer?
As age increases, previous breast cancer, BRCA1 and BRCA2, early menarche, late menopause, late or no pregnancy, HRT, alcohol, weight and post radiotherapy for Hodgkin’s
What is the lifetime risk of breast cancer?
Affects 1 in 7 women
What is the presentation of breast cancer?
Lump, mastalgia, nipple discharge, nipple retraction, Paget’s disease of nipple, change in size or shape, lymphoedema and dimpling
What is the 3 steps of diagnosis?
Clinical - history and examination
Radiological - bilateral mammograms/ USS
Cyto-pathological - FNA cells and core biopsy
What is used for breast imaging?
Mammography, US or MRI
Mammography is most sensitive in older women - sensitivity reduced in younger women as increased glandular tissue
What is the invasive types of breast cancer?
80% ductal carcinoma
10% lobular carcinoma
10% others - mucinous, tubular, papillary, medullary, sarcoma and lymphoma
What is the non-invasive types of breast cancer?
DCIS - ductal carcinoma in situ
LCIS - lobular carcinoma in situ
What is investigations are used for staging of breast cancer?
FBC, U+Es, LFTs, Ca2+/PO2-
CXR
Describe T in TNM classification of breast cancer
T1 - size less than 2cm
T3 - more than 5cm
T4 - invading
What is the management/ treatment used for breast cancer?
Surgery
Radiotherapy
Chemotherapy
Hormonal therapy
Neoadjuvant and adjuvant
What are the 2 main types of breast surgery?
Breast conservation surgery
Mastectomy
What patients are suitable for breast conservation surgery?
Breast/ tumour size ration
Suitable for radiotherapy
Patients wish
Why might there be surgery to the axilla?
Prognostic information and staging
Regional control of disease/ eradication in the axilla
Describe sentinel lymph node (SLN) biopsy
First node to receive lymphatic drainage so first node for tumour spread
If negative then other nodes are negative
Preoperative axillary USS
What happens when the SLN contains tumour?
Remove them all surgically or give radiotherapy to all axillary nodes
What are the complications of axillary treatment?
Lymphoedema
Sensory disturbance
Decreased ROM
Nerve damage
Vascular damage
Radiation-induced sarcoma
What factors are associated with increased risk of disease recurrence?
Lymph node involvement, tumour grade and size
Steroid receptor status
HER2 status
LVI - lymphovascular invasion
What is the prevention/ adjuvant treatment for breast cancer?
Local - radiotherapy
Systemic - hormone therapy, chemotherapy and targeted therapies
Describe RT in breast cancer
All patients after WLE as adjuvant treatment over 3 weeks
Boosts reduce local recurrence
After Mx if there is local involvement or LN involvement
What are the complications of radiotherapy?
Skin reaction - skin telangiectasias
Radiation pneumonitis, cutaneous radionecrosis and angiosarcoma
What is the action of oestrogen receptor positive (ER+)?
Blocks stimulation of cell growth by oestrogen
Tamoxifen and aromatase inhibitors
Describe tamoxifen
20mg daily for 5-10 years
Blocks directly on ER receptor
All age groups
More effective after chemo
Side effect - thromboembolic
Describe aromatase inhibitors
Arimidex and Letrozole
Once daily more 5 years
Inhibiting ER synthesis
Used in post-menopausal women
Improves disease free survival
Side effect -osteoporosis
When does chemotherapy have the greatest benefits?
Younger women and patients with increasing adverse prognostic factors
Anthracycline and taxane
What is oncotype DX?
21 gene assay to determine whether chemo is likely to benefit
What is Trastuzumab?
Monoclonal antibody against HER-2 receptor
Given when overexpression of HER2 and chemo
50% decrease in recurrence
33% increase in survival
What is the local spread of breast cancer?
Chest wall, skin and nipple
What is the distant spread of breast cancer?
Contralateral breast
Bone, lung, liver, brain and bone marrow
