breast- malignant Flashcards
where do metastatic tumours go to the breast?
Lung
Ovarian
Renal
Melanoma
most common place to metastasise to the breast?
Lung
what are examples of in situ breast carcinomas?
-Lobular carcinoma in situ
-Ductal carcinoma in situ
what is the most common type of insiotu carcinoma of breast?
Ductal carcinoma in situ more common
what is a true precursor lesion for invasive carcinoma?
Ductal carcinoma in situ
investigations of lobular carcinoma in situ?
Asymptomatic
-usually incidental finding on CORE BIOPSY
management of lobular carcinoma in situ found on core biopsy?
-excision or vacuum biopsy
(to exclude higher grade lesion)
managmenet of lobular carcinoma in situ found on vacuum or excision biopsy?
-follow up
-clinical trials
investigations for ductal carcinoma in situ?
usually asymptomatic and detected during screening on mammogram
what would mammogram show of ductal carcinoma in situ?
Microcacalcifications either localised or wide spread
what happens if ductal carcinoma in situ spreads to nipples?
high grade DCIS can do this:
-considered Paget’s disease of nipple
management of ductal carcinoma in situ?
-surgery
-adjuvant radiotherapy
-chemoprevention
what is a microinvasive carcinoma?
high grade DCIS with invasion <1mm
what is invasive breast carcinoma?
malignant epithelial cells which have breached the basement membrane
genes associated with breast cancer?
BRCA 1 and BRCA2 genes
HER2
PTEN
ATM
STK11/L
KB
how can invasive breast carcinoma spread?
-Local invasion
-Lymphatics (axillary, sentinel)
-Metastasis
who gets a 2 week referral?
-unexplained breast lump in patients 30 or older
-unilateral nipple changes in patients 50 or over (discharge, retraction or other changes)
who would you consider a referral for?
-patients 30 or older with an unexplained lump
-skin changes suggestive of breast cancer
what is the screening programme for breast cancer?
mammogram every 3 years to women 50-70
medication given to oestrogen receptor positive breast cancer?
Premenopausal= tamoxifen
Postmenopausal= aromatose inhibitors (e.g. anastrazole + letrozole)
example how tamoxifen works?
Selective Oestrogen receptor modulator (SERM) blocks oestrogen receptors in breast + stimulates oestrogen receptors in uterus + bones (increases chance of endometrial cancer but prevents osteoporosis)
given to pre menopausal oestrogen +ve breast cancer
examplain how aromatose inhibitors (e.g. anastrazole + letrozole) work?
Aromatase is an enzyme found in fat (adipose) that converts androgens to oestrogen. After menopause fat is the main source of oestrogen. Aromatose inhibitors block the creation of oestrogen in fat tissue
so are CI in osteoperosis
Given to post menopausal oestrogen +ve breast cancer
patient wants breast conserving surgery- what else should be offered?
couple breast conserving surgery with radiotherapy
when should a mastectomy be coupled with radiotherapy?
> 3 nodes
Positive surgical margins
and/or
Tumour >5cm
what is neoadjuvant chemotherapy?
chemotherapy given BEFORE surgery to shrink tumour
what is adjuvant chemotherapy?
Chemotherapy given AFTER surgery to reduce recurrence
what is done to assess lymph nodes once a woman is diagnosed with breast cancer?
-ALL women diagnosed with breast cancer are offered US of axilla + US guided biopsy of any abnormal nodes
-Sentinel lymph node biopsy may be used during breast surgery if US doesnt show any abnormal nodes
what is the sentinal node?
the first node in the drainage of the tumour area
what is offered is cancer is found in lymph nodes?
Axillary clearance (removal of axillary nodes)
also option of axillary radiotherapy
what does axillary clearance increase risk of?
Chronic lymphoedema in the arm
management of chronic lymphaodema?
massage techniques to manually drain lymph, compression bandages, specific exercises, wt loss, good skin care
these places are prone to infection!!
what type of breast cancer has the worst prognosis?
triple negative cancer- one that does not express either ER, PR or HER2 receptors
hormonal therapy given for HER+ve cancers
Herceptin (trastuzumab)
