Breast management Flashcards
What proportion of breast cancer will be cured long-term?
80%
Why are breast cancer cases increasing?
Lifestyle eg obesity
Increased screening and detection
Ageing population
What proportion of women in the uk will develop breast cancer?
1 in 8
How does breast cancer present?
Skin tethering Breast lump - usually painless Pau de orange Bloody nipple discharge Nipple inversion or in-drawing Locally advanced disease - cancer has invaded most of the breast Metastases eg bone
Signs: painless lump which is irregular, hard and fixed
How do we diagnose breast cancer?
Use a tripple assessment:
- clinical score 1-5: normal-clearly malignant
- imaging score 1-5
- biopsy score 1-5
Is pain a common feature of breast cancer? If not, what is it likely due to?
No it is unlikely for BC to be painful (though it can rarely present as a painful lump)
Cysts and hormonal changes
What is microcalcification due to?
DCIS
or can be an invasive cancer
What are the main investigations for breast cancer?
Mammogram
ultrasound and core biopsy
When are MRIs used to diagnose breast cancer?
Carriers of BRCA 1 and 2
Young women with more dense breasts
Women with breast implants
What are the surgical options for pts with breast cancer?
- Breast conservation - lumpectomy or wide excision: always give radiotherapy afterwards
- Mastectomy
Both procedures will involve some surgery to the axilla
What factors would mean that breast conservation surgery can be done instead of mastectomy?
- Small tumour relative to breast size usually <25%
- Neoadjuvant chemotherapy - where the pt is given chemo before surgery. this can shrink the tumour making it suitable for lumpectomy
- No previous radiotherapy to the breast
- Pt choice
What factors would mean that a mastectomy would be the preferred option over breast conservation?
- large tumour relative to breast size
- more than one tumour in the same breast esp if in different quadrants
- patient choice
What factors affect the outcome from conservation surgery?
tumour size relative to breast size
position of tumour in the breast
radiotherapy fibrosis
What type of axillary surgery will a pt with a large palpable node undergo?
Full axillary clearance - remove all of the nodes from the underarm
What type of axillary surgery will a pt with clinically normal nodes undergo?
Limited axillary surgery
Sentinel node biopsy
Remove between 1-4 glands under the arm
Identify which nodes are most likely to have cancer in by using a radioactive dye or blue dye
What are the advantages of full axillary clearance?
Accurate staging
Good local control - 1% reccurance rate in axilla
No need for further surgery or radiotherapy
What are the disadvantages of full axillary clearance?
10-12% lymphoedema Seroma - fluid build up at site of excision Arm stiffness axillary numbness Longer admission and surgical time
What are the advantages of limited axillary surgery?
No significant complications
No drains
Day surgery
What are the disadvantages of limited axillary surgery?
May need clearance or radiotherapy
What do you do if you do a sentinel node biopsy after surgery and you find no axillary disease?
No further axillary surgery
What do you do if you find large volume axillary disease after surgery?
Second axillary clearance
What do you do if you find small volume axillary disease after surgery with a low risk cancer?
No further treatment
or radiotherapy to axilla
What are the two most common types of breast cancer?
Ductal
Lobular
How does ductal carcinoma feel?
Lump
