FN: Breast cancar: Pathology, presentatin and Assessment

Question 1

Epi

Answer 1

Affects 1/10 women
20000 case/yr in UK
Commonest cause of cancer in females between 15-54
Second commonest cause of deaths overall

Question 2

Risk Factors

Answer 2

Family Hx
Oestrogen Exposure
Proliferative breast disease w/ atypia
Previous breast cancer
increasing age
Breast feeding is protective

Question 3

Family History

Answer 3

10% breast Ca is familial - one first degree relative 2x risk
5% association with BRCA mutations

Question 4

BRCA 1 (17q)

Answer 4

80% breast cancer, 40% + ov Ca

Question 5

BRCA2 (13q)

Answer 5

80% breast Ca

Question 6

Oestrogen exposure

Answer 6

Early menarch, lat emenopause
HRT, OCP (million women study)
First child >35 yrs
Obesity

Question 7

Pathology

Answer 7

DCIS/LCIS
Invasive Ductal Carcinoma, NST/NOS
Phyllodes tumours

Question 8

DCIS/LCIS

Answer 8

Non-invasive pre-malignant condition
Microcalcification on mammography
10x increased risk of invasive CA

Question 9

Invasive ductal Carcinoma

Answer 9

commonest 70% of cancer
Feels hard (scirrhous)

Question 10

Other subtypes

Answer 10

1. Invasive lobular - 20% of cancer
2. Medullary: affects younger pts. feels soft
3. Colloid/mucinous: occur in elderly
4. inflammatory: pain, erythema, swelling, paeu d’orange
5. Papillary

Question 11

Phylloides tumour

Answer 11

Stromal tumour

Large, non tender mobile lump

Question 12

Spread

Answer 12

1. Direct extension - muscle and or skin
2. Lymph - p’eau d’orange and arm oedema
3. Blood:

Question 13

Blood spread signs

Answer 13

1. Bones: bone pain, fractures, Raised Calcium
2. Lungs: dyspnoea, pleural effusion
3. Liver: abdo pain, hepatic impairment
4. Brain: headache, seizures

Question 14

Screening

Answer 14

Every 3 yrs from 47-73
Craniocaudal and oblique views
reduced breast cancer deaths by 25%
10% false negative rate

Question 15

Presentation

Answer 15

Lump
Skin changes
Nipple
Mets
May present through screening

Question 16

Lump presentation

Answer 16

Commonest presentation of Ca breast

1. usually painless
2. 50% in upper outer quadrant
3. ± axillary nodes

Question 17

Skin changes

Answer 17

Pagets: persistent eczema

Pean d’orange

Question 18

Nipple

Answer 18

Discharge

Inversion

Question 19

Mets

Answer 19

Pathological fractures
SOB
Abdominal pain
Seizures

Question 20

differential

Answer 20

cysts
fibroadenomas
DCIS
Duct ectasia

Question 21

Tripple assesment: any breast lump

Answer 21

1. History and clinical examination
2. Radiology
3. Pathology

Question 22

Radiology

Answer 22

35yrs US + mammography

Question 23

Pathology

Answer 23

Solid lump: tru-cut core biopsy

Cystic lump: FNAC (green/18g needle)

1. reassure if clear fluid
2. send cytology if bloody fluid
3. ccore biopsy residual mass
4. core biopsy if +ve cytology

Question 24

Bloods to do

Answer 24

FBC
LFTs
ESR
Bone profile

Question 25

Imaging

Answer 25

Staging
CXR
Liver US
CT scan
Breast MRI: multifocal disease or with implants
Bone scan and PET-CT

May need wire-guided excision biopsy

Question 26

Clinical staging: stage 1

Answer 26

Confined to breast, mobile no LNS

Question 27

Stage 2

Answer 27

Stage 1 + nodes in ipsilatera axilla

Question 28

Stages 3

Answer 28

Stage 2 + fixatino to muscle (not chest wall)

LNS matted and fixed, large skin involvement

Question 29

Stage 4

Answer 29

Complete fixation to chest wall + mets