invasive breast cancer

Question 1

what type of tumour are breast cancers?

Answer 1

carcinomas

Question 2

where do breast cancers usually arise from?

Answer 2

almost all breast carcinomas arise in the terminal duct lobular unit

Question 3

what are the different types of invasive carcinomas of the breast?

Answer 3

• Invasive ductal carcinoma (75-85%)
• Invasive lobular carcinoma (10%)
• Other subtypes (5%), such as medullary carcinoma or colloid carcinoma

Question 4

what is the most common type of breast carcinoma?

Answer 4

invasive ductal carcinomas

IDCs can be further classified into tubular, cribriform, papillary, mucinous (/colloid), or medullary carcinomas

Question 5

what type of breast carcinoma is most common in older women?

Answer 5

Invasive lobular carcinoma

characterised by a diffuse pattern of spread that makes detection difficult. By the time of diagnosis, tumours are often quite large.

Question 6

what are the risk factors for invasive breast cancer?

Answer 6

• female
• age
• BRCA1/2
• family history
• previous benign disease
• alcohol
• degree of exposure to unopposed oestrogen e.g early menarche, late menopause, nulliparous women

Question 7

what are the clinical features of invasive breast cancer?

Answer 7

Patients can present symptomatically or asymptomatically via screening (particularly for ILC).

Breast lumps, asymmetry, or swelling, abnormal nipple discharge, nipple retraction, skin changes (dimpling/peau d’orange, or Paget’s-like changes), mastalgia, or with a palpable lump in the axilla.

Question 8

what investigation is done for invasive breast cancer?

Answer 8

gold standard for diagnosis of breast lumps is via the triple assessment, involving examination, imaging, and histology or cytology.

Question 9

what is the prognosis for invasive breast cancer?

Answer 9

Nodal status is the most important prognostic factor in breast cancer, however size, grade, and receptor status also influence prognosis.

The Nottingham Prognostic Index (NPI)* is a widely used staging system for primary breast cancer prognosis.

Receptor status is also assessed due to new targeting therapies. Check for Oestrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal growth factor Receptor (HER2) status allowing for suitable treatment options.

Question 10

what is the breast screening process like in the UK?

Answer 10

NHS breast cancer screening programme currently invites women aged 50-70yrs to have a mammogram every three years; any abnormalities identified will be referred to breast clinic for triple assessment.

Question 11

What is Paget’s disease of the nipple?

Answer 11

a rare condition presents as a roughening, reddening, and slight ulceration of the nipple, usually with an underlying neoplasm, either in situ or invasive.

Microscopically there is involvement of the epidermis by malignant ductal carcinoma cells.

Question 12

what is the clinical presentation of Paget’s disease?

Answer 12

itching, redness, flaking and thickened skin around/on the nipple.
Painful, sensitive, flattened nipple with yellowish discharge.

Question 13

what are the differentials for Paget’s disease?

Answer 13

dermatitis or eczema.

Paget’s disease can be differentiated from eczema on the basis that the former always affects the nipple and only involves the areola as a secondary event, whilst eczema nearly always only involves the areola and spares the nipple.

Question 14

what investigations need to be done for Paget’s disease?

Answer 14

Biopsie for diagnosis

breast and axilla examination should also be performed. Mammograms, ultrasounds, or MRI breast may also be warranted.

Question 15

what is the management for paget’s disease?

Answer 15

surgical, how advanced will depend what the surgery is.

underlying malignancy may also need radiotherapy.