Invasive Breast Cancer Flashcards
Epidemiology
Most common cancer in the western world and accounts for 20% of all cancers in women in the UK
1 in 10 women will develop it in their lifetime.
Classifications
Invasive ductal carcinoma (75-85%)
Invasive lobular carcinoma (10%)
Other such as medullary or colloid carcinoma (5%
Further classification of IDC
Tubular (circumscribed)
Cribriform (circumscribed)
Paillary (circumscribed)
Mucinous/Colloid
Medullary
Well Circumscribed subtypes show more favourable prognoses
ILC in older vs younger women
More common in older women
Characterisation of ILC
Diffuse stromal pattern of spread
This makes detection more difficult
This means that at the time of diagnosis the tumours are often quite large
Risk factors
Female
Age
BRCA1/2 +ve
FH
Previous benign disease
Obesity (oestrogen)
Alcohol consumption
Geographic variation
Exposure to unopposed oestrogen
Early menarche
Late menopause
Nulliparous women
Oral contraceptives
HRT use
Clinical features
Breast lumps
Asymmetry
Swelling
Abnormal nipple discharge
Nipple retraction
Skin changes like dimpling/peau d’orange or Paget’s like changes
Mastalgia
Palpable lump in the axilla
Dx
Benign tumours
Breast cysts
Infective causes
Investigations
Gold standard = triple assessment with examination, imaging and histology or cytology
How is prognosis calculated?
Nottingham Prognostic Index NPI
Explain Nottingham Prognostic Index
Size x 0.2 + Nodal status + Grade
Nodal status is number of axillary lymph nodes involves
0 nodes = 1, 1-4 nodes = 2, >4 nodes = 3
Grade is by Bloom-Richardson classification
What else should be investigated to determine mortality rates?
Receptor status
What receptors should be checked for?
Oestrogen receptor ER
Progesterone receptor PR
Human Epidermal Growth Factor Receptor HER2
Explain breast screening programmes
Women aged 50-70 yrs every three years
Going down to 47-73 or not?????
