Treatment of Breast Disease Flashcards
breast cancer affects how many women?
1 in 8
what is a carcinoma in situ?
cells have malignant changes but are contained within the basement membrane.
discuss the finding and progression of DCIS
This is the commonest type of breast cancer. 3% are symptomatic and 17% of the cancers detected at screening. If you follow the patient up without doing anything there is a 2% of invasion in the same area of the same breast.
discuss lobular carcinoma in situ
0.5% are symptomatic and 1% for cancers found at screening. If you follow the patient up without doing anything there is a 2% of invasion but it can happen anywhere in either breast.
what is invasive carcinoma?
cells have malignant changes and have penetrated the basement membrane.
how can you diagnose breast ca?
- History and clinical examination
- Mammography
- Ultrasonography
- Magnetic resonance mammography
- Cytology (FNAC)
- Core biopsy
- Image guided cytology or core biopsy
- Open (surgical) biopsy
risk factors for breast ca
Anything that exposes the breast to radiation increases the risk of breast cancer: • Age • Geographical variation (more common in Western world) • Age at menarche and menopause • Age at first pregnancy o Older = more likely • Family history • Previous benign breast disease • Cancer in the other breast • Radiation o Hodgkin’s disease is treated with radiation to the chest and as a result 1 in 3 will develop breast cancer • Lifestyle o High fat – produces oestrogen o Alcohol – exposes breast to acetyl aldehyde • Oral contraceptive o Disappears within 5 years • HRT
signs and symptoms of breast ca
• Lump or thickening in the breast, often painless
o Most common
• Discharge or bleeding
• Change in size or contours of breast
• Change in colour or appearance of areola
• Redness or pitting over the skin of the breast
o Peau d’orange
o Inflammatory breast Ca, often misdiagnosed as an abscess or an infection and associated with a poor prognosis
how can you assess the severity of breast ca
- Hb, FBC, U+Es, LFTs
- CXR
- Isotope bone scan
- Others as clinically indicated
- No reliable tumour markers – none sensitive or specific enough
staging of breast ca
• Tumour (T) o T1 – <2cm o T2 – 2-5cm o T3 – >5cm o T4 – fixed to skin or muscle (poor prognosis) • Nodes (N) o N0 – node o N1 – nodes in axilla • Metastases (M) o M0 – none o M1 - metastases
treatment of breast ca
• Primary breast cancer o Local control, eradicate disease • Regional tumour-draining nodes o Regional control, staging, eradicate disease • Micrometastases o Eradicate disease
breast ca surgery
- Breast conservation
a. Wide local excision, quadrantectomy or segmentectomy
b. Tumour + 1mm of healthy breast tissue - Mastectomy
when is breast conservation surgery suitable?
Trials have shown that for tumours less than 4cm survival for breast conservation is equal to mastectomy Patients suitable for breast conservation: • Tumour size <4cm (clinically) • Breast/tumour size ration • Suitable for radiotherapy • Single tumours • Minimal in situ cancer component present • Patients wish – most important
axillary clearance in breast ca
If sentinel node is involved or patients have FNAC at clinical which shows malignant cells, then all nodes need to be removed from the axilla. No radiotherapy is given, even if nodes are involved with tumour. There is more morbidity than other types of axillary surgery.
complications of axillary clearance
- Lymphoedema
- Sensory disturbance as a result of damage to the intercostobrachial nerve
- Decrease ROM in the shoulder joint
- Nerve damage (long thoracic, thoracodorsal, brachial plexus)
- Vascular damage
- Radiation-induce sarcoma
