Treatment of breast disease Flashcards
What is the incidence of breast cancer?
Affects 1 in 8 women
What are risk factors for breast cancer?
Increasing age Previous breast cancer BRCA1/2 genes Early menarche and late menopause Late or no pregnancy HRT Alcohol High BMI Post radiotherapy treatment - especially for Hodgkin's disease - chest exposure
How may an asymptomatic patient be found to have breast cancer?
In breast screening
Who gets invited for breast screening?
Women aged 50-70
What are possible symptoms of breast cancer?
Lump Mastalgia Nipple discharge Nipple changes Change in the size or shape of the breast Lymphoedema Dimpling of the breast skin
What is mastalgia?
Persistent unilateral breast pain
What will happen as a result of lymphoedema?
Swelling of the arm
What will a patient do when they go through the clinic?
History and examination
Bilateral mammogram
FNA or Core Biopsy
What is the general history in a patient with breast cancer?
Previous breast problems
Family history
Hormonal status
Drug history
What should be examined in examination of suspected breast cancer?
Both breasts
Axillae
What is the most sensitive form of breast imaging?
Mammography
What is fine needle aspiration used for?
Cytology
What is core biopsy used for?
Histo-pathology
What are the 2 most common types of invasive breast cancer?
Ductal carcinoma - 80%
Lobular carcinoma - 10%
Other - 10%
What are the 2 most common types of non-invasive breast cancer?
Ductal carinoma in situ
Lobular carcinoma in situ
What is the general management for breast cancer?
Diagnosis
Staging
Treatment
What members of the MDT may be involved in breast cancer treatment?
Breast surgeon Radiologist Cytologist Pathologist Clinical oncologist Medical oncologist Nurse counsellor Psychologist Reconstructive surgeon Patient and partner Palliative care
How can staging be assessed?
FBC
Chest x ray
How is the primary tumour T graded?
Tx - primary tumour can not be assessed T0 - primary tumour not palpable T1 - tumour <2cm T2 - tumour 2-5cm T3 - tumour >5cm T4a - tumour invading skin T4b - invading chest wall T4c - invading both T4d - inflammatory breast cancer
How is the primary tumour N graded?
N0 - no regional lymph nodes palpable
N1 - regional lymph nodes palpable - mobile
N2 - regional lymph node palpable - fixed
How is breast cancer treated?
Surgery - may have radiotherapy, chemotherapry, hormonal therapy
What are the 2 main types of surgery?
Mastectomy
Breast conservation surgery
Who is suitable for surgery?
Patient suitable for radiotherapy
Patient who wants it
What is the sentinel lymph node?
The first node to receive lymphatic drainage and therefore the first node the tumour spreads to
