Women's Health : Breast Cancer Flashcards
What is the most common cancer in the UK?
Breast cancer, accounting for 15% of new cancer cases annually.
How many new cases of breast cancer are diagnosed annually in the UK?
Approximately 56,000.
2 types of pre-invasive breast cancer
Ductal carcinoma in situ (DCIS) & Lobular carcinoma in situ (LCIS)
Ductal carcinoma in situ (DCIS).
● Neoplastic proliferation of epithelial cells - confined to duct without invasion through basement membrane. ● Precursor to invasive breast cancer. ● Comedo and non-comedo subtypes
Lobular carcinoma in situ (LCIS).
Neoplastic proliferation of epithelial cells, confined to TDLU.
Name some types of Invasive breast cancer
Invasive ductal carcinoma, Invasive lobular carcinoma, Medullary carcinoma, Many others - including mucinous, tubular, papillary, inflammatory etc
Which type of breast cancer is most common?
Invasive ductal carcinoma (commonest - 75%). ; Neoplastic proliferation of epithelial cells that invades through the ductal basement membrane
medullary carcinoma
More prevalent in the younger population. ● Higher grade than IDC.
Invasive carcinoma can be graded using the _________
Nottingham criteria
Which 3 components make up the Nottingham criteria
○ Gland formation ○ Nuclear atypia / pleomorphism ○ Mitosis counts (indicates rate of cellular reproduction)
A higher grade carcinoma is one that is markedly different from ___________ and is considered ________.
A higher grade carcinoma is one that is markedly different from normal breast tissue and is considered poorly differentiated.
What genetic mutation is often linked to breast cancer?
BRCA1 mutation.
What are the five steps of metastasis in breast cancer?
- Invasion through basement membrane 2. Intravasation (entry into circulation) 3. Circulation 4. Extravasation 5. Colonisation
What are the common sites of breast cancer metastasis?
bones, liver, lungs and brain.
List key risk factors for breast cancer.
- Increasing age 2. Female sex (100:1 F:M incidence) 3. Family history 4. Inherited genetic mutations e.g. BRCA1 5. Endogenous oestrogen exposure: a. Early menarche b. Nulliparity / absence of breastfeeding c. Late menopause 6. Exogenous oestrogen and progestin exposure: a. Systemic hormonal HRT b. Systemic hormonal contraception
What are the common symptoms of breast cancer?
breast lump
What are the common signs of breast cancer
nipple discharge, nipple retraction, skin changes e.g. peau d’orange, axillary lymphadenopathy
Metatastic features of breast cancer
weight loss, bony pain, shortness of breath.
What type of staging is used for breast cancer
TNM staging (tumour, node, metastasis) -
Stage 1A
<2cm, isolated to breast
Stage 1B
<2cm, minor axillary LN spread
Stage 2A
<2cm, spread to 1-3 ipsilateral LNs.
Stage 2B
2 - 5cm, minor axillary nodal spread or 2 - 5cm with 1-3 ipsilateral nodes or >5cm, no nodal spread
Stage 3A
4-9 ipsilateral nodes or >5cm with 1-3 ipsilateral nodes
Stage 3B
spread to skin / chest wall
Stage 3C
> 10 axillary nodes or supraclavicular spread or parasternal + axillary spread
Stage 4
distant metastatic spread to organs.
What is the NHS breast cancer screening programme?
3-yearly mammogram for women aged 50-71.
What are the “2-week wait” criteria for breast cancer referral?
○ Unexplained breast lump in a woman aged >30.
○ Unexplained axillary lump in a woman aged >30.
○ Unilateral nipple changes in a woman aged >50.
○ Skin changes suggestive of breast cancer, any age.
First line Ix for breast cancer
○ >30 or highly suspicious for cancer: mammogram ○ <30: breast ultrasound ○ Plus: ultrasound of the axilla +/- needle biopsy
Second line Ix for breast cancer
○ Fine needle aspiration and cytology ○ Plus: oestrogen / progesterone receptor testing, HER2 receptor testing
Ix : If symptoms / signs suggestive of metastasis
CT scan (CT thorax-abdomen-pelvis, CT head).
What are mammogram features of invasive carcinoma?
Pre-invasive: unifocal / widespread microcalcifications ● Invasive carcinoma: 1. Irregular spiculated mass 2. Clustered microcalcifications 3. Linear branching calcifications.
What is the first-line surgical treatment for breast cancer?
Tumour excision or mastectomy +/- breast reconstruction ○ Plus sentinel lymph node biopsy (no evidence of nodal spread) or axillary node clearance
When is radiotherapy used in breast cancer management?
After surgery, especially for invasive cancers. radiotherapy
○ Whole breast / partial-breast
○ If tumour is invasive (i.e. not DCIS, LCIS), systemic third line therapy is indicated
What systemic therapies are used for breast cancer?
: systemic therapy (guided by the PREDICT tool); oestrogen-receptor positive, HER2, chemotherapy. - systemic therapies can be neoadjuvant i.e. used to reduce tumour size before attempting surgery.
Oestrogen-receptor positive:
■ Pre-menopausal / male - tamoxifen (anti-oestrogen) ■ Post-menopausal - anastrozole / letrozole (aromatase inhibitor, prevents peripheral oestrogen synthesis) ■ Note - tamoxifen therapy can be continued long-term (5 years) before
switching to an aromatase inhibitor.
HER2 (human epidermal growth factor receptor 2) positive:
Trastuzumab (Herceptin)
Chemotherapy:
■ Including a taxane and an anthracycline ■ E.g. ACT: doxorubicin, cyclophosphamide and paclitaxel
