booby cancer Flashcards
(31 cards)
breast cancer risk factors
- Female
- Increased oestrogen exposure – earlier onset of periods + later menopause
- More dense breast tissue – more glandular tissue
- Obesity
- Smoking
- Fam history – first degree relative
- HRT – particularly combined HRT containing bother oestrogen + progesterone
- COCP – gives small increase in risk of breast cancer, but risk returns to normal 10 yrs after stopping pill
breast cancer screening
mammogram every 3yrs to women age 50-70yrs
- bilateral MLO + CC
- suspicious finding go to 1 stop clinic
1 stop clinic = triple assessment
- imaging - US, mammography >40yrs
- pathology - core biopsy, large volume vacuum biopsy
-> scoring 1 to 5
origins of metastatic breast cancer
2Ls 2Bs
Lung
liver
bones
brain
breast cancer imaging
US
- lumps in young (<30)
- helpful distinguishing solid to cystic
mammograms
- more effective for older
- can pick up calcification missed by US
MRI
- screening high risk women
- to further assess size + feature of tumour
mastectomy vs wide local excision
mastectomy
- multifocal tumour
- central tuour
- large lesion in small breast
- DCIS >4cm
- patient choice
wide local excision
- solitary lesion
- peripheral tumour
- small lesion in large breast
- DCIS <4cm
- patient choice
who is radiotherapy offered to post breast cancer surgery
- wide local incision
- T3/T4 tumours + those with 4 or more positive axillary nodes
- palliative breast radiotherapy
for it to be effective should start within 12week
- if also requires chemo, this is delivered first + RT commences 4 weeks after last doses of chemo
hormone treatment in oestrogen receptor positive women
premenopausal = tamoxifen
postmenopausal = aromatase inhibitors (letrozole/anastrozole)
biological therapy in HER2 positive cancers
trastuzumab (Herceptin)
*cannot be used in patients with hx of heart disorders
indications for neoadjuvant chemotherapy
(neoadjuvant = before primary treatment)
downsizing a tumour (inoperable to operable) + coverting to lumpectomy instead of mastectomy
enrolling patients on clinical trial for “indow of opportunity”
locally advanced breast cancers
large primary tumours
indications of adjuvant chemo
(adjuvant = after primary treatment)
risk of relapse
tumour
extent
grade
proliferation
vascular invasion
online prognostic tool of breast cancer
PREDICT v2
- oncotype DX test used mostly in tayside
triple neg early breast cancer
chemo - neoadjuvant/adjuvant
20% of breast cancers
higher risk to develop brain / CNA or visceral mets
inflammatory breast cancer
1-3% of boob cancers
present similarily to breast abscess or mastitis
- swollen, warm, tender breast with pitting skin (peau d’orange)
- does not respond to antibiotics
worse prognosis than other breast cancers
in situ carcinomas
ductal (DCIS)
lobular (LCIS)
in situ carcinoma
- confined within basement membrane of acini + ducts
- cytologically malignant but non-invasive carcinoma
lobular in situ neoplasia
marker of subsequent risk
true precursor lesion - invasive malignancies arise from it
- atypical lobular hyperplasia
- lobular carcinoma in situ`
histology of lobular in situ neoplasia
solid proliferation
intracytoplasmic lumens
ER positive
E-cadherin neg
features of lobular carcnoma in situ
frequently multifocal +bilateral
low incidence - decreases more after menopause
not palpable, not visible grossly
may calcify - mammography
usually an incidental finding
intraductal proliferations risk of going malignant
- Epithelial hyperplasia of usual type – 2x RR
- Columnar cell hyperplasia +/- atypia
- Atypical ductal hyperplasia – 4x RR
- Ductal carcinoma in situ – 10x RR
- (RR = risk of going malignant)
ductal carcinoma in situ
15-20% of breast malignancies
pre/cancerous epithelial cells of breast ducts
localised to a single area
usually nonpalpable, picked up on screening
arises in TDLU
characteristically unicentric -> single duct system
confined within basement membrane of duct
- may involve lobules - cancerisation
- may involve nipple skin - Pagets
ductal carcinoma in situ on imaging + definitive diagnosis
malignant calcifications
shape - linear or branching
distribution - cluster or segmental
pleomorphic (varying) size + density
definitive diagnosis = vacuum assited core biopsy
microinvasive carcinoma
rare
DCIS (high grade) with invasion of <1mm
malignant invasive breast cancer
malignant epithelial cells which have breached the basement membrane
infiltration of normal tissue
risk of metastasis + death
assoc tumours with BRAC1 + BRAC2
BRAC1 - breast, ovarian, bowel, prostate
BRAC2 - breast, ovarian, prostate, pancreatic
which hormone recepter breast cancer carries the worst prognosis
triple neg
- cancers which do not express HER2, progesterone or oestrogen receptor
(progesterone receptor - supports ER, rarely positive is ER neg)
