Breast Cancer ☺️ Flashcards
Epidemiology and prognosis
No 1 female cancer in the west
No 1 cancer in UK
5% inherited
1% < affects men
Increasing incidence
Decreasing mortality
Risk factors
-personal
-genetics
Older females
-IC, obesity
-nulliparous/early menarche/late menopause/not breastfeeding
-HRT/COCP use
Genetics
-BRCA1, 2 (ovarian, breast)
-p53 mutation in TS (LiFraumeni -sarcoma, breast, leukemia, adrenal)
-PTEN
-1st deg premenopausal + BC
-Hx BC, RT
SMOKING NOT A BIG RISK FACTOR
Presentation
Common location - ULQ
Skin changes - red, peau d’orange, dimples, puckers
Nipple changes - discharge, inversion, ulcer/eczema
Breast lump
Axillary mass
Lymphodema
Asymptomatic - US/mammography detected
Investigations
-1 stop clinic for 2ww
-further investigations post diagnosis
2WW => Triple assessment at 1 stop clinic
History and clinical exam
Imaging - US in U35, mammogram 35+
-MRI if discordance between exam + imaging
-PET/CT, bone staging scan for mets
Cell diagnosis - FNA
Histology diagnosis - core biopsy
Once diagnosed => IHC for ER, PR, HER rec
Types of breast cancer
-receptor types and prevalence in different populations
Most common - ID
-can arise from DCIS
-poor prognosis
DCIS - not invasive at lower grades
Lobular carcinoma - less common
-more likely to be multifocal => contralateral breast
LCIS - asymptomatic, managed with close monitoring
Receptor type
-ER, PR most common in older adults
-HER2 - confirm with FISH if unsure
-Younger women often = 3-ve
Types of treatment
-considerations needed
-drug treatments and SE
Mastectomy
-multifocal or central
-large tumour in small breast
-DCIS 4cm+
WLE => no SLNB
-peripheral or solitary
-small tumour in large breast
-DCIS U4cm
ID + SLNB
-Mastectomy more likely but WLE possible
Neoadjuvant or adjuvant RT/endocrine/chemo
-ensures all cancer is destroyed
-delay reconstruction due to effects of radiotherapy on skin
ER+
SERM - tamoxifen
-VTE, endometrial cancer risk
-menstrual disturbance, hot flushes
aromatase inh - anatrozole, letrozole
-osteoporosis, arthralgia, myalgia, hot flushes
ER- -chemo, other drugs
HER+ - Trastuzumab
-cardiotoxic
Breast Screening Programme
Mammogram every 3 years for 47-70y/o
More frequent in BRCA+, TP53, FHx
U40 - MRI
40+ - mammogram
Breast cancer tumour marker
When would you use this
CA15-3
Monitor treatment and progression
Where does breast cancer most often metastatise to
Lymph nodes
Brain
Bone
Lung
Liver
Axillary
Int mammary chain
Sup/infclavicular
2WW criteria
2WW
Skin changes
30+ unexplained breast lump/axilla lump
50+ unilateral nipple discharge, retraction, other changes
Sentinal lymph node biopsy
-what is it?
-when is it done
-what is involved
-what next
-complications
LN that drains the breast
-breast conserving surgery => no SLNB
During a SLNB
-1-3 LN removed => reduce SE
-no cancer found => no further treatment
-cancer found => further ALN treatment needed (surgery, RT)
Invasive breast cancer => axillary LN dissection
-done when cancer cells found in LN
Lymphodema risk
Sensory nerve damage
Limited shoulder movements
Fibroadenoma
-epidemiology
-presentation
Fibroadenoma - U30 breast mice
-discrete, non tender, highly mobile lump
Fibroadenosis
-epidemiology
-presentation
Fibroadenosis - middle aged
-lumpy painful breasts
-symptoms worse premenstruation
Paget’s disease of the breast
-presentation
Paget’s disease of the breast - intraductal carcinoma
-erythematous thickening of areola (eczema-like)
Mammary duct ectasia
-epidemiology
-presentation
Mammary duct ectasia - menopause
-dilation of large breast ducts
-tender areolar lump +-green nipple discharge
-rupture => inflammation
