Breast cancer Flashcards
(40 cards)
Who is the breast 2ww service for
All patients with a lump/discrete thickening
What is involved in the breast triple assessment
History and examination
Imaging (mammography, ultrasound)
Biopsy (wide bore needle, fine needle aspiration)
Roughly what percentage of breast cancer patients are male
1 %
What is the breast screening programme
Mammograms every 3 years
For women between 50 and 70
What are the clinical categories based on the clinical examination section of a breast triple assessment
P1 - normal (no changes, symmetrical changes)
P2 - benign (well-defined mass, benign thickening)
P3 - uncertain (mass, thickening not clearly benign)
P4 - suspicious (ill defined mass with skin thickening/pectoral fixation, retracted nipple)
P5 - malignant (cancer certain)
When are mammograms used in the triple assessment
For people > 35 (breasts not as dense)
Do not detect all cancers (lobular cancers missed)
Not ideal if using HRT
What are the clinical categories based on mammograms used as part of the breast triple assessment
M1 - normal
M2 - benign
M3 - intermediate
M4 - suspicious
M5 - malignant
When is ultrasound used in the breast triple assessment
Not used for screening
Good for lumps and focal lesions
Differentiation between cyst and solid lesion
Differentiation between benign and malignant
What are the clinical categories based on ultrasound scans used as part of the breast triple assessment
U1 - normal
U2 - benign
U3 - uncertain
U4 - suspicious
U5 - malignant
When is MRI used in breast triple assessment
Family history
Dense breasts
Young patients
Lobular cancers
What are the types of biopsy that can be taken in breast triple assessment
Fine needle aspiration
Core biopsy
Punch biopsy
How is the primary lesion assessed in pre-op staging for breast cancer
MRI breast
Biopsy
How is the axilla assessed in pre-op staging for breast cancer
Ultrasound
Biopsy
How are distant metastases screened for in the pre-op staging of breast cancer
Routine bloods
Calcium
Tumour markers (CA 15-3)
CT CAP
Bone scan
When is surgery used in breast cancer treatment
Primary form of therapy in most cases
Explain chemotherapy as a form of adjuvant therapy for breast cancer
Aims to reduce annual risk of relapse
All patients < 70 considered
Particularly useful in: young, lymph node positive, high grade, advanced disease
Common drugs: anthracycline, 5-FU, cyclophosphamide
Usually 4-6 cycles, every 3 weeks
Side effects: nausea, vomiting, alopecia, neutropenia
Usually starts 4-6 weeks after surgery
Explain immunotherapy as a form of adjuvant therapy for breast cancer
20-25% overexpress HER-2 receptors
Use herceptin (monoclonal antibody, can cause heart failure)
Explain radiotherapy as a form of adjuvant therapy for breast cancer
Target lump
Target chest wall (high risk of recurrence)
Target supra-clavicular area (if >3 nodes positive)
Explain the follow up involves after breast cancer treatment
Clinic follow up for 3 years (5 years if high risk of recurrence)
Annual mammograms for 5 years
Open access to breast clinic and breast care nurses
What is the prognostic tool used for breast cancer, what does it involve
Nottingham prognostic index
Based on: tumour size, grade, lymph node status
Explain normal breast development
Female breasts develop under influence of oestrogen and progesterone
Asymmetry is common
Regress after menopause
Between 2nd and 6th rib
Have 15-20 lobes
Supported by Cooper’s suspensory ligament
Name the arteries that supply the breast
External mammary artery
Internal mammary artery
Intercostal artery
What are the types of breast lumps by age of presentation
Cancer (risk increases with age)
Fibroadenoma (risk decreases with age, highest risk before 20)
Fibrocystic and cystic changes (peak around age 50)
What are the signs and symptoms of breast cancer
Lump or thickening in breast (hard, irregular, fixed)
Usually painless
Nipple discharge/bleeding
Change in size or shape of breast
Change in size or colour of areola
Pitting of skin over breast
