Breast Cancer Flashcards
(28 cards)
What are the different types of breast cancer?
- Invasive ductal carcinoma (most common. Starts in milk ducts)
- Invasive lobular carcinoma (starts in milk lobules)
- Ductal carcinoma in situ (non invasive - doesn’t extend past basement membrane)
- Lobular carcinoma in situ
- Inflammatory breast cancer
what are some rarer types of breast cancer?
- Medullar cancer
- Mucinous
- Phyllodes
What are the risk factors for breast cancer?
- Increased hormone exposure: Early menarche or late menopause. OCP or HRT
- Genetic mutations (BRCA)
- Advancing age
- Caucasion ethnicity
- Obesity and lack of physical activity
- Alcohol and tobacco use
- History of breast cancer
- Previous radiotherapy treatment
- Not breastfeeding
What are the signs and symptoms of breast cancer?
- Unexplained mass in patient > 30
- Nipple discharge, retraction in patient > 50
-Skin changes: Puckering, dimpling, peau d’orange, rash, redness - Axilliary lymphadenopathy
Which patients are referred for an appointment within 2 weeks?
- Age 30+ with an unexplained lump
- Age 50+ with nipple symptoms
- Consider referring in patients with skin changes or lumps in axilla
What are the differentials for breast cancer?
Fibroadenoma - Solitary, painless, well-circumscribed lump
Cyst: Well defined movable mass which can vary with size with menstrual cycle
Mastitis: Typically in breastfeeding women
Lipoma - Soft, mobile and painless lump
What is the breast cancer screening?
Women between ages 50-70 are given a mammogram every 3 years
What is involved at a triple assessment?
- Clinical examination
- Imaging: Mammogram or ultrasound. MRI for lobular breast cancer
- Biopsy. Core needle biopsy is better but can use FNA
What is Paget’s disease of the nipple?
Persistent roughening, scaling, ulcerating and ecxematous changes to the nipple. Majority have underlying neoplasm
What is the clinical presentation of Paget’s disease of the nipple?
- Itching or redness in the nipple and/or areola with flaking or thickened skin
- Area is often painful and sensitive with or without discharge
- Can look like eczema so biopsy needed
What is the surgical treatment for breast cancer?
Wide local excision if - Solitary lesion, tumour is peripheral, lesion is small.
Mastectomy - Multifocal lesion, lesion is central and large.
If no palpable axillary lymphadenopathy - US ans sentinel node biopsy
If palpable lymphadenopathy then axillary clearence.
What are the risks of axillary clearence?
It can cause lymphoedema and functional arm impairment
What non surgical treatment is offered for breast cancer?
Radiotherapy - Recommended after wide local excision.
Hormonal therapy - If oestrogen or progesterone +
Biological therapy - If HER2+
Chemotherapy - Neoadjuvant or adjuvant
What is used in oestrogen positive breast cancers
- If premenopausal then tamoxifen (increases risk of endometrial cancer)
- If postmenopausal then aromatase inhibitors
What drug is given for HER2+
Trastuzumab. Contraindicated in patients with heart disorders
WHat is the importance of endocrine treatment?
Chemo can’t prevent metastatic relapse but endocrine treatments can
What are the pathological prognostic factors?
Carcinoma grade
Carcinoma stage
What are the side effects of transtuzumab?
Diarrhoea, liver disease, heart issues, mouth sores and hypertension
What is inflammatory breast cancer?
Cancerous cells block lymph drainage resulting in inflamed appearance of the breast. Very aggressive
What is the management of ductal carcinoma in situ or lobular carcinoma in situ?
DCIS - Surgical excision
LCIS - Monitoring unless BRCA+ then prophylaxtic mastectomy is recommended
What is ductal carcinoma in situ?
Pre-cancerous/cancerous epithelial cells.
It is localised to a single area and often picked up via mammogram
What is lobular carcinoma in situ?
Pre cancerous lesion which is usually asymptomatic and undetectable on mammogram.
What are the most common sites of breast cancer metastasis?
Lung, liver, bones and brain
What are the non surgical management of lymphoedema?
- Massage techniques to drain lymph,
- Compression bandages,
- Weight loss,
- Good skin care
