Breast cancer Flashcards
(25 cards)
Features of breast cancer?
Lump: hard, irregular, fixed, painful or painless
Nipple: retraction, discharge, rash
Skin: p’eau de orange, ulceration, retraction
Axilla: mass
When to refer patients on two week wait with a breast lump?
Unexplained breast/axilla lump in > 30 yo, unilateral nipple changes in > 50 yo or skin changes suggesting breast cancer
When to routinely refer patients with a breast lump?
Unexplained breast lump in < 30 yo
Risk factors for breast cancer?
Female
Early menarche/late menopause
Nulliparity or late first pregnancy
Oral contraceptives or HRT
Susceptibility gene mutations
Most commonly BRCA mutations (BRCA1/BRCA2)
Advancing age
Obesity
Alcohol and tobacco
History of breast cancer
First degree relatives with breast cancer
Previous radiotherapy
When does the risk of breast cancer caused by COCP decrease?
After 10 years of stopping it
Which HRT increases the risk of breast cancer?
Combined HRT (oestrogen and progesterone)
What is the most common mutation causing breast cancer?
BRCA 1 (chromosome 17) or BRCA 2 (on chromosome 13) gene mutations
What is invasive ductal carcinoma?
What is ductal carcinoma in situ?
Cancer starting in breast duct and invades fatty tissue of breast
Most common breast cancer type
Cancer starting in breast duct and is localised to it
What is invasive lobular carcinoma?
What is lobular carcinoma in situ?
Cancer starting in breast lobules
Not a cancer but abnormal cell growth of lobules which increases risk of invasive breast cancer later
What is Paget’s Disease of the Breast?
How does it present?
Carcinoma of the nipple epithelium
Erythematous, scaly rash of nipple/areola
What is inflammatory breast cancer?
Rare, aggressive type
Causes lymph vessel obstruction of the breast
Worse prognosis than other breast cancers
How is breast cancer classified?
Based off origin cell type, eg. ductal, lobular carcinomas, Paget’s disease
Or based off hormone receptors present on breast cancer e.g. inflammatory, triple negative, HER2 positive breast cancer
What is triple negative breast cancer?
Lacks oestrogen, progesterone and HER2 receptors
More aggressive, less treatments available
What is HER2 positive breast cancer?
Cancer with HER 2 receptors
More aggressive than other breast cancers
Who is breast cancer screening offered to?
How often is it done?
What does it involve?
All women registered with a GP and aged 50-70
Done every 3 years
Mammogram
Criteria for an annual mammogram?
What else may these patients be offered?
High risk patients for breast cancer such as:
1st degree relative with breast cancer under 40 years
1st degree male relative with breast cancer
1st degree elative with bilateral breast cancer, diagnosed under 50 years
Two 1st degree relatives with breast cancer
Tamoxifen if premenopausal
Anastrozole if postmenopausal (contraindicated in severe osteoporosis)
Risk reducing bilateral mastectomy/bilateral oophrectomy
Investigations for breast cancer?
Triple assessment: clinical examination of breast/lymph nodes, ultrasound/mammogram, and biopsy
How is staging for breast cancer assessed?
Axilla ultrasound and then if abnormal lymph nodes found, → needle sampling of lymph nodes
Then may do CT/bone scintigraphy if cancer deemed to be advanced
PET CT only used to diagnose metastasis, NOT staging
What and who are ultrasounds usually for to vs mammogram when breast cancer is suspected?
What other imaging modality may be used?
US = under 30yo women, helpful for distinguish solid lumps from cysts
Mammogram = older women, picks up calcifications missed by US
MRI
What are the first lymph nodes breast cancer spread to?
Which lymph nodes are biopsied during breast cancer surgery?
Sentinel LNs for both
Where does breast cancer usually metastasise to?
Lungs
Liver
Bones
Brain
Surgical management for breast cancer?
Breast conserving surgery + radiation
Mastectomy
What medications are used for:
ER+ breast cancer & premenopausal
ER+ breast cancer & postmenopausal
HER2+ breast cancer
Tamoxifen
Anostrazole
Trastuzumab
Side effects of tamoxifen?
↑ risk of Endometrial cancer
VTE
↑ menopausal symptoms
