Compare LCIS and DCIS prognostically and clinically?
Ductal carcinomas in situ are premalignant and can develop directly into an invasive ductal carcimonas
They present as a lump
Lubular carcinomas in situ are only risk factors for the development of adenomas and subsequent malignancies won't necessarily develop at the same site directly
They don't present as a lump
What are the medical therapies for breast cancer?
SERM - Tamoxifen
Herceptin - if HER2 positive
Chemotherapy - Cyclophosphamide, 5FU, Doxyrubicin, Methotrexate
Which ethnic group have a higher rate of BRA1 and 2?
Eastern European Jew - Ashkenazi
What is the recommended breast cancer screening?
1 mammography every two years for women 50-75 years
What are the main types of breast cancer?
What are the two endocrine therapy for breast cancer?
Oestrogen receptor antagonist - tamoxifen
Aromatase inhibitors - eg Anastrozole
Why does obesity increase the risk of breast cancer?
It increases the person's exposure to oestrogen
How are ductal carcinomas in situ treated?
Wide local excision with adjuvant radiotherapy
No chemo or hormal therapy required
What is the mechanism of action of aromatase inhibitors?
Block the conversion of testosterone to oestrogens to reduce the tissue concentration of oestrogen
What do intraductal papillary lesions present?
Nipple discharge - sometime with blood
Lump if large enough
What must you consider when giving a female patient chemotherapy?
Fertility - Chemotherapy induces menopause
What can be used if a patient is Her2 positive?
What often precipitates fat necrosis?
Trauma - eg seat belt injury
What is tamoxifen?
An oestrogen receptor antagonist
When is radiotherapy contraindicated?
When it has been performed previously
When the patient has scleroderma
Compare low and high grade carcinomas in situ
Low - Punched out cribiform
- Small regular nuclei
High - Large irregular nuclei
- Central necrosis
What regimen provides better reduction of risk of recurrence of breat cancer; total mastectomy or wide local excision and radiotherapy?
They are equvalent
What lifestyle factors can be modified to reduce the risk of breast cancer reoccurence?
Avoid weight gain
Where does breast cancer metastasize to?
How does fibrocytic disease present?
Lumpy, painful breast
What types of biopsies are there for breast Ca?
Fine needle aspirate
What types of cancers on FHx that increase the risk of breast cancer?
Familial gastric cancer
What investigations are helpful in breast Ca?
What is the most likely diagnosis of a new lump in a young woman?
What is Paget's disease of the nipple?
DCIS involving the nipple - extending into the epidermis
When is total mastectomy indicated?
When the patient is a carrier of a high risk gene - eg BRCA1 or 2
Or when wide local excision and radiotherapy is contraindicated