Breast Cancer Flashcards
(34 cards)
Risk Factors (9)
Age Oestrogen exposure (early menarche, late menopause, few pregnancies, no breastfeeding, COCP, HRT) Obesity Smoking Low activity level alcohol diet drugs-aspirin reduces, exogenous oestrogen radiation exposure
Genes associated with breast cancer and mode of inheritance
BRCA1-Auto D, also assoc. w. ovarian ca. BRCA2-Auto D Li fraumenti Ataxia telangiectasia Cowden (hamartomas)
Most common site for malignancies in the breast
upper outer quadrant
Features of carcinoma in situ (3)
Tumour hasn’t invaded basement membrane of epithelium
cancer present within DUCTAL and LOBULAR structures
cancer hasn’t spread to LNs therefore curable
Features of DCIS(7)
Most common non-invasive ca.
occurs in pre/post-menopausal women
usually unilateral and unifocal
can be clinically detectable (mass)
can be radiologically detectable (micro-calcifications)
histology may show comedo necrosis (assoc. w. high grade)
assoc. w. Paget’s (Paget’s +painless bloody discharge=DCIS)
Features of Lobular carcinoma in situ (4)
RARE
pre-meopausal
bilateral and multifocal
not clinically or mammographically detectable
Pathological features of invasive breast ca. (2)
invades basement membrane
arise at junction of extra and intralobular ducts
Presentation of invasive breast ca. (7)
Hard, irregular lump Inflammation nipple eczema (=paget's) peau d'orange-impaired lymph drainage but hair follicles anchored (=LN involvement) breast pain axillary lymphadenopathy distant effects (sometimes screening can detect microcalcifications which may be first presentation)
Mammographical features of invasive ca.
Ill-defined calcifications
Types of invasive breast ca. (3)
75% no special type
25% special type
inflammatory breast ca.
subtypes of “no-special type”
infiltrating ductal-more common post-menopausal
non-otherwise specified-worst prognosis
NST
Special type (6)
Lobular-multifocal, Hx of disease in other breast
ductal-unilater, unifocal, best prognosis
mucinous
tubules
papillary
medullary
Features of inflammatory breat ca. (5)
impaired lymphatic drainage progressive oedema and erythema of breast no palpable lump normal WCC and CRP elevated CA 15-3
Features of Paget’s disease of nipple (2)
seen in 2% of invasive breast ca.
nipple changes-ITCHY, roughened, ulcerated, red
(bilateral/nipple-sparing eczematous changes are probably just eczema)
what does Paget’s disease of the nipple indicate?
underlying invasive breast ca.; most commonly high-grade DCIS
Microscopic appearance of Paget’s nipple disease
Large malignant glandular cells present within epidermis of the skin of the nipple.
Mx of Paget’s nipple disease
Surgical resection of ca.
if ca. can’t be located then mastectomy is indicated.
(curative)
4 Types of breast ca.
Hormone sensitive-oestrogen/progesterone sensitive
HER2 overexpression-more aggressive, poorer prognosis
Triple negative (O/P/HER2-ve)- poor prognosis
BRCA1/2-inherited ca.
Definition of T1 stage
Size of T1a,b,c tumours
Confined to breast
a=<5mm
b=5-10mm
c=>1cm
Definition of T2 stage
spread to ipsilateral axillary LN
2-5cm
Definition of T3 stage
spread to internal mammary chain
5-10cm
Definition of T4 stage
Definition of 4a/b/c/d
Any distant metastases despite size/T or N stage.
Present at different sights. Bone, liver, lungs, brain and including supraclavicular LN involvement.
a=chest wall spread
b=skin
c=skin and chest wall
d=inflammatory breast ca.
Further Staging(2)
Examine axilla via US: if axilla normal, remove sentinel node, if abnormal give radioactive dye+axillary node clearance.
Sentinel node biopsy(DURING OPERATION): if clear leave axillary nodes, if cancer cells>axillary node clearance.
Methods of spread (3)
direct-muscle and skin
lymphatic-axillary and other LNs
blood-distant organs e.g. liver, lungs, brain
