Breast cancer Flashcards
(36 cards)
List the modifiable risk factors for breast cancer
obesity HRT >5 years COCP, HRT >5 years alcohol nulliparity/ late childbirth
List the non modifiable risk factors for breast cancer
genetic - BRCA gene (50% chance of gene if first degree relative with it), family history
early menarche and late menopause
breast density
Which ages are offered the NHS breast screening programme?
47-73 y/o
offered mammogram every 3 years
What are the common types of breast cancer?
invasive ductal carcinoma **
invasive lobular carcinoma
ductal carcinoma in situ
lobular carcinoma in situ
How might a cancerous breast lump present?
- palpable lump - hard, craggy, irregular, fixed
- nipple discharge
- +/- pain or tenderness
- nipple in drawing
- skin tethering
When would you consider referring a patient presenting with a breast lump?
previous breast cancer problems unexplained lump tenderness or pain nipple changes abscess or mastitis family history
How are breast lumps assessed?
TRIPLE ASSESSMENT (score out of 15)
- CLINICAL SCORE - examination, history
- IMAGING SCORE- mammogram +/- ultrasound
(mammogram not useful if <40 y/o as breast tissue too dense and not very useful) - distinguish between cystic and solid lesions - BIOPSY/ PATHOLOGICAL SCORE - core biopsy with USS guidance - send for histology
What is first line therapy in breast cancer?
SURGERY !!!
- lumpectomy
- mastectomy
- breast reconstruction - immediately or delayed
- surgery to the axilla - full axillary clearance or limited axillary clearance (SE: lymphedema in the arms)
When is a lumpectomy considered?
lump <25% of breast tissue or <4cm
patient choice
small lesion in big breast
no previous radiotherapy
When is a mastectomy considered?
central tumour large density inflammatory cancers previous breast surgery small breasts patient choice
How is breast cancer staged?
TNM staging
T- size
N- nodes involved
M- metastases
When is chemotherapy considered for breast cancer?
offered for high risk disease .... young age HER2 +VE grade 3 or more node positive ER -VE
What else should be offered alongside lumpectomy?
radiotherapy !
all women who undergo lumpectomy should have radiotherapy + mastectomy that are aggressive
How are oestrogen receptor (ER) positive women treated?
endocrine therapy for 5 years
premenopausal - tamoxifen
post menopausal - aromatase inhibitors e.g. anastrozole
What are the side effects of tamoxifen?
menopausal symptoms e.g. hot flushes, nausea, vaginal bleeding
increased risk of endometrial cancer
increased risk of VTE
How does tamoxifen work?
inhibit oestrogen receptor on breast cancer cells
How does aromatase inhibitors work?
inhibit aromatase which converts androgens to oestrogen so less oestrogen
SE: hot flushes, reduced bone mineral density
How are HER 2 +VE women treated?
trastuzumab (herceptin) and lapatinib for 1 year + chemotherapy
What is the management plan for metastatic breast cancer?
- refer to palliative care team
- analgesia
- treat hypercalcaemia, dehydration or electrolyte imbalance
which score if used for indication of survival?
Nottingham prognostic index
When diagnosing breast cancer, what must also be checked for management?
- oestrogen receptor status
- HER2 status - detect by immunohistochemistry / FISH
- CT and PET for staging and check for mets
List some differentials for breast lumps?
- breast cancer / pagets disease of breast
- fibroadenoma
- breast cyst
- sclerosis adenomas
- epithelial hyperplasia
- fat necrosis
- duct papilloma
- mammary duct ectasia
Describe the features of a fibroadenoma
“breast mice” in <30 y/o
mobile firm non tender breast lumps
How are fibroadenoma managed?
if >3cm = surgical excision
