Breast Cancer Flashcards
What is ductal carcinoma in situ?
Malignancy of the ductal tissue in breast
Most common type of non-invasive breast malignancy
Investigations for suspected ductal carcinoma in situ?
Detected during screening - appears as microcalcifications on mammography
Management of ductal carcinoma in situ
Wide local excision
Or mastectectomy if widespread
What is lobular carcinoma in situ?
Malignancy of secretory lobules
Clinical features of lobular carcinoma in situ
Usually asymptomatic
Incidental finding on biopsy
Management of lobular carcinoma in situ
Treated via monitoring
What is invasive ductal carcinoma?
Most common type of breast cancer
Can be further classified into:
- tubular
- cribiform
- papillary
- mucinous
- medullary
What is invasive lobular carcinoma?
Second most common type of breast cancer
More common in older women
Characterised by a diffuse pattern of spread - makes detection more difficult
Risk factors for breast cancer
Female Genes - BRCA1/BRCA2 Family history Obesity Exposure to unopposed oxygen (early period, late menopause, no children)
Clinical features of breast cancer
Breast lump Asymmetry Swelling Nipple retraction Skin changes
What is the Nottingham Prognostic index?
Staging system for primary breast cancer prognosis
(size(cm)*0.2) + nodal status + grade
Score (5 year survival) 2-2.4 = 93% 2.5-3.4 = 85% 3.5 - 5.5 = 7-% >5.4 = 50%
Nodal status
0 nodes = 1
1-4 nodes = 2
>4 = 3
What is the Bloom-Richardson classification?
Grade of primary breast tumour
Tubule formation
1 = >75% of tumour
2 = 10-75& of tumour
3 = <10% of tumour
Nuclear Pleomorphism
1 = minimal/mild nuclear variation
2 = moderate nuclear variation
3 = marked nuclear variation
Mitotic count
per high power field
Grade 1 = 3-5
Grade 2 = 6-7
Grade 3 = 8-9
What is receptor status?
Breast malignancies shoul all be checked for receptor status to allow for suitable treatment options
Oestrogen receptor (ER) Progesterone Receptor (PR) Human Epidermal growth factor receptor (HER2)
When does breast screening occur?
NHS breast cancer screening programme
Every 3 years
50-70 years
What are surgical managements of breast cancer?
Mastectomy
- removal of all breast tissue
Wide local excision
- remove tumour + 1cm surrounding tissue
- must be combined with radiotherapy
Sentinel node biopsy
- radioisotope dye injected into peri-areolar skin
- sentinel nodes identified and removed
- sentinel node = first node tumour drains into
Axillary clearance
- remove all nodes in axilla
- level 1 = below pec minor
- level 2 = level of pec minor
- level 3 = above pec minor
