Breast carcinoma

Question 1

What is the epidemiology of breast carcinoma?

Answer 1

Most common cancer in woman and 2nd most common cause of death from cancer

Question 2

What is the pathology of breast carcinoma?

Answer 2

• Originates from epithelial cells – ductal or lobules
• Cellular dysplasia in situ → invasive
• Tumours respond to oestrogen, progesterone or hersertin – affected treatment option

Question 3

What are the aetiology/risk factors for breast carcinoma?

Answer 3

• Alcohol
• Oestrogen – i.e. HRT, COP
• Obesity
• History of breast cancer
• Breast augmentation
• Never having borne a child (nulliparity)
• First child after the age of 30
• Age – risk ↑ with ↑ age
• Family history
• BRACA1/2 gene
• Breastfeeding - protective

Question 4

What are the signs/symptoms for breast carcinoma?

Answer 4

• Puckered/indrawn nipple
• Painless dense lump
• Peau d’orange - oedema
• Skin red and warm = inflammatory carcinoma
• Discharge – bloody
• Lump under the arm
• Nipple ‘eczema’ – Paget’s

Question 5

What other diseases present similarly to breast carcinomas?

Answer 5

• Fibroadenomas

* Benign breast disease i.e. breast cysts

Question 6

What investigations are carried out for suspected breast carcinoma?

Answer 6

• Breast examination
• Bilateral mammogram
• US of breast and regional lymph nodes
• Core needle biopsy
• Fine needle aspirations
• Monoclonal antibody techniques – to identify PR, OE or HER2 receptors
• Routine bloods
• CXR
• CT – if metastases expected

Question 7

What are the surgical treatments for breast carcinoma?

Answer 7

• Wide local excision
• Mastectomy
• Sentinel lymph node biopsy – acceptable if axillary node involvement is not present
• Axillary node clearance

Question 8

What are the pharmacological treatments for breast carcinoma?

Answer 8

• Tamoxifen
• Selective oestrogen receptor modulators (SERMs)
• Aromatase inhibitor hormone antagonists e.g. anastrozole
• IV trastuzumab/lapatanib – HER2 malignancy
• Radiotherapy
• Chemotherapy
• Bisphosphanates

Question 9

What are the non pharmacological treatments for breast carcinoma?

Answer 9

• TNM staging