BREAST CARCINOMA Flashcards
(42 cards)
Describe/ summarise basics:
- Can be ductal (arising from milk ducts) or lobular (originating from lobules).
- They can be in situ or invasive.
- Paget’s disease is an infiltrating carcinoma of the nipple epithelium (represents 1% of all breast cancers).
What are the 3 main types?
DCIS: Ductal carcinoma in situ
LCIS: Lobular carcinoma in situ (isn’t malignant, but are cancerous changes)
Paget’s disease
Lifetime risk of UK females developing breast cancer
1 in 8/9
Most common cause of lump in what age group
> 60 (postmenopausal),
How old are most people with breast cancer?
can affect women of any age (most commonly >50)
What % of cases are male?
Only 1% of cases are male.
How common is the cancer in women?
Most common cancer in women in the world
How common is death from this cancer?
2nd most common cause of death from cancer in UK
What is the aetiology?
Over-proliferation of cells in either the lobules or ducts of the breast
What are the genetic risk factors?
BRCA1/2 genes
What % of women with BRCA1 develop breast cancer by 70?
55-65% of women with the BRCA1 mutation will develop breast cancer by the age of 70,
What % of women with BRCA2 develop breast cancer by 70?
45% of women with inherited BRCA2 will develop breast carcinoma by the same age.
What are the risk factors?
• Female sex • Old age • Smoking • Previous history • Family history • Genetics – BRCA1, BRCA2 and TP53 mutations carry very high risk • No children • Uninterupted oestrogren receptors: o Nulliparity o Early menarche o Late menopause o 1st pregnancy >30yrs o HRT o Obesity (fat produces small amounts of oestrogen) o Not breastfeeding • Radiation to chest (even small doses) • High alcohol intake • Men with Klinefelter’s syndrome • Gynaecomastia • Adult height
What is most common presentation?
Painless lump in breast
4 most common symptoms
- Lump (80%)
- Nipple change (10%)
- Skin contour changes (5%)
- Nipple discharge (3%)
How is a lump likely to present?
painful in 20% - hard, irregular, fixed, painless, skin dimpling
How is skin likely to present?
dimpling or thickening of the breast skin, inverted nipple, bloody discharge, eczematous patch of skin on the nipple and surrounding areola
What % of all lumps aren’t malignant?
90%
Other symptoms
- Breast pain/mastalgia alone uncommon
- Bloody nipple discharge – intraduct carcinoma
- Swelling or lumps in the armpit may also be noticed (axillary sentinel node involvement).
- Change in shape or size of breast
- Rarely (most common in advanced inflammatory carcinoma) breast mastalgia (pain) may develop.
Signs
- Peau d’orange
- Skin ulceration
- Nipple inversion
- Gross deviation
- Discharge (clear – concerning because cysts don’t usually discharge/bloody), tethered lump (to skin above or chest wall), hard and non-tender lump, nodes feel matted and fixed together/to other structures in axillary involvement.
- Fixity to pectoral muscles (engage muscles when examining on that side).
Where might it metastasise?
bone, liver, brain, lungs – examine for hepatomegaly/abdominal pain. .
Other non-breast symptoms?
Tender spine (bone), breathlessness (respiratory symptoms), headaches and cognitive symptoms
Investigations - triple assessment
- clinical examination
- radiology (ultrasound <35 years, mammogram >35years),
- histology/cytology (core biopsy – can be ultrasound guided).
Mammography Fine needle aspiration Core biopsy Staged using TNM Can also do USS of breast and surrounding lymph nodes
Cystic lumps are aspirated, any residual mass is biopsied and the aspirate is studied - what do the results mean?
Clear aspirate is discarded and the patient can be reassured (more emphatically with no family history and biopsy shows non-proliferative lesion) and discharged from hospital. Bloody aspirate is sent to cytology for assessment.
Solid lumps undergo a core biopsy – any clear fluid is a reassuring sign of a simple cyst, but otherwise malignancy is expected.
