FN: Breast cancar: Pathology, presentatin and Assessment Flashcards Preview

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Flashcards in FN: Breast cancar: Pathology, presentatin and Assessment Deck (29):
1

Epi

Affects 1/10 women
20000 case/yr in UK
Commonest cause of cancer in females between 15-54
Second commonest cause of deaths overall

2

Risk Factors

Family Hx
Oestrogen Exposure
Proliferative breast disease w/ atypia
Previous breast cancer
increasing age
Breast feeding is protective

3

Family History

10% breast Ca is familial - one first degree relative 2x risk
5% association with BRCA mutations

4

BRCA 1 (17q)

80% breast cancer, 40% + ov Ca

5

BRCA2 (13q)

80% breast Ca

6

Oestrogen exposure

Early menarch, lat emenopause
HRT, OCP (million women study)
First child >35 yrs
Obesity

7

Pathology

DCIS/LCIS
Invasive Ductal Carcinoma, NST/NOS
Phyllodes tumours

8

DCIS/LCIS

Non-invasive pre-malignant condition
Microcalcification on mammography
10x increased risk of invasive CA

9

Invasive ductal Carcinoma

commonest 70% of cancer
Feels hard (scirrhous)

10

Other subtypes

1. Invasive lobular - 20% of cancer
2. Medullary: affects younger pts. feels soft
3. Colloid/mucinous: occur in elderly
4. inflammatory: pain, erythema, swelling, paeu d'orange
5. Papillary

11

Phylloides tumour

Stromal tumour
Large, non tender mobile lump

12

Spread

1. Direct extension - muscle and or skin
2. Lymph - p'eau d'orange and arm oedema
3. Blood:

13

Blood spread signs

1. Bones: bone pain, fractures, Raised Calcium
2. Lungs: dyspnoea, pleural effusion
3. Liver: abdo pain, hepatic impairment
4. Brain: headache, seizures

14

Screening

Every 3 yrs from 47-73
Craniocaudal and oblique views
reduced breast cancer deaths by 25%
10% false negative rate

15

Presentation

Lump
Skin changes
Nipple
Mets
May present through screening

16

Lump presentation

Commonest presentation of Ca breast
1. usually painless
2. 50% in upper outer quadrant
3. ± axillary nodes

17

Skin changes

Pagets: persistent eczema
Pean d'orange

18

Nipple

Discharge
Inversion

19

Mets

Pathological fractures
SOB
Abdominal pain
Seizures

20

differential

cysts
fibroadenomas
DCIS
Duct ectasia

21

Tripple assesment: any breast lump

1. History and clinical examination
2. Radiology
3. Pathology

22

Radiology

35yrs US + mammography

23

Pathology

Solid lump: tru-cut core biopsy

Cystic lump: FNAC (green/18g needle)
1. reassure if clear fluid
2. send cytology if bloody fluid
3. ccore biopsy residual mass
4. core biopsy if +ve cytology

24

Bloods to do

FBC
LFTs
ESR
Bone profile

25

Imaging

Staging
CXR
Liver US
CT scan
Breast MRI: multifocal disease or with implants
Bone scan and PET-CT

May need wire-guided excision biopsy

26

Clinical staging: stage 1

Confined to breast, mobile no LNS

27

Stage 2

Stage 1 + nodes in ipsilatera axilla

28

Stages 3

Stage 2 + fixatino to muscle (not chest wall)
LNS matted and fixed, large skin involvement

29

Stage 4

Complete fixation to chest wall + mets

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