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Flashcards in Breast Cancer Deck (12):

Epidemiology of breast cancer
Lifetime risk in women?

Most common female cancer
1 in 12 women will develop cancer in their lifetime


Risk factors of breast cancer

Duration of oestrogen exposure
Ionising radiation
Family history esp if under 50
Brca 1 and 2 associated with early onset


Histology of Breast cancer

Infiltrating ductal carcinoma - 70-80%
Lobular carcinoma - 10%

ER and PR positive have a better prognosis and can be treated with tamoxifen

Her2 worse prognosis but can be treated with herceptin


What is triple assessment?

History and exam
Bilateral mammogram/ultrasound
FNAC, needle, incisional, excisional


How is stage assessed in metastatic breast cancer

MRI, bone scan, or ct


What is the TNM staging of breast cancer

T1 less than 2cm
T2 2-5cm
T3 greater than 5cm
T4 skin
N1 mobile axillary nodes
N2 fixed axillary nodes
N3 internal mammary nodes
M1 distant mets


Management of localised breast cancer

Wide local excision and post op radiotherapy


Sentinel node biopsy


When is radiotherapy used in the management of breast cancer

Following wide local excision

Following mastectomy if high risk

NOT usually after axillary dissection - except if increased risk of local recurrence


How is endocrine therapy used in adjuvant treatment of breast cancer

Tamoxifen if ER positive for 2-5 years
Aromatase inhibitors- anastrozole letrozole in post menopausal women

Ovarian ablation in premenopausal women- oophorectomy, radio induced

Trastuzumab if her2 positive, in metastatic or localised disease


How is endocrine therapy used in metastatic disease

One third respond to endocrine therapy
Ovarian ablation with lhrh agonists, oophorectomy
Antioestrogens - Chlomiphene


How is chemotherapy used in the management of localised and metastatic disease?

Adjuvant to decrease recurrence, greater effect if less than fifty

To palliate in metastatic disease


Who should be urgently referred within 2 weeks for suspected breast cancer?

Breast lump with features of cancer
Breast lump in post menopausal woman
Breast lump in woman over 30 without features of cancer, persisting after her next period
Spontaneous nipple discharge
Skin change on breast not responding to treatment