Breast Cancer
Epidemiology
1/8 women
Risk Factors
Clinical Features
Investigations
To diagnose (Triple assessment)
1. Clinical
2. Imaging (mammogram/ US)
3. Biopsy (FNA - cytology; Core - histo/ cytology)
NOTE: Core biopsy tells invasion , type (ductal/ lobular), grade, ER/PR
NOTE: ductal grows as lump, lobular single file
NOTE: DCIS is pre-malignant, LCIS is not. LCIS can be left untreated.
Treatment
Surgery
Adjuvant treatment
F/U
Source
Dr Fiona Lee
1/8 women
Risk Factors
- Oestrogen exposure
- Endogenous (Early menarche, late menopause)
- Exogenous (>5y HRT, OCP)
- FHx
- N risk (80%)= 1o relative dx >50y
- Mod risk (15%) = 1o relative dx <50y/ ≥2 1o or 2o relatives (same side)
- High risk (5%) = ≥2 1o relatives <40y
- 1st Childbirth >30y
- No lactation
- Radiation
Clinical Features
- Breast lump
- Nipple changes
- Skin dimpling/ scabbing
- Discharge
Investigations
To diagnose (Triple assessment)
1. Clinical
2. Imaging (mammogram/ US)
3. Biopsy (FNA - cytology; Core - histo/ cytology)
NOTE: Core biopsy tells invasion , type (ductal/ lobular), grade, ER/PR
NOTE: ductal grows as lump, lobular single file
NOTE: DCIS is pre-malignant, LCIS is not. LCIS can be left untreated.
Treatment
Surgery
- Conservative (w radiation) - lumpectomy
- Masectomy (lobular ca, multifocal, ↑ca v breast vol, BRCA)
- No radiation
- Risks of surgery
- General (bleeding, infection)
- Specific (lympadema, nerves, seroma, axillary web syndrome)
- Anaesthetic
- Immobility (DVT/ PE, pneumonia, atelectasis)
Adjuvant treatment
- Chemo (hair loss, n+v, ulcers, dec WCC, fatigue, joint pain)
- XRT (for lumpectomy only)
- Herceptin (cardiotoxicity --> DVT)
- Tamoxifen (oestrogen blockage)
F/U
- q6mo for 5 years
- q1y MMG/ US
Source
Dr Fiona Lee