Breast cancer

38 Breast cancer





Questions



image Who is screened for breast cancer?

image How is a presurgical diagnosis of breast cancer formed?

image How is lymph node status determined?

Breast cancer is the commonest cancer affecting women: 1 in 10 women develop the disease in the UK. All women aged 50 to 70 years in the UK are currently invited for mammography. Less than 1% of breast cancers occur in males, where prognosis is worse because they present later.




Aetiology


Risk factors include:


image age: higher over 50 years; rare under 35 years

image family history: first-degree relatives

image genetics: 5% of cancers are caused by breast cancer genes (BRCA1 and BRCA2); they give an 80–90% risk of developing cancer

image oestrogen exposure: early menarche (< 12 years), late menopause (>55), oral contraceptives, hormone replacement therapy, obesity.


Clinical features


Breast cancer can present with specific features (Fig. 3.38.1), during screening (mammography; Fig. 3.38.2), which has reduced mortality by 30%, or as metastatic disease (back pain (vertebrae), breathlessness (lungs), jaundice/abdominal distension (liver)).


image

Fig. 3.38.1 Presentation of breast cancer.


image

Fig. 3.38.2 Mammography: (A) normal (craniocaudal view); (B) a spiculated mass.



Pathology


Ductal carcinoma is the most common type. The rarer variants (lobular, tubular, cribriform, mucinous, medullary) have distinctive histological appearances and a better prognosis.




Oestrogen receptor (ER) expression


A tumour expressing ERs is dependent on oestrogen and susceptible to hormone therapies. The ER status is determined histologically; ER-positive tumours (more common) have a better prognosis.



Ductal carcinoma in situ


This is a non-invasive cancer where malignant cells have not penetrated the epithelial basement membrane and so have not yet extended out of the breast duct system. It may be detectable by mammography and biopsy of microcalcification before invasion occurs and is usually asymptomatic.



Paget’s disease of the nipple


This is a skin manifestation (patch of eczema around the nipple) of an underlying breast malignancy (1% of cancers). Ductal carcinoma in situ is often associated early on, but it will develop into invasive cancer if untreated. An underlying lump may be palpable (not always), and mammography and nipple biopsy should be performed.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Breast cancer

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