4 risk factors for Breast cancer
- increase age
- genetics (BRAC 1 and 2 gene, fam Hx, ovarian or breast Ca
- HIGH ESTROGEN states
- Beast condition statues (SCIS or LCIS
types of breast cancer
- ADENOCARCINOMA!!
T II MM Tubular carcinoma invasive lobular cancerima inflammatory carcinoma Medullary carcinoma Mutinous carcinoma
invasive ductal carcinoma histology
recall this is the number one commonest histological subtype (75%)
- malignant ductal cells deposed in cords
- solid nest
- tubules and anastomosing sheets
histology of ILC
small uniform cells forming strands of infiltrating tour cells concentrically around ducts
what does mammogram show on DCIS
MICROCALCIFICATIONS
bowen’s disease of the breast
eczema like change of the nipple
late presentation of breast cancer
- ulceration
2. tumour function
define peau d’orange
sensation of texture of an orange peel arises as a result of tumour invasion of dermal lymphatics causing dermal edema
suspicious finding on mammogram
MM SS mass microcalcifciation stellate Spiculated mass
when do you use US for breast cancer
- detect LN
2. assess lumps on mammograms or clinical exam
FNAC use and disadvantage
sued for aspiration of beign cyst
- NOT GOOD TO DIFFERENTIATE b/w invasive and non invasive (therefore use CORE Bx)
when do you use Open wide guided bx
when all else fails (core Bx)
- under GA
when do you do an MRI when investigating breast cancer
- lobular cancer to determine the extent of disease , multifocality and the opposite breast
Breast cancer t staging
Tis - carcinoma in situ T0- no primary tumour located T1 - no primary tumour located T2 - <2cm T3 - 2-5cm T4 - extension to chest wall
Breast cancer n staging
No- no nodal involvement
N1 - mobile ipsilateral axillary nodes
N2 - fixed ipsilateral axillary node
N3 - ipsilateral supraclavicular node
what investigations must be done to stage breast cancer
- staging Ct - chest , abdomen and pelvis
- liver US
- bone scan
- LFT and serum calcium
when would you NOT do a wide local excision
- the tumour is located central / retroareolar
- small brest
indications for mastectomy
- widespread disease
- central located
- late presentation
- large tomour
- multifocal
- small breast
WCS LLM
types of reconstruction
implant reconstruction - tissue expanders , saline/ silicone implants
Autologues
- pedicle flap - latissimus dorsi (LD ) flap
- free flap
- deep inferior epigastric perforator (DIEP) flap- transverse upper gracious (TUG) flap
complication of reconstruction
- infection
- hematoma
- serum
- skin flap necrosis
axillary node clearance
involves 3 levels - lateral to , behind to and medial to the pectoral muscles
risk of axillary clearance
- lymphadoema
2. axillary numbness
when do you perform surgery if mets are present from breast cancer
only do if there is a fungating tumour
risk factor for anastrozole
recall: aromatase inhibitor used in ER positive postmenopausal women
RISK OF OSTEOPOROSIS
