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BREAST CANCER Part 01

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Epidemiology

 

  1. most common cancer in women (excluding skin)
  2. second leading cause of cancer mortality in women
  3. most common cause of death in 5th decade
  4. lifetime risk of 1/9 

 

Etiology

  1. multifactorial
  2. genetics play key role in 15% of cases

 

Risk factors

  1. age - 80% > 40
  2. sex - 99% female
  3. 1st degree relative with breast cancer
    • risk increased further if relative was premenopausal
  4. geographic - highest national mortality in England and Wales, lowest in Japan
  5. nulliparity
  6. late age at first pregnancy
  7. menarche < 12 ; menopause > 55
  8. obesity
  9. excessive alcohol intake
  10. some forms of mammary dysplasia
  11. prior history of breast cancer
  12. history of low-dose irradiation
  13. prior breast biopsy regardless of pathology
  14. BCP/estrogen replacement may increase risk 

 

Diagnostic workup of breast mass


History

 

  1. how long the lump has been noted
  2. any changes that have been observed
  3. history of biopsy or breast cancer
  4. breast CA risk factors should be noted, but their presence or absence do not influence decision to further investigate breast lump

Physical

  1. to identify those features that distinguish malignant from benign lump
  2. benign: smooth, well-demarcated, mobile
  3. malignant: irregular, poorly defined, less mobile

Other signs of malignancy

  1. skin changes: edema, dimpling, retraction, redness, ulceration
  2. nipple: bloody discharge, crusting, ulceration, inversion
  3. prominent veins, palpable axillary/supraclavicular lymph nodes, arm edema

 

Mammogram

  1. stellate appearance and spiculated border - pathognomonic of breast cancer
  2. microcalcifications
  3. ill-defined lesion border
  4. lobulation
  5. architectural distortion
  6. increased vascularity
  7. interval mammographic changes                                           

NORMAL MAMMOGRAM DOES NOT RULE OUT SUSPICION OF CANCER (BASED ON CLINICAL FINDINGS)

Fine Needle Aspiration

 

  1. if non-bloody fluid and mass completely disappears, diagnosis is simple cyst - no need for cytology
  2. if bloody/no fluid or mass does not fully disappear - send cells for cytology


Biopsy

  1. whenever reasonable doubt remains as to whether a lump is benign or malignant
  2. core biopsy - removal of core of intact tissue through 14-gauge needle
  3. excisional biopsy - surgical removal of entire lesion with
  4. cuff of normal tissue

 

Staging

 
Clinical vs. pathological


Cinical:

  1. assess tumour size, nodal involvement, and metastasis
  2. tumour size by palpation, mammogram
  3. nodal involvement by palpation
  4. metastasis by physical exam, CXR, LFTs

Pathological

  1. histology
  2. axillary dissection should be performed for accurate
  3. staging and to reduce risk of axillary recurrence
  4. estrogen/progesterone receptor testing
    Staging of Breast Cancer (American Joint Committee)

    Stage

    Tumour

    Nodes (regional)

    Metastasis

    0

    in situ

    none

    none

    1

    < 2 cm

    none

    none

    II

    < 2 cm

    or 2-5 cm

    or > 5 cm

    movable ipsilateral

    none or movable ipsilateral

    none

    none

    None

    none

    III

    any size

    or skin/chest

    wall invasion

    fixed ipsilateral or internal mammary

    any

    none

    none

    IV

    any tumour

    any

    distant

     

    BREAST CANCER Part 01 BREAST CANCER Part 01 Reviewed by Radiology Madeeasy on August 30, 2010 Rating: 5
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