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Medicine Notes Oncology Notes

Breast Cancer Notes

Updated Breast Cancer Notes

Oncology Notes

Oncology

Approximately 27 pages

Concise notes on Oncology, including palliative care. These notes cover the most common cancers and all of the oncology emergencies. Very clinically relevant - great for written and practical exams for medical finals. Colour coded by topic including diagrams and tables where relevant...

Available here

The following is a more accessible plain text extract of the PDF sample above, taken from our Oncology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Breast Cancer

Epidemiology

  • Commonest female cancer

Aetiology

  • Risk factors

    • Age

      • Very rare <30years

      • Increased risk up to age of menopause

      • Rate of increased risk slows after menopause

    • Age of menarche and menopause

      • Early menarche and late menopause = increased risk

    • Pregnancies

      • Nulliparity

      • Late first pregnancy

    • Family history

      • BRCA 1+2

    • Exogenous oestrogens

      • COCP

      • HRT

    • Diet

      • Increased fat intake

      • Obesity

      • Alcohol

    • Previous atypical hyperplasia

    • Radiation

Genetics

  • 5-10% of cases are due to inherited mutated BRCA

  • Cause younger age of onset

  • More male cases

  • Associated with ovarian and prostate cancers

  • Can be inherited through the father’s side – always ask about paternal family history

Pathology

  • More common in upper outer quadrant

  • Ductal carcinoma in situ

    • Atypical proliferation of ductal epithelium

    • Doesn’t invade basement membrane

    • Usually impalpable

    • Seen as microcalcification on mammography

    • < 50% progress to invasive cancer

  • Lobular carcinoma in situ

    • Pre-invasive lesion

    • Rare

    • Difficult to diagnose

  • Invasive ductal carcinoma

    • Commonest type

    • Has the ability to invade and spread via lymph and blood

    • Need histological grade and receptor status to predict its behavior + treatment options

  • Invasive lobular carcinoma

    • 20% go on to progress to a contralateral breast cancer

Clinical features

  • Palpable breast lump

  • Asymmetry

  • Skin changes

    • Pigmentation

    • Puckering

  • Nipple changes

    • Discharge

    • Inversion

  • New pain or discomfort not related to menstrual cycle

Prognostic factors

  • Size of tumour

  • Lymph involvement

  • Grade

  • Oestrogen receptor status

  • C-erbB2 receptor status (Herceptin receptor)

Diagnosis

  • Triple assessment

    • Clinical examination

    • Bilateral 2 view mammography (cranio-caudal, medio-lateral oblique)

    • Histology – FNA/core biopsy

Staging

  • Use TNM system

    • Tis = carcinoma in situ

    • T0 = no primary tumour found

    • T1 = < 2 cm

    • T2 = 2.5 cm

    • T3 = > 5 cm

    • T4 = Any size tumour with involvement of skin or chest wall

    • No = No nodes

    • N1 = Mobile, ipsilateral axillary nodes

    • N2 = Fixed ipsilateral axillary nodes

    • N3 = Internal ipsilateral mammary nodes

    • M0 = No mets

    • M1 = Distant mets

Management

  • Carcinoma in situ

    • Options

      • Simple mastectomy

      • Wide local excision

      • Wide excision and radiotherapy

  • Early breast cancer (those that can be completely excised)

    • Surgery

      • Total...

Buy the full version of these notes or essay plans and more in our Oncology Notes.

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