Breast cancer: Difference between revisions
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Other questions to ask in the history are: when the lump started; any change in size; menstrual history; any changes in the menstrual cycle; and family history. | Other questions to ask in the history are: when the lump started; any change in size; menstrual history; any changes in the menstrual cycle; and family history. | ||
On examination | '''On examination''' the key is to try and differentiate between breast cancer and [[benign breast disease]]. A hard, painless lump; irregular margins; fixation to chest wall; skin dimpling; unilateral discharge (with blood); anything else mentioned above: are all signs of breast cancer. | ||
If these things aren't present or the opposite is true (e.g. regular rather irregular) are suggestive of benign breast disease. | |||
===Investigations=== | ===Investigations=== | ||
Revision as of 18:01, 11 November 2008
Definition
Cancer of the breast tissue. Go figure...
Epidemiology
Commonest cancer in women - 1 in 3 malignancies in women are of the breast. 11000 women died of breast cancer in 2005 (and 81 men). Basically, there's lots of breast cancer so it's pretty important.
Pathophysiology
There are essentially two places breast cancer can arise from:
- ductal carcinoma - this effects the epithelial lining of the ducts. Hence, ductal. Cancer people are pretty good at naming stuff.
- lobular carcinoma - the effects the epithelial lining of the terminal ducts and lobules (found at the end of the ducts. It's where the milk is made).
Risk Factors
- Age
- FHx - sister or mother who has/had disease
- High premenopauseal insulin-like growth factor
- Born in North America/northern Europe
These are the four most important but there are others factors which affect risk:
- BRCA1, BRCA2 and TP53 gene predispose to cancer.
- Nulliparity
- Early menarche (before 11) or late menopause (after 55)
- HRT, oral contraceptives (due to oestrogen)
- Obesity after menopause
- FHx - first-degree relative who has/had disease
- Alcohol, diet with high saturated fats
- Radiation to chest
Clinical Features
The most important feature is a lump in the breast and 1 in 8 with a painless breast lump (90% of cancers are painless) will turn out to have breast cancer. Other features include:
- lumps under the arm
- retraction/inversion of the nipple
- bloody discharge from the nipple (intraduct carcinoma)
Other questions to ask in the history are: when the lump started; any change in size; menstrual history; any changes in the menstrual cycle; and family history.
On examination the key is to try and differentiate between breast cancer and benign breast disease. A hard, painless lump; irregular margins; fixation to chest wall; skin dimpling; unilateral discharge (with blood); anything else mentioned above: are all signs of breast cancer.
If these things aren't present or the opposite is true (e.g. regular rather irregular) are suggestive of benign breast disease.