Topic 9 of 74 in the MU Sofia syllabus for Surgery (Medicine, Year 5). The free AceMed note covers it in 9 sections, about 480 words (7 min of reading), with 17 flashcards.
In this note
TOPIC 9
Breast cancer
EPIDEMIOLOGY AND RISK FACTORS
PATHOLOGY AND CLASSIFICATION
CLINICAL FEATURES
DIAGNOSIS AND STAGING
DIFFERENTIAL DIAGNOSIS
TREATMENT
COMPLICATIONS AND FOLLOW-UP
EPIDEMIOLOGY AND RISK FACTORS
Breast cancer is a heterogeneous malignant disease arising most often from terminal duct-lobular units.
Risk increases with age, pathogenic variants (BRCA1/2, PALB2 and others), strong family history, prior atypical hyperplasia/LCIS, dense breasts, prior chest irradiation, prolonged oestrogen exposure, alcohol use and postmenopausal obesity.
Protective factors include physical activity and breastfeeding.
Most cancers are sporadic.
PATHOLOGY AND CLASSIFICATION
Invasive carcinoma of no special type is common; invasive lobular carcinoma is another important subtype.
In situ disease includes DCIS and LCIS.
Tumours are graded histologically and tested for oestrogen receptor (ER), progesterone receptor (PR) and HER2.
Molecular surrogate groups include hormone-receptor-positive/HER2-negative, HER2-positive and triple-negative disease.
These biomarkers predict prognosis and determine systemic treatment.
Spread occurs locally to skin/chest wall, via lymphatics to axillary/internal mammary/supraclavicular nodes, and haematogenously to bone, lung, liver and brain.
CLINICAL FEATURES
A painless hard irregular lump is classic, but presentation may include architectural distortion, nipple inversion, bloody discharge, skin dimpling, peau d’orange, ulceration or axillary node.
Inflammatory breast cancer causes rapid erythema, oedema and peau d’orange due to dermal lymphatic involvement and may have no discrete lump.
