SURGERY

risk of cancer in some women is increased substantially over the normal risk (but does not approach 100%),
counseling that explains the benefits and risks of prophylactic mastectomy?
Genetic tests for BRCA1 and BRCA2 mutations provide valuable information

Most common presentation is with a breast lump or lumpiness, which is usually painless.

Any discrete lump, no matter how small or mobile, can be cancer

Risk factors:

Age- rises with age
Early menarche and late menopause
Age at 1st pregnancy > 40
Nulliparous women
HRT (Hormone replacement therapy)
Obesity
Exposure to radiation
Diet (saturated fat)
Genetic factor (BRCA 1, BRCA 2)- 50-60 % of hereditary ca.
Previous benign disease (atypical hyperplasia)

Types of breast cancer

Management

I. MANAGEMENT OF BREAST CANCER- DCIS

Localized disease (<4cm):-
- “Wide local excision” with normal healthy tissue all round the margins + Radiotherapy (except for very small lesions)
Larger (>4cm) or widespread disease:
- “mastectomy”

II. MANAGEMENT OF INVASIVE BREAST CANCER

Operable: T1-T3, N0,N1,M0
Local therapy (surgery) +
systemic therapy (Chemotherapy, hormone therapy, immunotherapy)

Breast Cancer in Pregnancy

1-2% present during pregnancy
Diagnosis is often delayed
1st & 2nd trimester: Mastectomy, chemotherapy can be given (small risk to the fetus), RT after delivery.
3rd trimester: Surgery or delivering baby early (32 weeks) followed by treatment of breast cancer.

Management of Advanced & Metastatic Breast Cancer

Average survival 20-30 months
Effective symptom control with minimal side effects.
No evidence that treating metastatic disease improves survival.
Surgery only for fungating lesions.
Chemotherapy, hormone therapy, anti-HER2

IMAGING

Mammography in breast cancer (medio-lateral) Mammography (right breast; mediolateral oblique view) A high-density mass with an indistinct margin and containing microcalcifications projects in the upper breast. The features of this lesion are highly suspicious for malignancy.

Suspicious breast mass (Craniocaudal) - Mammography (right breast; craniocaudal view) A mass with suspicious features, including high density and indistinct margins, is visible in the posterior third of the breast.

In postmenopausal women and women ≥ 30 years of age with a suspicious breast mass, mammography is preferred over ultrasoundZ . In premenopausal women < 30 years of age, ultrasound is preferredZ , because the higher density of breast tissue decreases the diagnostic power of mammography.