Malignant Breast Disease

Incidence: Breast Cancer affects 1 in 9 women.

Risk factors: increasing age, genetics (BRCA 1/2), prolonged exposure to oestrogen (early menarche, late menopause, nulliparity, not breast feeding and HRT) as well as pregnancy after age 35.

Pathology: Breast cancer is either invasive or in situ. Non invasive cancer is either Ductal carcinoma in situ or lobuler carcinoma in situ (rarer). Invasive cancer can be lobular, tubular, medullary, mucionous, papillary, ductal or not otherwise specified (this carries a worse prognoses than named type).

Signs and Symptoms: patients may present with lump, nipple discharge/inversion, skin changes or breast pain. On exam one should look for assymetry of breasts, lumps, nodularity, tenderness, nipple inversion/discharge, eczematous changes, skin puckering, peau d’orange and lymphadenopathy.

Diagnosis: triple assessment should be performed at a one stop clinic (ideally) with clinical exam, USS+/- mammogram and core biopsy or FNA if there is a lump.

Management: Cancer needs to be graded according to cell atypia and staged to assess size, invasion, lymph node involvement and metastases. Carcinoma in situ is managed with wide local excision and often sentinal node biopsy is performed to assess whether axillary clearance is necessary. Invasive cancer is managed with mastectomy +/- reconstruction and axillary clearance. The management of breast cancer is multidisciplinary and involves surgeons, radiologists, specialist nurses and oncologists. Neo-adjuvant and adjuvant chemo/radiotherapy depend on histology, receptors and tumour size.

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