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Breast Cancer (Risk Factors (Late menopause, HRT, 1st pregnancy >30 yrs…
Breast Cancer
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Pathophysiology
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People who express HER2 (growth factor receptor gene) have a poorer prognosis and more aggressive disease
Investigations
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Physical examination of breast: nipple discharge, nipple inversion, skin changes, palpable lumps in armpit
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Examination of armpit, shoulder and neck
Prognosis
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Nottingham Prognostic Index is used to predict survival and risk of relapse. Takes into account the following factors:
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Epidemiology
60,000 new cases every year in the UK
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Aetiology
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There is a high risk of getting cancer if you have several close relatives who have had breast cancer, ovarian cancer or both
Staging
Stage 2 - growth confined to breast, mobile, spread to lymph nodes in ipsilateral axilla
Stage 3 - tumour is fixed to muscle (not chest wall), spread to ipsilateral lymph nodes and skin
Stage 1 - confined to breast, mobile
Stage 4 - complete fixation of tumour to chest wall, distant mets
Treatment
Treating Stage 3 + 4
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CNS surgery for solitary, easily accessible mets
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Treating Stage 1 + 2
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Radiotherapy: decreases risk of recurrence from 30% to <10% and increases overall survival. SE: pneumonitis, pericarditis, rib fractures
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