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Breast carcinoma

Definition:
  • Breast carcinoma refers to malignant tumours originating from breast tissue, the most common being ductal and lobular carcinomas.
Epidemiology:
  • Most common cancer in women in the UK.
  • Risk factors include age, female gender, family history, BRCA1/BRCA2 mutations, early menarche, late menopause, and hormone replacement therapy (HRT).
Classification:
  • Invasive ductal carcinoma (most common).
  • Invasive lobular carcinoma.
  • Ductal carcinoma in situ (DCIS).
  • Lobular carcinoma in situ (LCIS).
  • Other rarer subtypes.
Clinical Presentation:
  • Painless breast lump (most common).
  • Nipple discharge, retraction, or eczema-like changes.
  • Skin dimpling or “peau d’orange” appearance.
  • Swelling and inflammation in inflammatory breast cancer.
Investigations:
  • Mammography: Gold standard imaging for women over 35.
  • Ultrasound: Useful in younger women with dense breast tissue.
  • Core biopsy or fine needle aspiration: For histological diagnosis.
  • MRI: In selected cases, especially for those with BRCA mutations or dense breasts.
Management:
  • Surgery: Lumpectomy or mastectomy, often with sentinel lymph node biopsy or axillary dissection.
  • Radiotherapy: Often post-lumpectomy or after mastectomy in certain cases.
  • Chemotherapy: Depending on tumour size, grade, lymph node involvement, and other factors.
  • Hormonal therapy: e.g., tamoxifen or aromatase inhibitors for hormone receptor-positive cancers.
  • Targeted therapies: e.g., trastuzumab for HER2-positive tumours.
Prognosis:
  • Depends on stage at diagnosis, grade, lymph node involvement, and molecular characteristics.
  • Early detection improves prognosis significantly.
Screening:
  • The NHS Breast Screening Programme offers mammography every three years to women aged 50-70, with the age range set to expand to 47-73.

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