Breast cancer is the commonest cancer affecting women. Early
detection of this cancer is possible through monthly breast self examination,
which is especially recommended for women of child-bearing age, and
periodic screening through clinical breast examination (3 yearly for women
below 40 years and yearly for women above 40 years) as well as
mammography every 2 years for women 40 years and above.
Various modalities are available for the treatment of breast cancer
which depend on the biological characteristics of the tumour, stage of
disease and other patient factors.
CAUSES
· Unknown
· Associated risk factors
· Female sex
· Age
· Family history of breast cancer
· Previous personal history of breast cancer
· Oestrogen therapy
SYMPTOMS
· Lump in the breast
· Other changes in breast change in size or shape
· Skin changes in breast
· Peau d'orange
· Skin nodules
· Ulceration
· Changes in the nipple and areola
· Nipple discharge
· Nipple retraction
· Eczema/ulceration of nipple or areola
· Swelling in axilla
· Swelling of upper limb
· Metastatic disease
· Bone pain
· Pathological fractures
· Back pain
· Paraplegia
· Breathlessness from pleural effusion and lung metastasis
CHAPTER 28: COMMON MALIGNANCIES
· Brain metastasis (Headache, vomiting altered consciousness,
localizing signs)
SIGNS
· Breast lump
· Hard
· Edges may be indefinite
· Surface may be rough
· May be tethered to skin or attached to skin and underlying tissues
· Skin
· Peau d'orange, tethering, nodules or ulceration
· Nipple retraction
· Bloody nipple discharge
· Palpable axillary nodes
· Look for evidence of metastatic disease
INVESTIGATIONS
· Mammography
· Ultrasonography of the breast
· Biopsy and Fine Needle Aspiration for cytology and histology
TREATMENT
Treatment objectives
· To achieve a cure
· To prevent local and distant metastasis
· To prolong survival in metastatic disease
· To relieve pain in incurable cases
Non-pharmacological treatment
· None
Pharmacological treatment
(Evidence Rating: A)
· Surgery
· Wide Local Excision OR Mastectomy
· Axillary dissection
· Chemotherapy
· Hormonal therapy
· Radiotherapy
· Immunotherapy
COMMON MALIGNANCIES
REFER
If breast cancer is suspected, investigate (including needle biopsies) if
possible and refer. All cases of breast cancer must be referred for specialist
attention. Avoid excising suspicious lumps. All excisions must be sent for
histology.
