Metastatic Breast Cancer

Overview

Breast cancer is the most common cause of death in middle-aged women in western countries. The incidence is steadily rising. There is a 1 in 10 lifetime risk for women in worldwide. The treatment evolved significantly for breast cancer over the years.

Signs and Symptoms

Palpable breast lump, Change in breast size or shape, Skin dimpling, Recent nipple inversion or skin change, Nipple discharge – particularly if bloody, Skin ulceration (advanced cases), Arm swelling, Pain is not usually a feature, Breathing difficulties (metastatic), Bone pain or pathological fractures (metastatic), Symptoms of hypercalcemia (metastatic), Abdominal distension (metastatic), Jaundice (metastatic), Localizing neurologic signs (metastatic), Altered cognitive function (metastatic)

Common Causes

Cancer from other sites of the body

Risk Factors

Age- Risk increases with age and extremely rare before age 25, Family History- Risk increase two-fold with affected 1st degree relative <50yrs, Genetic Predisposition-Up to 10% of cases due to genetic predisposition with BRCA1 gene mutations (chromosome 17) and BRCA2 gene mutations (chromosome 13), Hormonal factors such as early menarche/ late menopause / age at 1st pregnancy / use of oral contraceptive and postmenopuasal oestrogen therapy, Radiation exposure, Lifestyle factors such as alcohol/ smoking/ obesity

Investigation Techniques

History & physical exam- Essential first step in establishing diagnosis using accurate history of presenting symptom and risk factor profile and physical exam to assess tumour characteristics and spread (axillary nodes, distant metastases), Radiological Assessment- Mammogram detects 80 - 90 % of breast cancers and tumours that are not clinically palpable. It is less reliable in women < 35yrs. Ultrasound is useful in younger patients and provides additional information on tumour, Cytology / Pathology which consist of fine needle aspiration cytology (FNAC)/ Core Biopsy and wire guided biopsy

Treatment and Prevention

Chemotherapy, Hormone therapy, Radiation therapy, Targeted therapy, Immune therapy, Surgery (Breast conserving surgery/ mastectomy/ Surgery to the axilla/ Sentinel node biopsy), Palliative care