181
H Sinh D c
TABLE 11.1 Breast Tumours
Breast tumour
Benign or
malignant
Fibroadenoma
Benign
Characteristics
Small
Also known as ‘breast mouse’
due to tumour not being
tethered
Sharp edges
Most common type of benign
breast tumour in young
women
Investigations
Treatment
Complications
Undergo triple assessment:
1 Examination
2 Imaging
3 Biopsy
Physical examination for
lumps and masses
Bloods: FBC, WCC, U&Es,
LFTs, TFTs
Radiology: mammogram,
ultrasound scan, fine
needle biopsy under
ultrasound guidance
(core needle biopsy may
be required). Look for
metastasis with CXR,
CT scan and MRI scan
Risk factors for breast cancer:
•
Female
•
Increasing age
•
Family history of breast
cancer
•
Liên quan đ n di truy n.
VD: BRCA1 (NST 17),
BRCA2 (NST 13)
•
Rư u
•
Béo phì
•
Tăng ti p xúc v i
estrogen như:
Có kinh s m
Mãn kinh mu n
S d ng thu c ng a
thai
Đi u tr hormon thay
th
Gi m sinh đ
Không cho bú
Treatment depends
on the cause of the breast
tumour and whether it is
benign or malignant;
treatment may be split
into 3 modalities:
1 Conservative: patient and
family education; refer to
Macmillan nurses; offer
genetic counselling; provide
psychological assessment
and support
2 Medical: prognosis of
disease is assessed using
the Nottingham Prognostic
Index (NPI):
NPI = (0.2 × invasive size) +
lymph node stage + grade
of tumour
Medical therapy may be
split into adjuvant hormone
therapy, chemotherapy or
Li u pháp nh m trúng đích
HER2, tùy thu c vào l ai
bư u
Đi u tr b ng hormon:
ph n trư c mãn kinh
đư c đi u tr b ng tamoxifen
(ch t đi u hòa ch n l c th
th estrogen); ph n sau
mãn kinh đư c đi u tr v i
anastrazol ( c ch
aromatase). Đó là do nh ng
th nghi m như ATAC đã
ch ra r ng c ch aromatase
thì hi u qu hơn tamoxifen
ph n sau mãn kinh. N u
m t ph n tr thành mãn
kinh trong th i gian đi u tr
s có l i ích t s chuy n đ i
thu c.
Hóa tr li u và x tr : thay
đ i tùy thu c vào lo i u
HER2 directed therapy:
treatment with trastuzumab
(herceptin). This is a
monoclonal antibody against
the extracellular domain of
the HER2 receptor
3 Surgical: the primary aim
of surgery is to remove
the invasive and
noninvasive cancer with
clear margins. Lumpectomy
followed by a radiotherapy
regime has been shown to
be as effective as
mastectomy, but
mastectomy may be
recommended in certain
circumstances such as
multifocal breast disease.
The ipsilateral axilla should
also be assessed with
ultrasound, fine needle
aspiration or core biopsy.
Clinical staging of the axilla
should also be assessed
by sentinel lymph node
biopsy. The reason for this is
to avoid unnecessary
axillary clearance in patients
Death
Metastasis
Complications of
chemotherapy regimen
Complications of
radiotherapy regimen
Depression
Intraductal
papilloma
Benign
Small
Under areola
Bloody discharge from nipple
Large
Leaf-like projections
Rapid growing
Phyllodes
tumour
Benign
From ductal hyperplasia
Cheesy discharge, confined to
ducts
Ductal carcinoma
in situ (DCIS)
Malignant
High-grade DCIS
Characterised by central
necrosis
Cheesy discharge
Comedocarcinoma Malignant
Xâm l n h bì và h
th ng b ch huy t
Màu da cam
Núm vú th t vào
M t kh i c ng
B s c
Thư ng g p nh t
R t xâm l n
U ng d n s a
xâm l n
Ác tính
Bi u hi n hai bên vú
U ti u thùy xâm l n Ác tính
Ung thư d ng
viêm
Ác tính
Bi t hóa t t
Thi u ph n ng t o mô xơ
Xâm nh p h ch lympho
Tiên lư ng t t
Ung thư d ng t y Ác tính
B nh Paget c a
vú
Ác tính
Xâm nh p bi u bì c a ung
thư bi u mô ng d n s a
i
Thay đ i núm vú d ng
chàm
TABLE 11.1 Breast Tumours (Continued )
Breast tumour
Benign or
malignant Characteristics
Investigations
Treatment
Complications
B ng11.1 U vú
Ti p t c trang sau
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