General Surgery for NEET-PG
Breast Carcinoma for NEET-PG
Breast carcinoma is the most common cancer in women and a frequent NEET-PG topic across surgery, pathology, and oncology. For the exam, the highest-yield areas are risk factors, the triple assessment for diagnosis, the significance of hormone receptor and HER2 status, and the principles of surgical and adjuvant management. Most breast cancers are invasive ductal carcinoma, presenting as a hard, irregular, painless lump, often in the upper outer quadrant, sometimes with skin tethering, nipple retraction, or peau d'orange from lymphatic obstruction. Risk factors include increasing age, early menarche, late menopause, nulliparity, family history, and BRCA1 and BRCA2 mutations. Diagnosis uses triple assessment: clinical examination, imaging with mammography or ultrasound, and pathology by core needle biopsy. Staging follows the tumour, node, metastasis system, and axillary status is the single most important prognostic factor. Tumours are tested for oestrogen and progesterone receptors and HER2 to guide treatment, since receptor-positive tumours respond to hormonal therapy and HER2-positive tumours to trastuzumab. Sentinel lymph node biopsy has replaced routine axillary clearance in clinically node-negative disease. Surgery ranges from breast-conserving surgery with radiotherapy to mastectomy, and systemic therapy includes chemotherapy, endocrine therapy, and targeted agents. Knowing peau d'orange, the triple assessment, receptor-directed treatment, and the sentinel node concept are recurrent anchors.
MedNext Academy | 3 min read
Breast Carcinoma for NEET-PG
Breast carcinoma is the most common cancer in women and a frequent NEET-PG topic across surgery, pathology, and oncology. For the exam, the highest-yield areas are risk factors, the triple assessment for diagnosis, the significance of hormone receptor and HER2 status, and the principles of surgical and adjuvant management. Most breast cancers are invasive ductal carcinoma, presenting as a hard, irregular, painless lump, often in the upper outer quadrant, sometimes with skin tethering, nipple retraction, or peau d'orange from lymphatic obstruction. Risk factors include increasing age, early menarche, late menopause, nulliparity, family history, and BRCA1 and BRCA2 mutations. Diagnosis uses triple assessment: clinical examination, imaging with mammography or ultrasound, and pathology by core needle biopsy. Staging follows the tumour, node, metastasis system, and axillary status is the single most important prognostic factor. Tumours are tested for oestrogen and progesterone receptors and HER2 to guide treatment, since receptor-positive tumours respond to hormonal therapy and HER2-positive tumours to trastuzumab. Sentinel lymph node biopsy has replaced routine axillary clearance in clinically node-negative disease. Surgery ranges from breast-conserving surgery with radiotherapy to mastectomy, and systemic therapy includes chemotherapy, endocrine therapy, and targeted agents. Knowing peau d'orange, the triple assessment, receptor-directed treatment, and the sentinel node concept are recurrent anchors.
Breast carcinoma is the most common cancer in women and a frequent NEET-PG topic across surgery, pathology, and oncology. For the exam, the highest-yield areas are risk factors, the triple assessment for diagnosis, the significance of hormone receptor and HER2 status, and the principles of surgical and adjuvant management. Most breast cancers are invasive ductal carcinoma, presenting as a hard, irregular, painless lump, often in the upper outer quadrant, sometimes with skin tethering, nipple retraction, or peau d'orange from lymphatic obstruction. Risk factors include increasing age, early menarche, late menopause, nulliparity, family history, and BRCA1 and BRCA2 mutations. Diagnosis uses triple assessment: clinical examination, imaging with mammography or ultrasound, and pathology by core needle biopsy. Staging follows the tumour, node, metastasis system, and axillary status is the single most important prognostic factor. Tumours are tested for oestrogen and progesterone receptors and HER2 to guide treatment, since receptor-positive tumours respond to hormonal therapy and HER2-positive tumours to trastuzumab. Sentinel lymph node biopsy has replaced routine axillary clearance in clinically node-negative disease. Surgery ranges from breast-conserving surgery with radiotherapy to mastectomy, and systemic therapy includes chemotherapy, endocrine therapy, and targeted agents. Knowing peau d'orange, the triple assessment, receptor-directed treatment, and the sentinel node concept are recurrent anchors.
Key points
- **Commonest type:** Invasive ductal carcinoma is the most common histological type. It presents as a hard, irregular, fixed, usually painless lump.
- **Common site:** The upper outer quadrant is the commonest location because it contains the greatest volume of breast tissue.
- **Clinical signs:** Skin tethering, nipple retraction, and peau d'orange from dermal lymphatic obstruction suggest malignancy and local advancement.
- **Risk factors:** Age, early menarche, late menopause, nulliparity, family history, and BRCA1 and BRCA2 mutations raise breast cancer risk.
- **Triple assessment:** Clinical examination, imaging (mammography or ultrasound), and core needle biopsy together confirm or exclude malignancy.
- **Prognostic factor:** Axillary lymph node status is the single most important prognostic factor in operable breast cancer.
- **Receptor status:** Oestrogen and progesterone receptor and HER2 testing guide therapy. Triple-negative tumours lack all three and have a poorer prognosis.
- **Hormonal therapy:** Tamoxifen is used in premenopausal receptor-positive disease, and aromatase inhibitors in postmenopausal women.
- **HER2 therapy:** Trastuzumab targets HER2-positive tumours and improves outcomes when added to chemotherapy.
- **Sentinel node biopsy:** Sentinel lymph node biopsy replaces routine axillary clearance in clinically node-negative disease to reduce lymphoedema.
- **Surgery options:** Breast-conserving surgery with radiotherapy is equivalent to mastectomy in survival for suitable early tumours.
Frequently Asked Questions
What is triple assessment in breast cancer?
Triple assessment combines clinical examination, imaging by mammography or ultrasound, and pathology by core needle biopsy to diagnose a breast lump.
What is peau d'orange?
Peau d'orange is skin dimpling resembling an orange peel caused by dermal lymphatic obstruction, a sign of locally advanced breast cancer.
What is the most important prognostic factor?
Axillary lymph node status is the single most important prognostic factor in operable breast carcinoma.
Why is receptor status tested?
Oestrogen, progesterone, and HER2 receptor status guides treatment. Receptor-positive tumours respond to endocrine therapy and HER2-positive tumours to trastuzumab.
What is sentinel lymph node biopsy?
It samples the first draining lymph node to assess axillary spread, sparing full axillary clearance in clinically node-negative patients and reducing lymphoedema.
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