SU25.3-4 | Breast Tumours and Malignancy Counselling — Summary & Reflection

KEY TAKEAWAYS

Breast tumours range from benign (fibroadenoma, phyllodes) to malignant, and breast cancer is not one disease. By invasion: DCIS is non-invasive/premalignant (microcalcifications), LCIS is mainly a risk marker, while invasive ductal carcinoma (NST) is the commonest (~70-80%) and invasive lobular carcinoma tends to be multifocal/bilateral. Receptor biology drives treatment: ER/PR-positive = endocrine-responsive (tamoxifen pre-menopausal, aromatase inhibitors post-menopausal); HER2-positive = trastuzumab; triple-negative (ER-/PR-/HER2-) = mainly chemotherapy, worse prognosis. Confirm with triple assessment + core biopsy; stage by TNM; assess the axilla by sentinel lymph node biopsy if node-negative (clearance if positive). Treatment is multimodal: BCS (wide local excision) + whole-breast radiotherapy gives survival equivalent to mastectomy; mastectomy for large/multifocal disease; adjuvant chemo/radio/endocrine/anti-HER2 by biology and stage. Counsel using SPIKES and obtain informed consent covering diagnosis, treatment and alternatives, material risks/side-effects (lymphoedema, fertility), outcomes and questions — voluntary, with capacity, as a continuing dialogue.

REFLECT

Imagine you must tell the next patient that her biopsy shows cancer. Have you prepared the setting and the people who should be present, and could you deliver the news in plain language while leaving room for her emotions, as SPIKES asks? Now test your oncology: could you explain to her why her receptor status matters — why one woman takes tamoxifen for years and another needs chemotherapy — and why keeping her breast is safe only with radiotherapy? Finally, consider consent: would your conversation cover the realistic alternatives, the material risks such as lymphoedema, and the effect of treatment on fertility, and would it be a genuine dialogue rather than a signature? Reflect on one thing you will do to make both the science and the humanity of breast cancer care your own.