Flashcards in 17 Breast Cancer Chan Deck (72)
What are the risk factors for breast cancer?
Age (80% diagnosed at 50 years of age). Race (White > AA > Asians). Genetics (carriers of BRCA-1, BRCA-2 genes). Family history (one 1st degree relative = two-fold increase, two 1st degree relatives = four-fold increase). Presence of atypical hyperplasia (benign breast cancer) = four-fold increase. Exogenous estrogen. Prolonged estrogen stimulation (long menstrual history). Long phases of uninterrupted ovulation. Alcohol consumption. Diet (high fat intake). Obesity and BMI. Lack of physical activity. Smoking is NOT a risk factor for breast cancer
What are the signs and symptoms of breast cancer?
When tumor is detectable, presentation may include: Lump (solitary, unilateral, solid, hard, irregular and non-mobile), Tenderness, swelling or pain, Areas of thickening, distortion, or skin irritation, Nipple pain or discharge (clear fluid = benign; red brown or bloody = suspicious of malignancy), Breast pain (not usually a first symptom)
What are the ABCs of Breast Health?
A = A screening mammography. B = Breast self-examination (BSE). C = Clinical Breast Exam (CBE)
How often should BSE or Breast awareness be done?
Recommended monthly for all high risk women 20 years of age (best 1 week after menstrual period ends or same day each month if no regular periods). Optional for low risk asymptomatic women
How often should women get a Mammography?
Annual screening in women 50 years of age. Controversial in women ages 40-49. Women at high risk (with strong family history) should be evaluated with annual screening starting 10 years younger than when the youngest family member developed breast cancer
When should a CBE be done?
Recommended annually in women 40 years of age. Recommended every 1-3 years in women ages 20-39 years with breast awareness encouraged. Not uniformly recommended. Most beneficial when used with mammography
Breast Tissue Anatomy: What are Lobules?
Breast Tissue Anatomy: What are Ducts?
Milk passages connect lobules/nipple
Breast Tissue Anatomy: What are Stroma?
Fatty connective tissue/ligaments surround ducts, lobules, blood vessels and lymphatic vessels
What are the five types of breast cancer?
Lobular Carcinoma in Situ (LCIS). Ductal Carcinoma in Situ (DCIS). Invasive Lobular Carcinoma (ILC). Invasive Ductal Carcinoma (IDC). Inflammatory Breast Cancer
What is the most common type of breast cancer?
IDC (Invasive Ductal Carcinoma)
Which breast cancer has the worst prognosis?
IDC (Invasive Ductal Carcinoma)
What is the second most common type of breast cancer?
ILC (Invasive Lobular Carcinoma)
What is LCIS (Lobular Carcinoma in Situ)?
NOT a pre-malignant lesion, but a risk factor. Usually involved both breasts (risk of developing breast cancer relatively low)
What are the management options for PRE- and POST-menopausal women with LCIS (Lobular Carcinoma in Situ)?
Tamoxifen 20mg PO QD x5 years (decreases risk by 49%)
What are the management options for POST-menopausal women with LCIS (Lobular Carcinoma in Situ)?
Raloxifene 60mg PO QD x5 years
What is DCIS (Ductal Carcinoma in Situ)?
Consider a pre-malignant lesion and a risk factor (can present as palpable mass, nipple discharge -- red brown or bloody)
What management option can be considered in DCIS (Ductal Carcinoma in Situ)?
Tamoxifen 20mg PO QD x5 years (decreases risk by 37%). Benefit observed w/ ER+ tumor, unknown benefit w/ ER- tumor
How does Inflammatory Breast Cancer present?
Skin of the affected breast is red, feels warm, and may thicken to the consistency of an orange peel. Thought to be d/t inflammation, but is rather caused by spread of cancer cells to lymphatic vessels of the skin
What is the prognosis of Inflammatory Breast Cancer?
Considered an aggressive tumor with poor prognosis
How is a diagnosis of breast cancer made?
Biopsy = ONLY mean to confirm diagnosis. Most common - fine need aspiration biopsy or core needle biopsy (can determine hormonal and HER2 receptor status)
What do the different stages of breast cancer mean?
Stage 1: Localized. Stage 2-3: Lymph node involvement. Stage 4: Metastases to other organ
What does the ER and/or PR Receptor status mean for prognosis?
ER and/or PR positive indicates less aggressive tumors, better prognosis
What does the presence of HER2/neu overexpression mean?
Indicates more aggressive tumor for node (+) and node (-) patients. Better outcome with Doxorubicin containing chemotherapy regimen (decrease in recurrent rates observed with node (+) patients). Dose-intensive (i.e. Dose-Dense Q2week dosing) of Doxorubicin containing chemotherapy may be more effective of HER2 (+), node (+) patients. Predicts clinical response to therapy with Trastuzumab (Herceptin)
What are the treatment options for breast cancer?
Surgery w/ or w/o reconstruction. Radiation therapy (adjuvant (post lumpectomy at completion of chemo), recurrence of metastatic disease as palliation). Pharmacological intervention
What are the different types of pharmacological intervention that can be used?
Chemotherapy (adjuvant and recurrence disease). Targeted immunotherapy (HER2+ tumor). Hormonal therapy (ER+ and/or PR+ tumor)
What is a Modified Radical Mastectomy (MRM)?
Removes entire breast and some axillary (underarm) lymph nodes (ALND). Does NOT usually require XRT post-op
What is a Segmental Mastectomy (Lumpectomy)?
Considered breast conservation surgery. Removes breast tumor and margin of surrounding normal tissue preserving the natural contour of the breast. Used in combination with ALND and XRT. Selection based on tumor size and location
What is Axillary Lymph Node Dissection (ALND)?
Indicated in ALL women with invasive breast cancer undergoing surgery with MRM or lumpectomy. Controversial in women with small tumors and node (-) breast cancer