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Cancer, Palliative Care and Pain Medicine > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is ductal carcinoma in situ (DCIS). (2)

A

It is carcinoma that has not penetrated the basement membrane.
It is considered to be pre-malignant.

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2
Q

What is the most common form of carcinoma in situ in the breast.

A

DCIS.

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3
Q

How is DCIS graded.

A

From low to high grade lesions on histopathology.

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4
Q

What are the clinical signs of DCIS. (3)

A

Lump.
Nipple discharge.
May be detected on screening (asymptomatic).

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5
Q

What is lobular carcinoma in situ. (2)

A

A rare form of breast cancer.

It is a pre-malignant condition.

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6
Q

What are the complications of lobular carcinoma in situ.

A

There is a high risk of progression to invasive carcinoma.

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7
Q

What is invasive ductal carcinoma of the breast.

A

It is the most common cancer in women. (70%)

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8
Q

What is the most common form of breast cancer.

A

Invasive ductal carcinoma.

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9
Q

What is the lifetime risk of developing invasive carcinoma.

A

1 in 10. (and increasing)

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10
Q

When does invasive carcinoma usually occur. (2)

A

It can occur at any age.

It is rare under 30.

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11
Q

What are the risk factors for breast cancer. (9)

A

Female. (less than 1% of breast cancers occur in men).
Increasing age.
Family history (genes such as BRCA1 and BRCA2).
Early menarche, late menopause.
Nulliparity, higher age at first pregnancy (ie >30).
Higher socioeconomic group.
Obesity.
Alcohol intake.
HRT (small effect).

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12
Q

What are the histological gradings of breast tumours.

A

1, 2, or 3 according to differentiation level.

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13
Q

What is the histological grading of breast tumours dependent on.

A

Differentiation of cells.

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14
Q

What does the TNM staging system look at. (3)

A

Tumour size.
Lymph node involvement.
Metastases.

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15
Q

What is Paget’s disease of the nipple. (2)

A

Eczematous skin change to the nipple due to underlying malignancy.
It is intra-epidermal spread of an intraductal cancer.

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16
Q

What associated symptoms may be present with paget’s disease of the nipple.

A

There may be an associated lump.

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17
Q

What screening is in place in the UK for detection of breast cancer. (4)

A

Self examination.
Two view mammography offered to women every 3 years to women aged 50-64.
After age 64, women can self refer for mammography if they wish.
Suspicious mammography signs a prompt recall.

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18
Q

What are the benefits to the UK screening system for breast cancer.

A

Screen-detected cancers generally smaller and lower grade than symptomatic lesions.

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19
Q

What are the drawbacks of the screening system for breast cancer in the UK. (2)

A

Cost.

Potential psychological morbidity of false positive.

20
Q

What are the non invasive breast cancers. (2)

A

Ductal cancer in situ.

Lobular cancer in situ.

21
Q

What are the invasive breast cancers. (6)

A 
Infiltrating ductal cancer. 
Infiltrating lobular cancer. 
Mucinous cancer.
Medullary cancer. 
Papillary cancer. 
Tubular cancer.
22
Q

What are the ‘other’ breast cancers (ie rare). (5)

A

Adenoid cystic, secretory, apocrine cancers.
Paget’s disease of the nipple.
Phyllodes tumours.

23
Q

What percentage of breast cancers does invasive ductal carcinoma account for.

A

70%

24
Q

What percentage of women have familial breast cancer.

A

10%

25
Q

What percentage of women with familial breast cancer have detectable mutations in BRCA1/2 and TP53.

A

3%

26
Q

What are the genes that predispose to breast cancer. (2)

A

BRCA1/2.

TP53.

27
Q

What are the most common symptoms that a women will present with (when she has breast cancer). (6)

A

Painless increasing mass.
May also be associated with: nipple discharge, skin tethering, ulceration, and in inflammatory cancers, oedema and erythema.

28
Q

How do you differentiate a benign breast mass from a breast cancer. (3)

A

Palpation.
Radiology (mammography, ultrasound, MRI scans).
Fine needle aspiration cytology.

29
Q

Is there a connection between the contraceptive pill and breast cancer.

A

None has been proven.

30
Q

What are the most common sites for breast cancers to metastasise to. (7)

A 
Bone. 
Lung. 
Liver.
Pleura. 
Adrenals. 
Skin. 
Brain.
31
Q

How is non-invasive ductal carcinoma in situ appear on a mammography.

A

Microcalcification.

32
Q

What percentage of cancers does invasive lobular carcinoma account for.

A

10-15%.

33
Q

What type of breast cancer tends to affect young patients.

A

Medullary cancers.

34
Q

What percentage of breast cancers does medullary cancer account for.

A

5%.

35
Q

Who does colloid/mucoid breast cancer tend to affect.

A

The elderly.

36
Q

What percentage of breast cancers are mucoud/colloid.

A

2%

37
Q

What conveys a better prognosis for breast cancer.

A

Oestrogen receptor positive.

38
Q

What percentage of breast cancers are oestrogen receptor positive.

A

70%

39
Q

What conveys a worse prognosis for breast cancer.

A

Over expression of HER2.

40
Q

What percentage of breast cancers over express HER2.

A

30%

41
Q

What should all breast lumps undergo.

A

Triple assessment.

42
Q

What is a stage 1 breast tumour.

A

Tumour confined to breast.

43
Q

What is a stage 2 breast tumour. (3)

A

Growth confined to breast.
Mobile.
Lymph nodes in ipsilateral axilla.

44
Q

What is a stage 3 breast tumour. (4)

A

Tumour fixed to muscle, but not the chest wall.
Ipsilateral lymph nodes matted.
May be fixed.
Skin involvement larger than the tumour.

45
Q

What is a stage 4 breast tumour. (2)

A

Complete fixation of the tumour to the chest wall.

Distant metastases.

46
Q

What stage of the TNM tumour staging system is peau d’orange associated with.

A

T4.

Cancer, Palliative Care and Pain Medicine (14 decks)

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