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4th Year CCC > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

When does incidence of breast ca peak

A

about 34 and then again 60-69 (screening)

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2
Q

What are risk factors/causes of breast ca

A

Uninterrupted oestrogen exposure

Chest wall/mediastinal RT

Genetics

Lifestyle- smoking and alcohol >14u/w

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3
Q

What are the causes of uninterrupted oestrogen exposure

A

1 Early menarche/late menopause

2 Nullip/1st child at older age

3 HRT

4 Prolonged use OCP

5 Obese (Esp. post meonpause)

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4
Q

What are the genes that contribute to breast ca

A

BRCA1

BRCA2

P53

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5
Q

What do the normal variants of BRCA genes do?

A

Tumour supressors

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6
Q

BRCA also increase the risk of what other type of gynae ca?

A

Ovarian

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7
Q

Can BRCA be inherited from mother and father?

A

Yes

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8
Q

What is the inheritance pattern of BRCA?

A

Autosomal dominant

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9
Q

How much does BRCA increase risk?

A

BRCA1- 72%

BRCA2- 69%

To get breast ca by age 80

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10
Q

Ovarian cancer risk with brca?

A

brca1- 44%

brca2- 17%

By age 80

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11
Q

Does BRCA increase risk of other cancers?

A

Yes prostate in men (esp BRCA2)

Fallopian tube, peritoneal, pancreatic

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12
Q

What ethnic group is more at risk of BRCA?

A

Ashkenazi jews

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13
Q

Who is eligible for brca genetic testing?

A

an inherited faulty gene has already been identified in a

Or

there is a strong family history of cancer (at least 2 close family members on the same side of the family who have the same cancer or related cancer types, such as bowel and womb cancer)

= referral to genetics

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14
Q

When is screening for breast ca carried out

A

50-70yrs every 3yrs

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15
Q

what is ‘interval cancer’

A

occurs between screenings

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16
Q

What % of those called back from mammogram have cancer?

A

25%

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17
Q

Peau d’orange on the breast could be what?

A

Mastitis

Inflammatory breast cancer (v bad)

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18
Q

What nipple fluid is most worrying

A

Blood

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19
Q

Breas cancer history

A

Onset

Skin/nipple changes

Assoc sx (discharge and pain)

Relation to menstruation (and menarche and menopause ages)

Prev lumps in breast

Lumps in axillae

FHx and if they have children (when)

PMH (OCP/HRT use, prev RT)

20
Q

What is involved in the triple assessment?

A

Examination scored P1-P5

Radiology- mammogram (x ray), USS if lump O/E

Biopsy- FNA or core (core is more common)

21
Q

When would you do bloods in a breast cancer assessment?

A

Pre-op

Concern about mets

Tumour markers Ca15.3, CEA

22
Q

What means a breast cancer is poorer prognosis?

A

> 5cm tumour

Higher grade

ER -ve

HER-2 +ve

Lymph nodes involved

23
Q

What are surgery options for breast and axilla?

A

WLE

Mastectomy

Sentinel lobe biopsy

Axillary clearance

24
Q

Where is oestrogen produced pre and post menopause?

A

Pre- ovaries

Post- liver, skin, breast, fat, muscle

25
Q

What is the effect of oestrogen on the cancer?

A

It grows off oestrogen

26
Q

What are the hormonal therapies available for breast cancer?

A

Tamoxifen

Oophorectomy

Aromatase inhibitors

27
Q

How does Tamoxifen work?

A

selective estrogen-receptor modulator (competitively binds to oestrogen receptor sites on the cancer)

28
Q

How long should tamoxifen be taken for?

A

5yrs PO OD

29
Q

What SE tamoxifen?

A

Prevents osteoporosis!

Risk endometrial cancer as partial AGONIST (not antagonist) in endometrium

Increased risk VTE

30
Q

When is oophorectomy offered as a hormonal treatment for breast ca

A

Pre menopausal

31
Q

Who can take tamoxifen?

A

All

32
Q

Who takes aromatase inhibitors?

A

Post meonpausal`

33
Q

Action of aromatase inhibitors

A

Block extra ovarian oestrogen production

34
Q

Example of aromatase inhib

A

Anastrazole

35
Q

SEs aromatoase inhibis?

A

hot flushes, altered mood, joint pain, and nausea

Risk osteoporosis and heart disease

36
Q

What type of treatment is herceptin

A

Targeted

37
Q

How does herceptin work?

A

Blocks HER2 receptors from signalling the cancer cells to grow

38
Q

% breast ca with HER2 receptors?

A

15%

39
Q

SE herceptin?

A

Cardiotoxic

40
Q

What is trastuzumab?

A

Like herceptin

41
Q

What is a possible therapy for breast ca in future

A

immunotherapy

42
Q

What are the prognoses/benfits/drawbacks of ER/PR positive breast cancer?

A

Respond to hormone treatment is a benefit

43
Q

What are the prognoses/benfits/drawbacks of HER2 positive breast cancer?

A

More aggressive, but responds to herceptin

44
Q

What are the prognoses/benfits/drawbacks of ‘triple negative’ breast cancer? What is meant by triple negative?

A

It is ER/PR/HER2 -ve (often BRCA) and harder to treat

45
Q

Where does breast cancer tend to spread?

A

Lymph, liver, lung, bones, brain

46
Q

Histological type of breast ca?

A

Carcinoma (e.g. ductal)

4th Year CCC (19 decks)

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