Anatomy - Breast cancer

Question 1

What are the properties of malignant lumps?

Answer 1

• Irregular and hard
• Fixed to chest wall
• Skin above is tethered
• Palpable lymph nodes in axilla
• Indrawn nipple
• Bone tenderness/pain

Question 2

What data is required for breast cancer diagnosis?

Answer 2

• Tumour size
• Lymph node staging
• Histological type and grade
• Vascular invasion
• Excision margins
• In-situ components
• Hormone and HER2 status

Question 3

Where in the breast does breast cancer usually occur?

Answer 3

Lobular cells and duct

Question 4

What does histology of a high grade tumour look like?

Answer 4

Question 5

What type of tumour is this?

Answer 5

Oestrogen receptor positive tumour

Question 6

What type of tumour is this?

Answer 6

Oestrogen receptor negative tumour

Question 7

What type of tumour is this?

Answer 7

HER2 receptor positive tumour

Question 8

What is the triple approach to breast cancer diagnosis?

Answer 8

• Physical examination
• Mammogram
• Biopsy

Question 9

What are the 4 types of chemotherapy?

Answer 9

• Neo-adjuvant –> shrinks tumours before surgery
• Adjuvant –> follow up after surgery
• Palliative –> relieves symptoms
• Immunotherapy

Question 10

What are the properties of anti-cancer drugs?

Answer 10

• Use cytotoxic drugs
• Kill rapidly dividing cells
• Target DNA synthesis and mitosis
• Given in cycles

Question 11

What does the treatment cycle graph for chemotherapy look like?

Answer 11

Question 12

What is the function of anitmetabolites?

Answer 12

• Interfere with metabolic pathways in DNA synthesis
• Folate antagonist –> inhibit purine and pyramidine synthesis
• Methotrexate
• Dihydrofolate reductase inhibitor

Question 13

What is the function of false substrates?

Answer 13

• 5-Fluoruracil
• Similar to pyrimidines
• Inhibits thymidylate synthase
• Incorporated into DNA as false metabolites
• Lead to DNA damage

Question 14

What is the function of alkylating agents?

Answer 14

• Cyclophosphamide
• Causes chemical cross-linking of DNA
• Leads to defective DNA replication

Question 15

What is the function of platinum compounds?

Answer 15

• Inhibit DNA synthesis by cross-linking guanine residues
• • nausea though

Question 16

What is the function of antibiotics in chemotherapy?

Answer 16

• Interfere with nucleotide synthesis by intercalating between DNA strands
• Inhibit topoisomerase
• Generate free radicals

Question 17

What is the function of topoisomerase inhibitors?

Answer 17

• Inhibit topoisomerase ii
• Prevents ligation of DNA
• Leads to breaks in DNA strand

Question 18

What is the function of microtubule inhibitors?

Answer 18

• Vinca alkaloids block formation of mitotic spindle
• Taxanes stabilise spindle fibres and make them rigid so cells can’t separate

Question 19

What are all the chemotherapy side effects?

Answer 19

• Inhibit all fast-growing cells
• Myelosuppression
• Reduced white cell counts
• Infections
• Nausea (+ with platinum compounds)
• Hair loss
• Infertility
• Cardiotoxicity (anthracycline antibiotics)

Question 20

How do you reduce all of the chemotherapy side effects?

(myelosuppression, reduced white cell counts, infections, nausea, hair loss, infertility, cardiotoxicity)

Answer 20

• Monitor blood counts and Hb
• Colony-stimulating factors
• Antibiotics and antifungals
• Anti-emetics
• Cool cap
• Max lifetime dose and regular ECGs

Question 21

What are the types of palliative care?

Answer 21

• Pain relief
• Strong opioids (morphine, diamorphine, fenatyl patches
• Syringe drivers
• Hospice care

Question 22

What are the benefits of molecular testing of cancer cells?

Answer 22

• Determines receptor expression
• Can effectively be targeted

Question 23

What is the function of tamoxifen?

Answer 23

• Blocks oestrogen as is selective oestrogen-receptor modulator
• Prevents breast cancer
• Reduces oestrogen-driven breast cancer growth
• Used in ER+ breast cancer
• Guven after surgical removal
• A receptor modulator

Question 24

What is the function of aromatase inhibitors?

Answer 24

• Prevent peripheral conversion of oestrogen in post-menopausal women
• Tamoxifen alternative
• Inhibit aromatase enzymes that convert androgens to oestrogen

Question 25

What are the properties of HER2?

Answer 25

• Overexpression in some breast cancers
• Phosphorylates tyrosine - dysregulation of cell cycle - cancer
• Naturally present in low levels
• Due to oncogene
• Treatment = trastuzumab

Question 26

What is the mode of action of trastuzumab?

Answer 26

• Monoclonal antibody
• Targets HER2 - slowing of cell replication
• Used in early and metastatic breast cancer with HER2 positive tumours

Question 27

What is the functions of EGF receptor kinase?

Answer 27

• ‘Small molecule’ approach
• Used in lung and pancreatic cancers
• Inhibits tyrosine kinase activation - no gene transcription or cell cycle dysregulation - apoptosis

Question 28

What are the properties of tyrosine kinase activity?

Answer 28

• Philadelphia chromosome = associated with chronic myeloid leukaemia
• Philadelphia chromosome = produces bcr-abl protein
• Bcr-abl protein has tyrosine kinase activity
• Chronic myeloid leukaemia = ‘Philadelphia positive’

Question 29

What is imatinib?

Answer 29

Tyrosine kinase inhibitor

+ effective for chronic myeloid leukaemia

Question 30

What is the function of PARP inhibitors?

Answer 30

• Enzyme which repairs DNA
• Repairs single strand breaks in DNA
• Prevents double strand repair –> cell death
• BRCA gene association
• Used in chemo-resistant ovarian cancer

Question 31

What is the function of proteasome inhibitors?

Answer 31

• Proteasomes degrade proteins but some proteins kill cancer (pro-apoptotic factors)
• Inhibits intracelular proteasomes - altered intracellular protein regulation
• Used in multiple myeloma (bone cancer/cancer of plasma-producing cells in bone marrow)

Question 32

What are the properties of anti-VEGF?

Answer 32

• Vascular endothelial growth factor
• Secreted to promote angiogenesis
• Leads to blood vessel growth to support metastasis
• Used in renal carcinoma