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Surgery: Breast > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the most common cancer in the UK, what is the lifetime risk, and in what age does it most commonly occur?

A
  1. Breast cancer
  2. 1 in 8 for women in the UK
  3. 40-70 years of age
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2
Q

What are the risk factors for developing breast cancer?

A
  1. Increasing lifetime oestrogen exposure
  2. Female sex
  3. Increasing age
  4. Obesity - peripheral aromatisation of androgens to oestrogens
  5. Early menarche, late menopause
  6. Long term COCP, HRT >10 years.
  7. Nulliparous
  8. Family history (5-10% familial)
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3
Q

What is the genetic trait responsible for some breast cancers and how is it inherited?

A
  1. Germline BRCA1 and BRCA2 (tumour suppressor genes) mutation account for 85% of familial breast cancers.
  2. Autosomal dominant
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4
Q

What is there a risk of developing with the BRCA1 and BRCA2 gene mutations?

A
  1. 85-100% lifetime risk of breast cancer

2. High risk of ovarian cancer as well

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5
Q

What prophylactic treatment is provided if a patient is identified to have the BRCA1 or BRCA2 gene mutation?

A

Bilateral mastectomy and salpingo-oophrectomy

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6
Q

What is this a presentation of?
Usually upper, outer quadrant of breast. Hard, painless lump, may be fixed to chest wall/skin. Nipple inversion and skin dimpling.

A

Breast cancer

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7
Q

What conditions is breast cancer associated with?

A
  1. Ulceration/fungation
  2. Peau d’orange
  3. Nipple eczema in Paget’s disease
  4. Palpable axillary lymph nodes
  5. Metastatic disease (weight loss, pleural effusions)
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8
Q

How is a suspected breast cancer investigated?

A
  1. Triple assessment
  2. Graded and staged
  3. MDT discussion
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9
Q

What type of cancer are almost all malignant breast tumours?

A

Adenocarcinoma:

  1. Ductal carcinoma (75%)
  2. Lobular carcinoma (10-15%)
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10
Q

What is ductal carcinoma in situ?

A

Epithelial cells show cytological changes of malignancy. However, basement membrane is intact and the cells have not invaded surrounding tissue. Significant proportion progress to invasive ductal carcinoma.

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11
Q

What is ductal carcinoma in situ associated with on mammography and how is it treated?

A
  1. Microcalcifications

2. Surgical excision

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12
Q

What is Paget’s disease of the nipple?

A

Disease affecting the skin of the nipple and areola due to the presence of ductal carcinoma in situ cells in the epidermis.

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13
Q

What is the appearance of the skin in Paget’s disease of the nipple?

A

Eczematous

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14
Q

How does Paget’s disease of the nipple prgress?

A

DCIS cells extend along the major ducts and reach the nipple where it enters deeper layers of the epidermis. Still does not invade basement membrane so is not a cancer.

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15
Q

What is the pathophysiology of invasive lobular carcinoma?

A

Composed of tumour cells which infiltrate the normal breast tissue as linear cords of cells. This discohesive the pattern is a reflection of loss of function of the E-cadherin-catenin cell adhesion system.

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16
Q

What is the most important prognostic factor in breast cancer?

A

TNM staging - lymph node status in particular

17
Q

What are the prognostic factors in breast cancer?

A
  1. Stage - TNM
  2. Grade - 3-tier system
  3. Histological subtype
  4. Vascular invasion
  5. Excision margins
  6. Oestrogen receptor and HER2 status
18
Q

What are the features of an oestrogen receptor positive breast cancer and how is it treated?

A
  1. Low grade and less aggressive

2. Responds to hormonal therapy - tamoxifen in pre/peri-menopausal women, aromatase inhibitors in post-menopausal women

19
Q

What are the features of an oestrogen receptor negative breast cancer?

A

Tend to be higher grade and more aggressive

20
Q

What is HER2 and what is it associated with?

A
  1. Oncogene that encodes transmembrane tyrosine kinase receptor, overexpressed in 15% of invasive breast cancers.
  2. Poorer prognosis, good response to Herceptin (monoclonal Ab against HER2)
21
Q

What is a sentinel lymph node?

A

The first lymph node draining a cancer

22
Q

What is the process of identifying an affected sentinel lymph node in breast cancer?

A

Dye and/or isotope injected around tumour, visual inspection for staining, gamma probe for isotope.

23
Q

What is done if a sentinel node is positive in breast cancer?

A

Axillary clearance - removal of all axillary lymph nodes

24
Q

What is the NHS breast screening programme and what does it aim to identify?

A
  1. All women aged 50-70 invited for screening mammogram every 3 years.
  2. If suspicious features are detected, called back for further assessment.
  3. Aim to identify ductal carcinoma in situ.
25
Q

What is the name of the isotope used in identifying an affected sentinel lymph node in breast cancer?

A

Technetium-99

Surgery: Breast (3 decks)

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