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MBChB Surgery > Breast cancer > Flashcards

Breast cancer Flashcards

(48 cards)

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1
Q

What is the incidence of breast cancer?

A

8-10%

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2
Q

What is the peak age of breast cancer?

A

63yo

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3
Q

Name risk factors for breast cancer

A 
Non-modifiable:
Female 
Age 
Family history 
Genetics 
Early age at menarche
Older age at menopause
Race
Nulliparity 
Personal history 
Modifiable:
Obesity
Alcohol
Smoking
HRT
Parity
>30yo first live birth
Night shift work 
Histologic
Proliferative breast disease
Atypical ductal/lobular hyperplasia
Lobular carcinoma in situ 
Lack of breastfeeding
Hormonal use
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4
Q

How does family history affect breast cancer risk?

A

1 direct family member >50 = 12% risk
2 direct family members >50 = 18% risk
1 direct family member <50 = 22% risk
2 direct family members <50 = 40% risk

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5
Q

What is the BRCA gene risk for breast cancer?

A

80%

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6
Q

Why is imaging done before biopsy?

A

Tumour size assessment is important and biopsy causes bleeding that distorts the actual size

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7
Q

When can FNA be done for biopsy?

A

Clinical impression and imaging suggest that the lump is benign

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8
Q

What information should be provided by pathology?

A 
Benign vs malignant 
In situ vs invasive 
Ductal vs lobular 
Characteristics (mucinous, scirrhous) 
Elston Nottingham classification
Receptors
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9
Q

What is the Elston Nottingham classification?

A

It grades breast carcinomas by adding up scores for

  • tubule formation
  • nuclear pleomorphism
  • mitotic count
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10
Q

How is the Elston Nottingham classification graded?

A 
3-5 = well differentiated
6-7 = moderately differentiated
8-9 = poorly differentiated
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11
Q

How is tubule formation scored using the Elston Nottingham classification?

A

75% of tumour shows tubules (1)
10-75% of tumour shows tubules (2)
<10% of tumour shows tubules (3)

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12
Q

How is nuclear size scored using the Elston Nottingham classification?

A

Small, regular nuclei (1)
Intermediate size nuclei - 1.5/2x the size of normal nuclei (2)
Large nuclei - >2x the size of normal nuclei (3)

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13
Q

How is mitotic count scored using the Elston Nottingham classification?

A

0-7 mitoses/10HPF (1)
8-14 mitoses/10HPF (2)
>15 mitoses/10HPF (3)

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14
Q

Which score looks at the oestrogen and progesterone receptors?

A

Allred Quick Score

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15
Q

What is a positive predictor of effective anti-oestrogen treatment?

A

Progesterone receptor >30%

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16
Q

What is HER2?

A

Human epidermal growth factor receptor 2 - indicates high recurrence rates

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17
Q

What is Ki-67?

A

A nuclear protein that gives exact assessment of proliferation
Indicates % of cells in mitotic process

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18
Q

Name the sites of breast cancer metastases

A 
Lung
Liver
Pelvis
Ovaries
Bone
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19
Q

How is metastatic staging done in breast cancer?

A

Clinically
Radiologically
Blood tests

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20
Q

How do we look clinically for breast cancer metastases?

Study These Flashcards
A 
Pleural effusion
Enlarged nodular liver 
Pouch of Douglas nodules 
Bone pain
Fractures
21
Q

Which imaging do we routinely do for TNM staging?

Study These Flashcards
A

CXR
Abdominal U/S
Pelvic U/S

22
Q

When do we do CT/PET CT in TNM staging?

Study These Flashcards
A

If there is doubt about findings

23
Q

Which blood tests should be done for TNM staging?

Study These Flashcards
A

FBC
LFT
Calcium
Tumour markers (for baseline and treatment response)

24
Q

If you find an elevated calcium with no other signs of bone metastases, how do you proceed?

Study These Flashcards
A

Rule out hyperparathyroidism before doing expensive bone scintigram

  • Repeat the calcium
  • Do a PTH assessment
25
When should surgery of the primary breast tumour not be undertaken?
Tumour cannot be removed with clear surgical margins | Wound cannot be closed primarily
26
How do we make the primary lesion operable?
Neo-adjuvant systemic therapy - chemotherapy - hormonal therapy
27
What are the two surgical options?
Mastectomy | Breast conservation
28
What must breast conservation therapy always be followed by and why?
Radiotherapy due to high local recurrence rate
29
What is the only indication for breast conservation surgery?
Cosmesis
30
How is the axilla managed in breast cancer?
Not involved - sentinel node biopsy | Involved - dissection of at least 1 level
31
When is radiotherapy indicated after mastectomy?
>4 involved nodes after axillary dissection
32
When do we use radiotherapy for metastatic disease?
1. Spinal cord compromise - symptoms of spinal cord compression need urgent MRI and radiotherapy to prevent paralysis 2. Brain metastases - BBB prevents chemotherapeutic treatment - RT to stop increase in pressure
33
When do we start systemic adjuvant treatment of breast cancer?
Within 3-4 weeks after surgery | >12w no benefit shown
34
What is herceptin?
Monoclonal antibody
35
Which chemotherapy agents are usually used for breast cancer?
1. Monthly cycles for 6 months - 5-fluorouracil - cyclophosphamide - adriamycin ``` 2. Newer regimen: Monthly cycles for 4 months - cyclophosphamide - adriamycin Followed by taxane weekly for 12w ```
36
What should you monitor if you give a patient adriamycin?
Cardiac function for cardiotoxicity | Poor function = methotrexate instead
37
Which hormonal therapy do we use in premenopausal women?
SERMs (tamoxifen)
38
Which hormonal therapy do we use in postmenopausal women?
Aromatase-inhibitors (anastrasole, letrosole)
39
Discuss staging of the primary tumour (T)
``` Tx - cannot be assessed T0 - no evidence of tumour Tis - carcinoma in situ T1 - <20mm T1mi - <1mm T1a - >1mm but <5mm T1b - >5mm but <10mm T1c - >10mm but <20mm T2 - >20mm but <50mm T3 - >50mm T4 - any size with extension to chest wall and/or skin T4a - extension to chest wall T4b - ulceration and/or ipsilateral satellite nodules and/or skin edema T4c - both T4a and T4b T4d - inflammatory carcinoma ```
40
Discuss staging of the regional lymph nodes (N)
Nx - cannot be assessed N0 - no metastasis N1 - 1-3 axillary nodes and/or in SLNB detected internal mammary nodes N2 - 4-9 axillary nodes or in clinically detected internal mammary nodes N3 - >9 axillary nodes or in infraclavicular or clinically detected internal mammary nodes w/ 1 or more axillary nodes
41
Give the TNM stages for stage 0 breast cancer
Tis N0 M0
42
Give the TNM stages for stage 1a breast cancer
T1 N0
43
Give the TNM stages for stage IB breast cancer
T0 N1 T1 N1 T2 N0
44
Give the TNM stages for stage 2b breast cancer
T2 N1 | T3 N0
45
Give the TNM stages for stage 3a breast cancer
``` T0 N2 T1 N2 T2 N2 T3 N1 T3 N2 ```
46
Give the TNM stages for stage 3b breast cancer
T4 N0 T4 N1 T4 N2
47
Give the TNM stages for stage 3c breast cancer
Any T | N3
48
Give the TNM stages for stage 4 breast cancer
M1

MBChB Surgery (38 decks)

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