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Breast cancer Flashcards

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1
Q

What are some risk factors for breast cancer?

A

Female
Ageing
Denser breast tissue
Family history 1st degree relative
Increased oestrogen exposure
Lifestyle factors

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2
Q

What are some causes of increased oestrogen exposure that increase breast cancer risk

A
  • Earlier onset of periods (Menarche)
  • Later menopause
  • Nulliparous
  • HRT (Especially combined) or oral contraceptive (Small increase which returns to normal after 10 years cessation)
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3
Q

What are some lifestyle factors that increase risk of breast cancer?

A

Obesity
Lack of physical activity
Alcohol consumption
Poor diet
Smoking

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4
Q

What percentage of breast cancers are hereditary?

A

5-10%

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5
Q

What is involved in a genetic risk assessment for breast cancer?

A

Detailed family history (3+ generations)
Accurate tumour pathology

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6
Q

What are some features suggestive of a hereditary cancer

A
  • Early onset
  • Multiple primaries
  • Clustering of same type of cancer in close relatives
  • Cancers in multiple generations in a family
  • Tumour histology/pathology
  • Different types of cancer or unusual cancers seen in rare cancer syndromes
  • Founder mutations
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7
Q

What are the 4 genetic breast cancer risk classifications

A

Very high risk (≥40%)
High risk (30-40%)
Moderate risk (17-30%)
Low risk (≤17%)

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8
Q

What is meant by very high risk of genetic breast cancer

A
  • Heterozygous carrier of a variant in BRCA1, BRCA2, TP53, PALB2, STK11, PTEN and CDH1

OR

  • Childhood supradiaphragmatic radiotherapy for lymphoma
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9
Q

What is meant by high risk of genetic breast cancer

A

Families where there is an estimated 20% or greater risk of carrying a pathogenic variant in genes such as such as RAD51C, RAD51D, ATM, CHEK2

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10
Q

What is meant by moderate risk of genetic breast cancer

A
  • One 1st-degree relative diagnosed under 40 or male breast cancer at any age

OR

  • Two 1st or one 1st and one 2nd-degree relative with breast cancer under 60 or ovarian cancer at any age, on the same side of the family

OR

  • Three 1st or 2nd-degree relatives with breast or ovarian cancer in the same blood line

OR

  • Females with a diagnosis of NF1
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11
Q

What type of genes are BRCA1 and 2

A

Tumour suppressor genes

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12
Q

On what chromosome is BRCA1 found?

A

17

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13
Q

ON what chromosome is BRCA2 found?

A

13

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14
Q

What are the risks associated with a BRCA1 mutation?

A
  • 70% will develop breast cancer by 80yo
  • 50% will develop ovarian cancer
  • Increased risk of bowel and prostate
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15
Q

What are the risks associated with a BRCA2 mutation?

A
  • 60% will develop breast cancer by 80yo
  • 20% will develop ovarian cancer
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16
Q

What are some characteristics of BRCA1 breast cancer?

A
  • Poorly differentiated
  • More commonly triple-negative
  • More rapid growth then sporadic cancer
  • Fibroadenoma-like appearance
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17
Q

What are some characteristics of BRCA2 breast cancer?

A
  • Moderately-poorly differentiated
  • ER/PR similar to sporadic cancer
  • HER-2 over-expression
  • More DCIS
  • More rapid growth than sporadic cancer
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18
Q

What are some characteristics of BRCA positive ovarian cancer?

A
  • High-grade serous carcinoma
  • Aggressive
  • Late presentation
  • No screening programme
  • Risk-reducing bileratl salpingo-oophorectopmy
  • BRCA-1 have higher risk from an earlier age than BRCA-2
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19
Q

How common is breast cancer

A

1 in 8 women will develop breast cancer
Breast cancer is the most common cancer in the UK (2016-18) and incidence is increasing

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20
Q

What is the purpose of breast cancer receptor testing?

A

Allows for targeted treatment

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21
Q

What are the 3 breast cancer receptors tested for?

A

Oestrogen receptors (ER)
Progesterone receptors (PR)
Human epidermal growth factor 2 (HER2)

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22
Q

What is triple-negative breast cancer

A

Breast cancer that is negative for all 3 breast cancer receptors

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23
Q

What is the significance of triple negative breast cancer

A

Worse prognosis
Limited treatment options

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24
Q

What are the 4 most common locations that breast cancer metastasises to

A

2L 2B:
L - Lungs
L - Liver
B - Bones
B - Brain

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25
What are the 2 main categories of breast cancer
Invasive Non-invasive
26
What are the 2 main categories of non-invasive breast cancer
Ductal Lobar in-situ neoplasia
27
What are the 4 main types of ductal non-invasive breast cancer
- Epithelial hyperplasia of usual type - Columnar cell change (± Atypia) - Atypical ductal hyperplasia (ADH) - Ductal carcinoma in-situ (DCIS)
28
What are the 2 main forms of lobar in-situ neoplasia?
- Atypical lobular hyperplasia (ALH) - Lobular carcinoma in-situ (LCIS)
29
What is meant by atypical lobar hyperplasia?
<50% lobule is involved
30
What is meant by lobular carcinoma in-situ?
>50% lobule is involved
31
What is the most common non-invasive breast cancer?
DCIS (20%)
32
What is DCIS?
a malignancy of the ductal tissue of the breast that is contained within the basement membrane
33
How common in invasive development in DCIS
20-30%
34
What are some sub-types of DCIS
comedo, cribriform, micropapillary, and solid types, however most lesions are mixed
35
How does DCIS usually present
Asymptomatic Detected during screening
36
How does DCIS show on mammography
Localised or wide-spread micro-calcifications
37
How should localised DCIS be managed?
Wide excision Adjuvant radiotherapy and chemoprevention (Endocrine therapy)
38
How should widespread, multifocal DCIS be managed?
Complete mastectomy Adjuvant treatment (Good prognosis)
39
What is lobular carcinoma in situ?
A malignancy of the secretory lobules of the breast that is contained within the basement membrane
40
What is the invasive risk of LCIS
30% More than DCIS
41
How does LCIS present?
Asymptomatic
42
Who is LCIS most common in?
Pre-menopausal women
43
How is LCIS found on core biopsy managed?
Proceed to excision or vacuum biopsy to exclude higher grade lesion
44
What is breast carcinoma?
A malignancy arising in the glandular epithelium of the terminal duct lobar unit (TDLU) It is an adenocarcinoma
45
What are the main classifications of breast carcinoma
Invasive ductal carcinoma (75-85%) Invasive lobular carcinoma (10%) Others (5%)
46
What are some other, rarer forms of breast cancer?
Medullary carcinoma Colloid carcinoma Inflammatory breast cancer
47
Where does invasive ductal carcinoma originate?
Cells from the breast duct
48
How is invasive ductal carcinoma further classified?
tubular, cribriform, papillary, mucinous (/colloid), or medullary carcinomas
49
Where does invasive lobular carcinoma originate?
Cells of the breast lobules
50
How is invasive lobular carcinoma characterised?
Diffuse stromal pattern of spread making detection more difficult
51
Where does breast carcinoma locally invade?
Stroma of breast skin Muscles of chest wall
52
Where does breast carcinoma lymphatic ally spread?
axillary, sentinel, apical, infraclavicular, supraclavicular, cervical, internal mammary, inframammary
53
What are some clinical features of breast carcinoma?
breast lump(s), asymmetry, or swelling (all or part of breast), abnormal nipple discharge, nipple retraction, skin changes (dimpling/peau d’orange, or Paget’s-like changes), mastalgia, or with a palpable lump in the axilla.
54
How does inflammatory breast cancer present?
- Similar to breast abscess or mastitis - Swollen, warm, tender breast with pitting skin (Peau d'orange) - Does not respond to antibiotics
55
What are some rarer forms of malignant breast tumour?
Inflammatory breast cancer Medullary breast cancer Mucinous breast cancer Malignant phyllodes tumour Angiosarcoma Lymphoma Metastatic tumours
56
What are some common cancers that metastasise to the breast
Carcinoma - Bronchial, ovarian serous, clear cell kidney carcinoma Malignant melanoma Soft-tissue tumours (E.g. Leiomyosarcoma)
57
When does angiosarcoma of the breast usually occur?
Post-radiotherapy
58
Who is put on a two week wait referral for suspected breast cancer?
- Unexplained breast lump in patients over 30 - unilateral nipple changes in patients over 50 - unexplained lump in axilla in patients over 30 - Skin changes suggestive or breast cancer
59
What is the gold standard investigation regime for breast cancer?
Triple assessment
60
What is the triple assessment for breast cancer?
Clinical assessment (history and examination) Imaging (USS or mammography) Biopsy (FNA or core biopsy)
61
Who receives breast USS as primary imaging modalities?
Women under 40
62
Why do women under 40 not receive mammography?
They breasts are more dense with glandular tissue so would not be effective
63
When may MRI scans of breasts be done?
- For screening in women at higher risk of developing breast cancer (e.g., strong family history) - To further assess the size and features of a tumour
64
What lymphatic imaging is performed in women with diagnosed breast cancer?
USS of the axilla US guided biopsy of any abnormal nodes
65
How is sentinel node sampling performed in breast cancer?
An isotope contrast and blue dye are injected into the tumour area This travels through lymphatics The first lymph node the dye reaches is the sentinel lymph node This can be detected by an isotope scanner
66
What is sentinel lymph node biopsy?
Biopsy of the sentinel lymph node during breast cancer surgery
67
What are some additional investigations required in breast cancer?
- Lymph node assessment and biopsy - MRI of the breast and axilla - Liver ultrasound for liver metastasis - CT of the thorax, abdomen and pelvis for lung, abdominal or pelvic metastasis - Isotope bone scan for bony metastasis
68
What staging system is used in breast cancer?
TNM
69
What is the current NHS screening regime for breast cancer
mammogram every 3 years to women aged 50 – 70 years.
70

Breast week (5 decks)

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