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Flashcards in Breast cancer Deck (58):

differential diagnosis of a breast lump?

• Fibroadenoma
• Cyst
• Fibrocystic change
• Cancer


Biopsy investigation options?

• FNA (biopsy)
• Excisional biopsy (whole lump is taken out)
• Incisional biopsy
Core biopsy


what are some family history of cancers that you would want to know about?

Previous family history of breast cancer, ovarian cancer, prostate cancer, familial gastric cancer


what are the 4 main sites of metastases from the breast lump?

1. Bone
2. Lung
3. Liver
4. Brain


what are some medical management options for breast cancer?

• Chemotherapy
• Radiotherapy
• Biological (antibody)
Endocrine therapies- SERMs (tamoxifen)


what are 3 indications for total mastectomy rather than radiation or wide local excision?

• Inability to achieve a wide local excision--> indication for mastectomy
• Can only radiate a place once- so radiotherapy cannot be performed. Hence mastectomy is required.
- pregnant woman
-an adverse SE to radiotherapy= scleroderma, so if the patient has this, they are recommended to have a mastectomy


what are the important aspects of axillary lymph nodes in breast cancer?

-The status of the axillary lymph nodes indicate the management of the cancer
-Indicates prognosis


Which is more relevant, paternal versus maternal family history of breast cancer?

equally important and should be considered


what age of onset is most important to consider in a family history of cancer?

less than 40 Age of onset is most important for family history of cancer


Which ethnicity predisposes risk to developing breast cancer?

Jewish populations from Eastern Europe- Ashkenazi


what are the 2 imaging modalities for breast cancer?

u/s and mammogram


what are the australian guidelines for mammograms?

• 50-75 year old women should have a mammogram every 2 years


what are the 2 surgical managements to the breast?

total mastectomy and wide local excision


why are mastectomies more popular amongst younger women?

more popular bc higher risk of new primary breast cancer occurring without a mastectomy (e.g. a patient with high risk BRCA genes)


what is herceptin? what is its chemical name?

Trastuzumab. it is a monoclonal antibody that targets the HER2 receptor


what are some factors that indicate poor prognosis in breast cancer?

Young age
▪ Premenopausal
▪ Large tumour size
▪ High tumour grade
▪ Oestrogen, progesterone Her2 receptor negative (triple receptor negative)
▪ Positive nodes


what do we mean by sentinel lymph node?

A sentinel lymph node is defined as “the first node in a regional lymphatic basin that receives lymph flow from the primary tumor.” 


why would we want to do a sentinel lymph node biopsy?

In the absence of clinical or radiological (usually ultrasound) evidence of lymphadenopathy, surgery of the axilla can be minimized by sentinel lymph node guided sampling (after dye or radioactive tracer injection).


why do we want to minimise surgery of the axillary lymph nodes as much as possible?

Axillary lymph node removal is a very large operation and carries risk of damaging important structures in the axilla such as the brachial plexus. Post surgery there may also be the unwanted consequence of chronic non pitting lymphoedema that many patients do not want.


What characteristics of the breast cancer do we need to establish prior to deciding therapeutic management?

We need to know whether the breast cancer is hormonally responsive. So whether it over-expresses oestrogen receptors, progesterone receptor or HER2 receptor. Some breast cancers are triple negative to all 3 receptors, and hence will not respond to hormonal therapy such as tamoxifen. This generally leads to poorer prognosis


what are the risk factors related to oestrogen exposure are there for breast cancer?

generally, the more oestrogen you are exposed to the higher the risk of breast cancer. E.g. early menarche, late menopause, nulliparity, late pregnancy, HRT, obesity and not breastfeeding


what genes predispose breast cancer?

BRCA 1 and BRCA 2


what are the two subtypes of carcinomas in the breast?

lobular and ductal carcinoma


what is the triple assessment of a breast lump?

palpation, radiology (mammogram/ultrasound) + FNA biopsy


what are the 4 stages of breast cancer?

Stage 1= confined to breast, mobile
Stage 2= growth confined to breast, mobile, lymph nodes in ipsilateral axilla
Stage 3= tumour fixed to muscle, some skin involvement, lymph nodes in ipsilateral axilla
Stage 4= complete fixation of tumour to chest wall + distant metastases


When would surgery be more indicated- stage 1, stage 2, stage 3, stage 4 breast cancer?

Surgery is more indicated in stage 1 and 2 cancer. chemo, hormonal and radiotherapy are more indicated in stage 3 and 4 due to wider invasion of the cancer


how is a sentinel lymph node biopsy conducted?

a blue dye or radio colloid is injected into the preareolar region and a gamma probe is used to identify the sentinel lymph node


what kind of genes are BRCA 1 and BRCA 2?

tumour suppression genes


what does overexpression of HER2 result in?

enhanced amplification of EGFR pathway leading to cell proliferation


what are some advantages of FNA and what are some disadvantages of FNAs

Advantages: instant answer, cheap, not very invasive
Disadvantage- architecture is not assessed.


what is a FNA?

needle is placed into lesion and cells and fluid are removed


what is a core biopsy?

tissue is removed by varying calibre canal and processed into H and E section


what is a radiological characteristic of DCIS?

massive calcification


why would you do a sentinel node for a DCIS?

in case it has invaded


what is the difference between DCIS and LCIS in terms of progression to breast cancer?

DCIS= precursor lesion
LCIS= risk factor lesion


relationship between breastfeeding and breast cancer

breastfeeding is protective for breast cancer


what generally causes sporadic breast cancer?

Sporadic breast cancer
• Oestrogen overexpression
Due to hormone exposure


what is the only breast cancer that causes pain and swelling?

inflammatory breast cancer


what other parts of the body would you screen in the breast examination?

liver, bone and lungs


what situation do we typically see mastitis?

breast feeding


blood in nipple discharge?

can't ignore this. Differential diagnoses= papilloma, duct ectasia, malignancy


what is duct ectasia?

dilation of the ducts


what is a papilloma?

lump inside a duct. can be associated with cancer. Bloody discharge is often due a papilloma


how do we treat papillomas?

always surgically excise. need to determine whether the patient intends to breast feed or not.


what markers do we use for sentinel lymph node biopsy?

patent blue dye and radioactive marker


difference between the discharge of ductal ectasia vs papilloma?

papilloma- bloody serous
ductal ectasia usually milky discharge but can be bloody


what chemotherapy drugs do they use in breast cancer? should endocrine and chemotherapy drugs be used together?

cyclophosmaphide is the main chemo drug
5 flurouracil

usually endocrine therapy FOLLOWs chemo therapy not done concurrently


which out of aromatase inhibitors or oestrogen therapy do we prefer for post menopausal women with breast cancer?

aromatase inhibitors


define DCIS?

malignant clonal proliferation of epithelial cells limited by to ducts and lobules by the basement membrane


what mutation is associated with LCIS?

loss of E cadherin tumour suppressor proteins


can we detect LCIS on mammography or palpation?

no. only diagnosed via biopsy bc LCIS does not produce calcifications etc on mammography unlike DCIS, and also doesnt present as a mass


what are the different implications between LCIS and DCIS in terms of progression to cancer?

Lobular carcinoma in situ (LCIS) develops in breast lobule(s) and is usually found incidentally. Whereas DCIS predicts an increased risk of invasive duct carcinoma developing at the site of a biopsy demonstrating DCIS, LCIS implies increased risk of invasive ductal or lobular carcinoma developing in the future in either breast


what are the 2 architectural subtypes of DCIS?

comedo and non comedo


tell me about paget disease of the breast

ARISE FROM DCIS. Malignant DCIS cells migrate to the epithelium, disrupt the epithelial layer causes pruritis (ezcema like rash) and an oozy discharge when scratched.


Side effects of radiotherapy to the breast tissue?

Skin changes- tanning/sunburn
Lung scarring
reduced breast size


what is a surgical alternative to tamoxifen?

surgical oophrectomy


what other medications should be prescribed in a patient post surgery for breast cancer who is about to begin 5 yr tamoxifen?

calcium (cholecalciferol)

+/- bisphosphonates


what do you think about micro vs macro calcifications on mammography?

micro- more likely to be malignant, and macro more likely to be benign