Flashcards in Breast cancer Deck (58):
differential diagnosis of a breast lump?
• Fibrocystic change
Biopsy investigation options?
• FNA (biopsy)
• Excisional biopsy (whole lump is taken out)
• Incisional 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?
what are some medical management options for breast cancer?
• 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
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?
▪ 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?
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?
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
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?
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
reduced breast size
what is a surgical alternative to tamoxifen?
what other medications should be prescribed in a patient post surgery for breast cancer who is about to begin 5 yr tamoxifen?