Breast Cancer Flashcards Preview

Pathobiology of Neoplasia > Breast Cancer > Flashcards

Flashcards in Breast Cancer Deck (29):
1

Epidemiology of Breast ca

Most common cancer in women
1 in 8 women

2

Secondary Risk factors for breast ca

Early menarche
Late menopause
HRT
Pregnancy hx
Benign breast disease

3

What are BRCA1 and BRCA2 Mutations?

Breast and ovarian gene
Increases risk to 85%

4

Primary Risk factors for breast ca

Female
>50
Personal hx
1st degree relative hx
BRCA1 or BRCA2 mutation
North America & Northern Europe

5

ACS Screening Guidelines

Monthly self exam
CBE (q 6mo if high risk)
Annual mammo at age 40
-10yrs earlier than relative diagnosed/fam hx of BRCA mutation

6

BI-RADS

0-1: annual mammogram
2-3: return in 6mo
4: f/u imaging or biopsy
5: biopsy
6: malignancy already present

7

What is a suspicious lump?

Stoney-hard
Fixed
Skin changes
Bloody nipple discharge
Complex/solid on US

8

How is diagnosis of Breast Ca made?

*Core needle bx is standard w/ lymph node bx

Incisional bx: takes part of mass
Excisional bx: takes all (like lumpectomy)

9

Histopathology of breast ca

Adenocarcinoma
Usually in UOQ
More common on left side r/t increased circulation

10

What are the types of breast cancer?

Carcinoma In Situ (CIS)
Infiltrating ductal (IDC) (75%)
Infiltrating lobular (ILC) (5-50%)
Inflammatory

11

Describe CIS

No invasion/spread
Confined to ducts or lobules

12

Subtypes of CIS

DCIS
-common, non-malignant
-calcification on mammo
-Tx: lumpectomy, tamoxifen
-GOOD PROGNOSIS
LCIS
-more of a tumor marker
-not seen on mammo
-usually seen w/ another invasive cancer

13

Describe IDC

MOST COMMON
starts in duct
Not always palpable
Mets thru lymph system
May or may not have calcifications

14

Describe ILC

2nd most common
Starts in milk glands
Palpable
Usually w/ contralateral findings (bilateral)
May not appear on mammo
Node mets common

15

Characteristics of Inflammatory Breast Ca

Sudden onset; Emergent
quick spread of ca cells into lymph of skin
Dermal invasion
Poor prognosis
*Peau d' orange, ulceration, erythema, heat, edema, skin nodules



16

What is a lumpectomy?

Removes cancer and tissue 1-2mm around
Local control of breast ca w/ XRT
Lumpectomy+XRT= mastectomy

17

Types of Mastectomies

Simple: takes breast tissue (also prophy for BRCA)
Skin-sparing: leaves skin and nipple; empties breast
Modified: most common, removes breast tissue,skin, nipple
Radical: takes muscles and ribs out
W/ or w/o reconstruction

18

Sentinel lymph node hypothesis

If SLN in regional basin is negative; all others are too
-node mapping

19

Lymph Nodes

Primary prognostic factor
1st site of spread
# of lymph nodes + shows risk of mets

20

Hormone receptors (Estrogen)

Estrogen receptor/Progesterone receptor (0-100%)
-the more + cells is= better response to hormone tx

When receptors are blocked= no response
-blocking/decreasing estrogen=decrease ER+ tumor cells

21

What is HER2+ Breast Ca ?

Human epidurmal receptor growth factor 2

Too much HER2
-more relapses and chemo-refractory (aggressive)

22

Adjuvant Therapy for Breast ca

Tx after surgery for stage I, II, III
Prevents regional/distant spread
-chemo (Adria and Cyclophosphamide + taxane)
-XRT
-endocrine therapy

23

Treatment for HER2 Neu +

Tx'd with Herceptin (for 12mo) *standard of care*

Pertuzumab: 1st Neoadjuvant approved drug

Iapatinib: metastatic breast ca; crosses bob

24

What does tamoxifen do?

Inhibits reuptake of estrogen in cells

Used in ER+ breast ca

Only used premenopausal

25

Side effects of tamoxifen

Blood clots
Endometrial ca
Bone pain
Hot flashes

26

Things to do with hot flashes

Avoid CYP2D6 antidepressants
-Prozac, Paxil, Wellbutrin, cymbalta

27

What are aromatase inhibitors?

Used post-menopausal

Block androgens to stop estrogen production

Anastrazole (Arimidex)
Femara

Causes osteoporosis

28

Oncologic emergencies r/t breast ca

Hypercalcemia (bone mets common)

Spinal cord compression (spine mets common)

SVC syndrome (mediastinal node mets)

29

What is lymph edema and tx ?

Swelling of hand and arm r/t increased lymph fluid after node removal

*exercise prevents