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Flashcards in Breast Cancer Deck (117):
1

What proportion of women are affected by breast cancer?

1/10

2

How many cases of breast cancer are there a year in the UK?

20,000

3

How does the mortality of breast cancer compare to other cancers?

It is the most common cause of cancer death in females 15-54, and the second most common cause of cancer deaths overall

4

What % of breast cancer cancers are familail?

10%

5

By how much does having a first degree relative with breast cancer increase the risk?

2x

6

What % of cases of breast cancers are associated with BRCA mutations?

5%

7

What are the risk factors for breast cancer?

Family history
Oestrogen exposure
Proliferative breast disease with atypia
Previous breast cancer
Older age

8

What factor is protective against breast cancer?

Breast feeding

9

What factors can increase a persons oestrogen exposure?

Early menarche, late menopause
HRT and OCP
First child >35 years
Obesity

10

What is DCIS/LCIS?

A non-invasive pre-malignant condition

11

How is DCIS/LCIS discovered?

Microcalcification on mammography

12

How much does DCIS/LCIS increase the risk of invasive breast cancer?

10x

13

What are the subtypes of breast cancer?

Invasive ductal carcinoma
Invasive lobular
Medullary
Colloid/mucinous
Inflammatory
Papillary
Phyllodes tumour

14

What is the most common subtype of breast cancer?

Invasive ductal carcinoma

15

What % of breast cancers are invasive ductal carcinoma?

70%

16

How does a invasive ductal carcinoma feel on palpation?

Hard (scirrhous)

17

What % of breast cancers are invasive lobular?

20%

18

Who do medullary breast cancers affect?

Younger patient

19

How do medullary breast cancers feel on palpation?

Soft

20

Who do colloid/mucinous breast cancers affect?

Elderly

21

What are the features of inflammatory breast cancers?

Pain
Erythema
Swelling
Peau d'orange

22

What is a Phyllodes tumour?

Stromal tumour

23

How does a Phyllodes tumour present?

Large, non-tender, mobile lump

24

How can breast cancer spreadd?

Direct extension
Lymph
Blood

25

Where might breast cancer spread by direct extension?

Muscle and/or skin

26

What are the signs of lymphatic involvement in breast cancer?

P'eau d'orange
Arm oedema

27

Where does breast cancer commonly spread to in the blood?

Bones
Lungs
Liver
Brain

28

How does breast cancer that has spread to bones present?

Bone pain
Increased calcium
Fractures

29

How does breast cancer that has spread to lungs present?

Dyspnoea
Pleural effusion

30

How does breast cancer that has spread to brain present?

Headache
Seizures

31

How does breast cancer that has spread to the liver present?

Abdominal pain
Hepatic impairment

32

How often is breast cancer screening done?

Every 3 years from 50-70

33

What views are taken in breast cancer screening?

Craniocaudal and oblique views

34

By how much does breast cancer screening reduce breast cancer death?

25%

35

What is the false negative rate of breast cancer screening?

10%

36

How might breast cancer present?

Lump
Skin changes
Nipple problems
Symptoms of mets

Presentation through screenin

37

What is the most common presentation of breast cancer?

Lump

38

Is the lump in breast cancer painful or painless?

Painless

39

Should elliot buy mollie a present for making all the brainscape cards?

Yes

40

What % of breast cancer lumps occur in the upper outer quadrant?

50%

41

What skin changes might be seen in breast cancer?

Paget's
Peau d'orange

42

What is Paget's skin change in breast cancer?

Persistent eczema

43

What nipple problems might breast cancer present with?

Discharge
Inversion

44

What symptoms of mets might breast cancer present with?

Pathological fractures
Abdominal pain
SOB
Seizures

45

What are the differential diagnoses of breast cancer?

Cysts
Fibroadenomas
DCIS
Duct ectasia

46

When is a triple assessment required?

For any breast lump

47

What is involved in the triple assessment of breast lumps?

Hx and clinical examination
Radiology
Pathology

48

What radiology technique is used in the triple assessment of a breast lump?

If <35 years, ultrasound. If >35 years, ultrasound and mammography

49

How is a biopsy carried out in the triple assessment if it is a solid lump?

Tru-cut core biopsy

50

How is a biopsy carried out in the triple assesment if it a cystic lump?

FNAC with 18G needle

51

What should be done if clear fluid is extracted from cystic lump in FNAC?

Reassure

52

What should be done if bloody fluid is extracted from cystic lump in FNAC?

Send cytology

53

When should a core biopsy be done in a cystic lump?

If there is a residual mass
If +ve cytology

54

What other investigations might be done in suspected breast cancer?

Bloods
Imaging
Wire-guided excision biopsy

55

What bloods should be done in breast cancer?

FBC
LFTs
ESR
Bone profile

56

What constitutes clinical stage 1 breast cancer?

Confined to breast, mobile, to LNs

57

What constitutes clinical stage 2 breast cancer?

Stage 1 + nodes in ipsilateral axilla

58

What constitutes clinical stage 3 breast cancer?

Stage 2 + fixation to muscle (not chest wall)
LNs matted and fixed
Large skin involvement

59

What constitutes clinical stage 4 breast cancer?

Complete fixation to chest wall
Mets

60

What constitutes Tis in breast cancer?

CIS

61

What constitutes T1 in breast cancer?

<2cm
No skin fixation

62

What constitutes T2 in breast cancer?

2-5cm
Skin fixation

63

What constitutes T3 in breast cancer?

5-10cm
Ulceration and pectoral fixation

64

What constitutes T4 in breast cancer?

>10cm
Chest wall extension
Skin involvement

65

What constitutes N1 in breast cancer?

Mobile nodes

66

What constitutes N2 in breast cancer?

Fixed nodes

67

Who should be involved in the MDT management of breast cancer?

Oncologist
Breast surgeon
Breastcare nurse
Radiologist
Histopathologist

68

What factors should be considered when determining treatment for breast cancer?

Age
Fitness
Wishes
Clinical stage

69

What is the aim of surgery in breast cancer?

Gain local control

70

What are the options for surgery in breast cancer?

Wide local excision and radiotherapy
Mastectomy

71

What % of surgical breast cancer patients are treated with wide local excision and radiotherapy?

80%

72

When is mastectomy used in breast cancer treatment?

Large tumours >4cm
Multifocal or central tumours
Nipple involvement
Patient choice

73

What is the difference in effectiveness between wide local excision and mastectomy?

No difference in survival, but WLE has increased recurrence rates

74

What is the sentinel node?

The first node that a section of breast drains into

75

What is the significance of a clear sentinel node?

If the sentinel node is clear, there is no need for further axillary dissection

76

How is a sentinel node biopsy carried out?

Blue dye/radiocolloid is injected into the tumour. In surgery, a visual inspection/gamma probe is used to identify the sentinel node, which is removed and sent for frozen section

77

What is done if the sentinel node is clear?

Axillary clearance or radiotherapy

78

How does sentinel node biopsy compare to axillary clearance?

There is no difference overall, or in disease free survival, but sentinel node biopsy has reduced mortality in terms of lympoedema, pain, and numbness

79

What are the surgical complications of axillary node clearance?

Haematoma
Seroma
Frozen shoulder
Long-thoracic nerve palsy
Lymphoedema

80

What is the purpose of the Nottingham Prognostic Index in breast cancer?

It predicts survival and risk of relapse

81

What does the Nottingham Prognostic Index guide in breast cancer?

Appropriate adjuvant systemic therapy

82

How is the Nottingham Prognostic Index calculated?

(0.2 x tumour size) + histological grade + nodal status

83

What is used to determine the histological grade in breast cancer?

The Bloom-Richardson system

84

What are the options for the management of breast cancer?

Radiotherapy
Chemotherapy
Endocrine therapy
Supportive

85

What is the purpose of radiotherapy post-wide local excision?

Reduce the chance of local recurrence

86

When is radiotherapy used post-mastectomy?

When there is a high risk of local recurrence, e.g. when large, poorly differentiated, node +ve cancer

87

When is axillary radiotherapy used in breast cancer?

Node +ve disease

88

When can axillary radiotherapy be used palliatively?

For bone pain

89

When is chemotherapy used in breast cancer?

In pre-menopausal, node +ve, high grade or recurrent tumours

90

What is the advantage of neo-adjuvant chemotherapy in large tumours?

Improves survival

91

What chemotherapy regime is used in breast cancer?

6x FEC (5-FU, epirubicin, cyclophosphamide)

92

What is trastuzumab?

Anti-Her 2 antibody

93

When is trastuzumab used in breast cancer?

If the cancer is Her2 +ve

94

What is the side effect of trastuzumab?

Cardiac toxicity

95

When is endocrine therapy used in breast cancer?

In ER or PR +ve disease

96

What is the purpose of endocrine therapy in breast cancer?

Improves survival

97

How long is endocrine therapy given in breast cancer?

5 years of adjuvant therapy

98

What are the options for adjuvant endocrine therapy in breast cancer?

Tamoxifen
Anastrazole

99

What is the mechanism of action of tamoxifen?

It is a selective oestrogen reuptake modulator, which is antagonistic in the breast and an agonist in the uterus

100

What are the potential adverse effects of tamoxifen?

Menopausal symptoms
Endometrial cancer

101

What is the mechanism of action of anastrazole?

It is an aromatase inhibitor, and so decreases oestrogen

102

When is anastrazole better than tamoxifen?

If she is post-menopausal

103

What can be considered if a patient is pre-menopausal and ER +ve?

Ovarian ablation or GnRH analogues e.g. goserelin

104

How is advanced breast cancer managed?

Tamoxifen if ER +ve
Chemotherapy

105

What is involved in the supportive management of bone pain?

DXT
Bisphosphonates
Analgesia

106

What is involved in the support management of brain mets?

Occasionally surgery can be performed

107

What is involved in the supportive management of lymphoedema?

Decongestion
Compression

108

When can reconstruction be offered in breast cancer?

Either at original surgery, or as delayed procedure

109

What are the options for reconstruction in breast cancer?

Implants
Latissimus dorsi myocutaneous flap
Transverse rectus abdominis myocutaneous flap
Nipple tattoo

110

What implants can be used in reconstruction in breast cancer?

Silastic or saline inflatable

111

What is the flap made of in a latissimus dorsi myocutaneous flap?

A pedicled flap, made up of the skin, fat, muscle, and blood supply

112

What artery supplies the latissimus dorsi myocutaneous flap?

The thoracodorsal, via the subscapular artery

113

What is the gold standard reconstruction option in breast cancer?

Transverse rectus abdominis myocutaneous flap

114

Is the flap in a transverse rectus abdominis myocutaneous flap pedicled or free?

It can be pedicled, supplied by the inferior epigastric artery, or free, supplied by the internal thoracic artery

115

What is the advantage of a transverse rectus abdominis myocutaneous flap?

No implant necessary
Combined tummy tuck

116

When is a transverse rectus abdominis myocutaneous flap contraindicated?

Smokers
Obese
PVD
DM

117

What is there a risk of in transverse rectus abdominis myocutaneous flap?

Abdominal hernia