Flashcards in Breast Cancer Deck (117):
What proportion of women are affected by breast cancer?
How many cases of breast cancer are there a year in the UK?
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
What % of breast cancer cancers are familail?
By how much does having a first degree relative with breast cancer increase the risk?
What % of cases of breast cancers are associated with BRCA mutations?
What are the risk factors for breast cancer?
Proliferative breast disease with atypia
Previous breast cancer
What factor is protective against breast cancer?
What factors can increase a persons oestrogen exposure?
Early menarche, late menopause
HRT and OCP
First child >35 years
What is DCIS/LCIS?
A non-invasive pre-malignant condition
How is DCIS/LCIS discovered?
Microcalcification on mammography
How much does DCIS/LCIS increase the risk of invasive breast cancer?
What are the subtypes of breast cancer?
Invasive ductal carcinoma
What is the most common subtype of breast cancer?
Invasive ductal carcinoma
What % of breast cancers are invasive ductal carcinoma?
How does a invasive ductal carcinoma feel on palpation?
What % of breast cancers are invasive lobular?
Who do medullary breast cancers affect?
How do medullary breast cancers feel on palpation?
Who do colloid/mucinous breast cancers affect?
What are the features of inflammatory breast cancers?
What is a Phyllodes tumour?
How does a Phyllodes tumour present?
Large, non-tender, mobile lump
How can breast cancer spreadd?
Where might breast cancer spread by direct extension?
Muscle and/or skin
What are the signs of lymphatic involvement in breast cancer?
Where does breast cancer commonly spread to in the blood?
How does breast cancer that has spread to bones present?
How does breast cancer that has spread to lungs present?
How does breast cancer that has spread to brain present?
How does breast cancer that has spread to the liver present?
How often is breast cancer screening done?
Every 3 years from 50-70
What views are taken in breast cancer screening?
Craniocaudal and oblique views
By how much does breast cancer screening reduce breast cancer death?
What is the false negative rate of breast cancer screening?
How might breast cancer present?
Symptoms of mets
Presentation through screenin
What is the most common presentation of breast cancer?
Is the lump in breast cancer painful or painless?
Should elliot buy mollie a present for making all the brainscape cards?
What % of breast cancer lumps occur in the upper outer quadrant?
What skin changes might be seen in breast cancer?
What is Paget's skin change in breast cancer?
What nipple problems might breast cancer present with?
What symptoms of mets might breast cancer present with?
What are the differential diagnoses of breast cancer?
When is a triple assessment required?
For any breast lump
What is involved in the triple assessment of breast lumps?
Hx and clinical examination
What radiology technique is used in the triple assessment of a breast lump?
If <35 years, ultrasound. If >35 years, ultrasound and mammography
How is a biopsy carried out in the triple assessment if it is a solid lump?
Tru-cut core biopsy
How is a biopsy carried out in the triple assesment if it a cystic lump?
FNAC with 18G needle
What should be done if clear fluid is extracted from cystic lump in FNAC?
What should be done if bloody fluid is extracted from cystic lump in FNAC?
When should a core biopsy be done in a cystic lump?
If there is a residual mass
If +ve cytology
What other investigations might be done in suspected breast cancer?
Wire-guided excision biopsy
What bloods should be done in breast cancer?
What constitutes clinical stage 1 breast cancer?
Confined to breast, mobile, to LNs
What constitutes clinical stage 2 breast cancer?
Stage 1 + nodes in ipsilateral axilla
What constitutes clinical stage 3 breast cancer?
Stage 2 + fixation to muscle (not chest wall)
LNs matted and fixed
Large skin involvement
What constitutes clinical stage 4 breast cancer?
Complete fixation to chest wall
What constitutes Tis in breast cancer?
What constitutes T1 in breast cancer?
No skin fixation
What constitutes T2 in breast cancer?
What constitutes T3 in breast cancer?
Ulceration and pectoral fixation
What constitutes T4 in breast cancer?
Chest wall extension
What constitutes N1 in breast cancer?
What constitutes N2 in breast cancer?
Who should be involved in the MDT management of breast cancer?
What factors should be considered when determining treatment for breast cancer?
What is the aim of surgery in breast cancer?
Gain local control
What are the options for surgery in breast cancer?
Wide local excision and radiotherapy
What % of surgical breast cancer patients are treated with wide local excision and radiotherapy?
When is mastectomy used in breast cancer treatment?
Large tumours >4cm
Multifocal or central tumours
What is the difference in effectiveness between wide local excision and mastectomy?
No difference in survival, but WLE has increased recurrence rates
What is the sentinel node?
The first node that a section of breast drains into
What is the significance of a clear sentinel node?
If the sentinel node is clear, there is no need for further axillary dissection
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
What is done if the sentinel node is clear?
Axillary clearance or radiotherapy
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
What are the surgical complications of axillary node clearance?
Long-thoracic nerve palsy
What is the purpose of the Nottingham Prognostic Index in breast cancer?
It predicts survival and risk of relapse
What does the Nottingham Prognostic Index guide in breast cancer?
Appropriate adjuvant systemic therapy
How is the Nottingham Prognostic Index calculated?
(0.2 x tumour size) + histological grade + nodal status
What is used to determine the histological grade in breast cancer?
The Bloom-Richardson system
What are the options for the management of breast cancer?
What is the purpose of radiotherapy post-wide local excision?
Reduce the chance of local recurrence
When is radiotherapy used post-mastectomy?
When there is a high risk of local recurrence, e.g. when large, poorly differentiated, node +ve cancer
When is axillary radiotherapy used in breast cancer?
Node +ve disease
When can axillary radiotherapy be used palliatively?
For bone pain
When is chemotherapy used in breast cancer?
In pre-menopausal, node +ve, high grade or recurrent tumours
What is the advantage of neo-adjuvant chemotherapy in large tumours?
What chemotherapy regime is used in breast cancer?
6x FEC (5-FU, epirubicin, cyclophosphamide)
What is trastuzumab?
Anti-Her 2 antibody
When is trastuzumab used in breast cancer?
If the cancer is Her2 +ve
What is the side effect of trastuzumab?
When is endocrine therapy used in breast cancer?
In ER or PR +ve disease
What is the purpose of endocrine therapy in breast cancer?
How long is endocrine therapy given in breast cancer?
5 years of adjuvant therapy
What are the options for adjuvant endocrine therapy in breast cancer?
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
What are the potential adverse effects of tamoxifen?
What is the mechanism of action of anastrazole?
It is an aromatase inhibitor, and so decreases oestrogen
When is anastrazole better than tamoxifen?
If she is post-menopausal
What can be considered if a patient is pre-menopausal and ER +ve?
Ovarian ablation or GnRH analogues e.g. goserelin
How is advanced breast cancer managed?
Tamoxifen if ER +ve
What is involved in the supportive management of bone pain?
What is involved in the support management of brain mets?
Occasionally surgery can be performed
What is involved in the supportive management of lymphoedema?
When can reconstruction be offered in breast cancer?
Either at original surgery, or as delayed procedure
What are the options for reconstruction in breast cancer?
Latissimus dorsi myocutaneous flap
Transverse rectus abdominis myocutaneous flap
What implants can be used in reconstruction in breast cancer?
Silastic or saline inflatable
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
What artery supplies the latissimus dorsi myocutaneous flap?
The thoracodorsal, via the subscapular artery
What is the gold standard reconstruction option in breast cancer?
Transverse rectus abdominis myocutaneous flap
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
What is the advantage of a transverse rectus abdominis myocutaneous flap?
No implant necessary
Combined tummy tuck
When is a transverse rectus abdominis myocutaneous flap contraindicated?