Breast cancer

Question 1

When does incidence of breast ca peak

Answer 1

about 34 and then again 60-69 (screening)

Question 2

What are risk factors/causes of breast ca

Answer 2

Uninterrupted oestrogen exposure

Chest wall/mediastinal RT

Genetics

Lifestyle- smoking and alcohol >14u/w

Question 3

What are the causes of uninterrupted oestrogen exposure

Answer 3

1 Early menarche/late menopause

2 Nullip/1st child at older age

3 HRT

4 Prolonged use OCP

5 Obese (Esp. post meonpause)

Question 4

What are the genes that contribute to breast ca

Answer 4

BRCA1

BRCA2

P53

Question 5

What do the normal variants of BRCA genes do?

Answer 5

Tumour supressors

Question 6

BRCA also increase the risk of what other type of gynae ca?

Answer 6

Ovarian

Question 7

Can BRCA be inherited from mother and father?

Answer 7

Yes

Question 8

What is the inheritance pattern of BRCA?

Answer 8

Autosomal dominant

Question 9

How much does BRCA increase risk?

Answer 9

BRCA1- 72%

BRCA2- 69%

To get breast ca by age 80

Question 10

Ovarian cancer risk with brca?

Answer 10

brca1- 44%

brca2- 17%

By age 80

Question 11

Does BRCA increase risk of other cancers?

Answer 11

Yes prostate in men (esp BRCA2)

Fallopian tube, peritoneal, pancreatic

Question 12

What ethnic group is more at risk of BRCA?

Answer 12

Ashkenazi jews

Question 13

Who is eligible for brca genetic testing?

Answer 13

an inherited faulty gene has already been identified in a

Or

there is a strong family history of cancer (at least 2 close family members on the same side of the family who have the same cancer or related cancer types, such as bowel and womb cancer)

= referral to genetics

Question 14

When is screening for breast ca carried out

Answer 14

50-70yrs every 3yrs

Question 15

what is ‘interval cancer’

Answer 15

occurs between screenings

Question 16

What % of those called back from mammogram have cancer?

Answer 16

25%

Question 17

Peau d’orange on the breast could be what?

Answer 17

Mastitis

Inflammatory breast cancer (v bad)

Question 18

What nipple fluid is most worrying

Answer 18

Blood

Question 19

Breas cancer history

Answer 19

Onset

Skin/nipple changes

Assoc sx (discharge and pain)

Relation to menstruation (and menarche and menopause ages)

Prev lumps in breast

Lumps in axillae

FHx and if they have children (when)

PMH (OCP/HRT use, prev RT)

Question 20

What is involved in the triple assessment?

Answer 20

Examination scored P1-P5

Radiology- mammogram (x ray), USS if lump O/E

Biopsy- FNA or core (core is more common)

Question 21

When would you do bloods in a breast cancer assessment?

Answer 21

Pre-op

Concern about mets

Tumour markers Ca15.3, CEA

Question 22

What means a breast cancer is poorer prognosis?

Answer 22

> 5cm tumour

Higher grade

ER -ve

HER-2 +ve

Lymph nodes involved

Question 23

What are surgery options for breast and axilla?

Answer 23

WLE

Mastectomy

Sentinel lobe biopsy

Axillary clearance

Question 24

Where is oestrogen produced pre and post menopause?

Answer 24

Pre- ovaries

Post- liver, skin, breast, fat, muscle

Question 25

What is the effect of oestrogen on the cancer?

Answer 25

It grows off oestrogen

Question 26

What are the hormonal therapies available for breast cancer?

Answer 26

Tamoxifen Oophorectomy Aromatase inhibitors

Question 27

How does Tamoxifen work?

Answer 27

selective estrogen-receptor modulator (competitively binds to oestrogen receptor sites on the cancer)

Question 28

How long should tamoxifen be taken for?

Answer 28

5yrs PO OD

Question 29

What SE tamoxifen?

Answer 29

Prevents osteoporosis! Risk endometrial cancer as partial AGONIST (not antagonist) in endometrium Increased risk VTE

Question 30

When is oophorectomy offered as a hormonal treatment for breast ca

Answer 30

Pre menopausal

Question 31

Who can take tamoxifen?

Answer 31

All

Question 32

Who takes aromatase inhibitors?

Answer 32

Post meonpausal`

Question 33

Action of aromatase inhibitors

Answer 33

Block extra ovarian oestrogen production

Question 34

Example of aromatase inhib

Answer 34

Anastrazole

Question 35

SEs aromatoase inhibis?

Answer 35

hot flushes, altered mood, joint pain, and nausea Risk osteoporosis and heart disease

Question 36

What type of treatment is herceptin

Answer 36

Targeted

Question 37

How does herceptin work?

Answer 37

Blocks HER2 receptors from signalling the cancer cells to grow

Question 38

% breast ca with HER2 receptors?

Answer 38

15%

Question 39

SE herceptin?

Answer 39

Cardiotoxic

Question 40

What is trastuzumab?

Answer 40

Like herceptin

Question 41

What is a possible therapy for breast ca in future

Answer 41

immunotherapy

Question 42

What are the prognoses/benfits/drawbacks of ER/PR positive breast cancer?

Answer 42

Respond to hormone treatment is a benefit

Question 43

What are the prognoses/benfits/drawbacks of HER2 positive breast cancer?

Answer 43

More aggressive, but responds to herceptin

Question 44

What are the prognoses/benfits/drawbacks of 'triple negative' breast cancer? What is meant by triple negative?

Answer 44

It is ER/PR/HER2 -ve (often BRCA) and harder to treat

Question 45

Where does breast cancer tend to spread?

Answer 45

Lymph, liver, lung, bones, brain

Question 46

Histological type of breast ca?

Answer 46

Carcinoma (e.g. ductal)