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Breast cancer Flashcards

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1
Q

What are the risk factors for breast cancer?

A 
Age
Previous breast cancer
Genetic
Early menarche and late menopause
Late or no pregnancy
HRT
Alcohol
Weight
Post radiotherapy treatment for Hodgkin's
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2
Q

What are the genes most associated with breast cancer?

A

BRCA 1 and 2

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3
Q

How do assymptomatic breast cancers usually present?

A

Breast screening (50-70yrs)

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4
Q

What are the symptoms of breast cancer?

A 
Lump
Mastalgia
Nipple discharge (blood)
Nipple changes
Change in size or shape of breast
Lymphoedema (swelling of arm)
Dimpling of breast skin
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5
Q

What are some of the nipple changes that can occur in breast cancer?

A

Paget’s disease

Retraction

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6
Q

What is Paget’s disease of the nipple?

A

Red, scaly rash on skin of nipple and areola
Sore and inflammed
Ulceration
Itchiness, bleeding

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7
Q

What are the stages that occur in a new patient clinic for breast cancer?

A
  1. Clinical: history and exam
  2. Radiological: mammograms/US
  3. Cyto-pathological: FNA, core biopsy
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8
Q

What is the difference between FNA and core biopsy investigations for breast cancer?

A

FNA - cells only -> cytology

Core biopsy - tissue -> histo-pathology

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9
Q

What should you ask about that is different in a history for breast cancer?

A

Previous breast problems

Hormonal status

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10
Q

What are signs/symptoms of breast cancer on examination?

A 
Lump or thickening in breast - often painless
Discharge or bleeding
Change in size or contours of breast
Change in colour or appearance of areola
Redness or pitting of skin over breast
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11
Q

What are the imaging techniques used for the breasts?

A

Mammography
US
MRI

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12
Q

What is the most sensitive imaging investigation for looking at the breasts?

A

Mammography

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13
Q

Why is the sensitivity of mammography reduced in young women?

A

Presence of increased glandular tissue

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14
Q

What are the two main groups of pathological types of breast cancer?

A

Invasive

Non-invasive

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15
Q

What are the two main types of invasive breast cancer?

A

Ductal carcinoma

Lobular carcinoma

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16
Q

What are the main types of non-invasive breast cancer?

A

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)

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17
Q

What are the three steps (triple assessment) in management of breast cancer?

A
  1. Diagnose
  2. Staging
  3. Treatment
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18
Q

What are the investigations done to try and stage breast cancer?

A

FBC, U&Es, LFTs, Ca2+/PO2-
CXR
Others as clinically indicated

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19
Q

What are the tumour markers for breast cancer?

A

No reliable tumour markers

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20
Q

What staging system is used for breast cancer?

A

TMN

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21
Q

What does a T4 breast cancer stage automatically mean?

A

Involves other structures

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22
Q

What is T0 stage in breast cancer?

A

Primary tumour not palpable

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23
Q

*What is T1 stage in breast cancer?

A

Clinically palpable tumour <2cm

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24
Q

What is T2 stage in breast cancer?

A

Tumour size 2-5cm

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25
*What is T3 stage in breast cancer?
Tumour size >5cm
26
What is N0 stage in breast cancer?
No regional lymph nodes palpable
27
What is N1 stage in breast cancer?
Regional lymph nodes palpable and mobile
28
What is N2 stage in breast cancer?
Regional lymph node palpable and fixed
29
What is Mx stage in breast cancer?
Distant metastasis cannot be assessed
30
What is M0 stage in breast cancer?
No distant metastasis
31
What is M1 stage in breast cancer?
Distant metastasis
32
What is the management for breast cancer?
Surgery | +/- radiotherapy/chemotherapy/hormonal therapy
33
What are the two main types of surgical procedure for breast cancer?
Breast conservation surgery | Mastectomy
34
Which patients are suitable for breast conservation surgery?
Depends on breast/tumour size ratio Suitability for radiotherapy Patient's wishes
35
What is a sentinel lymph node?
First node to receive lymphatic drainage and so first node tumour spreads to
36
What is a sentinel lymph node (SLN) biopsy?
Biopsy first node tumour has spread to
37
What does it mean if a sentinel lymph node (SLN) biopsy is negative?
Rest of nodes in lymphatic basin are negative
38
When is a sentinel lymph node (SLN) biopsy performed?
When preoperative axillary USS normal/benign
39
What is the treatment for the axilla if the SLN is negative?
No further treatment required
40
What is the treatment for the axilla if the SLN contains tumour?
Remove them all surgically OR Give radiotherapy to all the axillary nodes
41
What are the complications of axillary treatment in breast cancer?
``` Lymphoedema Sensory disturbance Decrease ROM shoulder joint Nerve damage Vascular damage Radiation-induced sarcoma ```
42
What nerves can be damaged during axillary treatment for breast cancer?
Long thoracic Thoracodorsal Brachial plexus
43
What factors are associated within increased risk of disease recurrence in breast cancer?
``` Lymph node involvement Tumour grade Tumour size Steroid receptor status HER2 status LVI - lymphovascular invasion ```
44
What is the NPI in breast cancer?
Nottingham Prognostic Index (NPI) | Determines prognosis following surgery for breast cancer
45
What three pathological criteria does the NPI look at in breast cancer?
Size of the tumour No of involved lymph nodes Grade of the tumour
46
What is the local adjuvant treatment for breast cancer?
Radiotherapy
47
What is the systemic adjuvant treatment for breast cancer?
Hormone therapy Chemotherapy Targeted therapy
48
Which type of surgery for breast cancer receives radiotherapy as an adjuvant treatment?
Wide local excision (WLE)
49
What are some complications of radiotherapy following breast cancer surgery?
Skin reaction - telangiectasis Radiation pneumonitis Cutaneous radionecrosis/osteonecrosis Angiosarcoma
50
What type of breast cancer responds to hormone therapy?
Oestrogen receptor positive (ER+)
51
What does hormone therapy in oestrogen receptor positive breast cancer do?
Blocks stimulation of cell growth by oestrogen
52
What are two types of hormone therapy used in breast cancer?
Tamoxifen | Aromatase inhibitors
53
What are two examples of aromatase inhibitors used in hormone therapy?
Arimidex | Letrozole
54
How does tamoxifen work?
Blocks directly on ER receptor
55
When is tamoxifen more effect?
After chemotherapy
56
What are the risks of tamoxifen?
Thromboembolic events
57
How is tamoxifen taken?
20mg once daily 5-10yrs
58
Which hormone therapy should only be used in postmenopausal women?
Aromatase inhibitors
59
Which hormone therapy is suitable in all age groups?
Tamoxifen
60
How do aromatase inhibitors work?
Inhibit ER synthesis
61
What are the risks of using aromatase inhibitors?
Osteoporosis
62
How long are aromatase inhibitors usually taken for?
Once daily for 5yrs
63
Who does chemotherapy benefit most in breast cancer?
``` Young women (<50) Patients with increasing adverse prognostic factor ```
64
What are the options for chemotherapy in breast cancer?
CMF combinations Anthracycline combinations Taxana based combinations
65
What is an example of a targeted therapy for breast cancer?
Trastuzumab
66
What is Trastuzumab a drug against?
Monoclonal antibody against Her2 receptor
67
Who is Trastuzumab given to in breast cancer?
Patients with over-expression of Her2 and chemotherapy
68
What is Her2?
Some breast cancer cells have a higher than normal level of a protein called HER2 (human epidermal growth factor receptor 2) on their surface, which stimulates them to grow
69
What is the follow up for breast cancer?
Mammograms yearly intervals 3-10yrs Clinical exam 1-5yrs Patient exam

Reproductive (20 decks)

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