Chapter 56 Breast Cancer : Early Stage Flashcards Preview

Perez and Brady's Principles and Practice of Radiation Oncology 6th Edition > Chapter 56 Breast Cancer : Early Stage > Flashcards

Flashcards in Chapter 56 Breast Cancer : Early Stage Deck (33):
1

Boundary of Breast

Superficial to Pectoralis major
Midline to mid axillary line
Cranially 2nd anterior rib
Caudally 6th anterior rib
Upper outer quadrant may extend to axillary tail of Spence

2

Contents of chest wall

Ribs
Intercostal muscles
Serratus anterior muscle(not pectoral muscle)

3

Where does most breast cancer develop anatomically?

Interface between ductal system and lobules, region called terminal ductal lobular unit

4

Lymphatic drainage of breast

Predominant axillary lymph nodes
Supraclavicular lymph nodes
Internal mammary lymph nodes

5

Describe division of axillary nodes

In relation to pectoral minor muscle
Level 1 caudal and lateral to muscle
Level 2 beneath the muscle
Level 3(Infraclavicular region) cranial and medial to muscle

6

Describe IMC lymph nodes

IMC lie along internal mammary vessels
3-4cm lateral to midline
First 3 intercostal space nodes are usually involved

7

Drainage of IMC lymph nodes

Medial, central and lower breast

8

Describe process of sentinel lymph node imaging

Use of lymphoscintigraphy by injecting technicium-99 radiocolloid into peritumoral region followed by scintillation scanning.

9

Causes of breast cancer

Older age (>50 years)
Age of menarche(early) and menopause(late)
Late age of first child birth, Nulliparity
Family history
Geographic and ethnic variability
Life style(Obesity)
Personal(dense breast)
Radiation induced
Hormonal therapy induced
Dietary factors(alcohol)

10

What percentage of postmenopausal hormonal replacement therapy increased annual relative risk of developing breast cancer?

2.3%

11

Randomized trial of postmenopausal hormonal therapy from Women's health initiative group E+P vs Placebo
What percentage had breast cancer

24% increase in breast cancer, coronary heart disease, stroke, pulmonary emboli

12

What percentage of women would have increased relative risk of breast cancer
Use of E+P vs non-user

8%

13

What percentage of women would have increased relative risk of breast cancer
Use of Estrogen only vs non-user

1%

14

Use of hormonal replacement therapy in women who have undergone hysterectomy

Estrogen only has minimal effect on breast cancer risk

15

Use of hormonal replacement therapy in women who have not undergone hysterectomy

Estrogen and Progesterone remains standard to avoid risk of endometrial cancer associated with unopposed estrogen replacement

16

How many years of oral contraceptives use prior to first pregnancy increases the risk of breast cancer

Some evidence shows 4 years

17

Risk of breast cancer in family history
1st degree
2nd degree

1.5
1.7-2.5

18

Describe genetic predisposition in breast cancer

1. Actual risk depends on number of relatives affected and their at diagnosis
2. Women with strong family history, multiple first and second degree relatives, diagnosed in premenopausal age are at risk of carrying mutation(BRCA1/BRAC2)

19

Factors for radiation induced breast cancer

Increasing Dose
Young Age

20

Relation of BMI and Breast cancer

Predominately in postmenopausal women
Higher estradiol levels associated with increased adipose tissue and increased aromatase involved in conversion of androgen to estradiol.

21

Gail et al model for predicting annual and lifetime risk of breast cancer,is based on

Present age
Number of first degree relatives
Age at first birth
Age at menarche
Number of breast biopsies
History of atypical ductal hyperplasia

22

Table 56.2

Table 56.3

23

Which tumor suppressor gene is called 'Guardian of the genome'

P53 because of its critical role in cellular pathway that recognize and direct the response to DNA injury

24

What percentage of patients with Li-Fraumeni syndrome have life time risk of breast cancer

90%

25

BRCA1 types of cancer and incidence

Breast cancer 65-85% life time risk
Ovarian cancer 50% life time risk
Colon and prostate cancer

26

BRAC2 types of cancer and incidence

Breast cancer 65-85% life time risk
Ovarian cancer much less risk than BRAC1
Male breast cancer
Pancreas cancer

27

What percentage of breast cancer patient carry germline mutation in BRAC1 and BRAC2

7%

28

Table 56.4

A

29

Most common site of origin of breast cancer

Upper outer quadrant 38.5%
Central area 29%
Upper inner quadrant 5%
Lower outer quadrant 8.8%
Lower inner quadrant 5%
Rates correlates with amount of breast tissue in various quadrants

30

Breast cancer is more common in which side?

Left

31

What percentage of women with history of breast cancer have risk of developing new primary in contralateral breast

10-15%

32

Voogd et al invasive ductal cancinoma, 5125 patients, clinically negative nodes underwent axillary dissection. Describe findings

34% had positive nodes in pathologic examination
Univariate analysis showed nodal metastasis associated with following
Tumor > 1cm
Moderately or poorly differentiated nuclear grade
High fraction of cells in growth phase (S phase)
LVSI
Age younger than 60 years

33

Veronesi et al. Internal mammary node spread

Tumor larger than 2 cm, younger than 40 years and positive axillary nodes had 41% risk of having positive IMNs.