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Detection and diagnosis of breast cancer > Detection and diagnosis of breast cancer > Flashcards

Detection and diagnosis of breast cancer Flashcards

1
Q

There are typically ……….. symptoms in early breast cancer

A

No

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2
Q

Screening methods are not …………… ………

A

diagnostic tests

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3
Q

Methods of early detections (4 of them)

A
  1. clinical breast exam (CBE)
  2. breast self exam (BSE)
  3. mammography
  4. breast magnetic resonance imaging (MRI)
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4
Q

There is broad acceptance of the value of breast examination as a ……………….. modality

A

complimentary

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5
Q

For patients that are at high risk such as those with family history, BRCA 1/2 mutations a ………… may be used in conjunction with ……………. to screen for breast cancer

A

breast MRI and Mammography

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6
Q

2 major organizations that have given screening guidelines

A

ACS - American cancer society

NCCN - National Comprehensive Cancer Network

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7
Q

The most common symptom of breast cancer is

A

a new lump or mass

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8
Q

Description of most new lumps or masses

A

painless, hard, irregular edges

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9
Q

Breast cancers can also be ……

A

tender, soft, round, and painful

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10
Q

Other signs of breast cancer (9 symptoms)

A
  1. breast or nipple pain
  2. change in size or shape of the breast
  3. skin irritation
  4. dimpling or puckering of the breast skin
  5. nipple retraction
  6. nipple discharge (not milk)
  7. redness, scaliness, thickening of the skin
  8. peau d’orange (dimpling that looks like orange skin)
  9. lump or swelling in lymph nodes in the underarm area or collar bone area
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11
Q

According to the ACS guidelines patients should start annual breast cancer screening with mammogram and CBE after age

A

40 yrs

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12
Q

What is the most common symptom of breast cancer?

A

new lump or mass

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13
Q

Medical history should include …..

A
  1. evaluation of patients complaints or symptoms
  2. assessment of the patients risk for breast cancer
  3. info about previous breast problems and diagnostic tests
  4. information about menstruation status
  5. family history of breast cancer
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14
Q

A physical exam should include

A
  1. inspection and palpation of the breasts and regional lymph nodes.
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15
Q

During physical exam breast should be examined in both the ………… and ………… position

A

seated and reclined

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16
Q

During physical breast size and obvious ………. should be noted

A

asymmetry

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17
Q

During physical the skin of the breast and nipple should be examined any signs of ……….., …………., and ……….. should be noted

A

retraction, edema, erythema

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18
Q

The entire breast should be thoroughly examined by …………..

A

palpation

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19
Q

Both the ……….. and …………. lymph nodes should be examined while the patient is upright

A

axillary and supraclavicular

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20
Q

If lymph nodes are palpable their ……… and ……… should be noted

A

size and characteristics

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21
Q

Imaging techniques for primary breast cancer (3)

A
  1. Diagnostic mammography
  2. Ultrasound
  3. MRI
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22
Q

Diagnostic mammography features

A
  • standard evaluation in women who have breast symptoms or an abnormal screening mammogram
  • contains additional images (cone or spot views)
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23
Q

Ultrasound used for

A
  • used to distinguish cysts from solid masses

- useful in women with dense breasts

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24
Q

MRI features

A
  • may be used to guide biopsies
  • NOT commonly used in diagnostic workup due to high false positive rate (detect lesions that are not cancers)
  • USEFUL when standard imaging is insufficient or in high risk patients
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25
Q

Routine chemistry tests may also be used to detect asymptomatic metastases such as (3 of them) The results can then be followed up with additional tests

A
  • alkaline phosphatase
  • alanine and aspartate aminotransferase
  • gamma-glutamyl transferase
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26
Q

Bone scan features

A
  • radioactive tracer via IV bone changes appear as hot spots
  • detect cancer that has spread to the bones
  • indicated if the patient has abnormal alkaline phosphatase levels
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27
Q

Chest x-ray used for

A

detecting lung metastases

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28
Q

Abdominal ultrasound used for

A
  • looking for tumors in the liver or other abdominal organs

- indicated if patient has elevated gamma glutamyl transferase

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29
Q

CT used for

A
  • To look at chest and/or abdomen for signs of metastases such as lungs or liver
  • indicated for elevated gamma glutamyl transferase
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30
Q

MRI used for

A

Helpful in looking at brain and spinal cord

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31
Q

PET features

A
  • can detect occult lesions throughout the body
  • useful for asymptomatic metastases
  • not as detailed as CT or MRI
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32
Q

Masses found to be solid during imaging tests require …….. evaluation

A

triple test

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33
Q

Triple test evaluation of solid masses includes

A
  1. physical exam
  2. radiologic examination
  3. needle biopsy (core or fine needle)
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34
Q

Limitations of fine needle aspiration

A
  • if insufficient material is obtain diagnosis may be difficult
  • it can’t rule out invasive carcinoma in ductal carcinoma in situ (DCIS)
  • does not capture histologic information
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35
Q

Features of core needle biopsy

A
  • more tissue
  • allows for histologic examination to determine tumor sub type and marker evaluation
  • Is the STANDARD of care for evaluating masses found in the breast
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36
Q

Surgical biopsy types (2)

A
  1. excisional biopsy (complete removal of tumor)

2. incisional biopsy (partial removal of tumor)

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37
Q

Core needle biopsy provides a slender core of tissue about ……. to …….. in length

A

1-2 cm

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38
Q

Fine needle aspiration removes some ……… or ….. that is smeared onto a slide

A

fluid or cells

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39
Q

Sentinel node definition

A

first node in the axilla to receive lymphatic drainage from the primary breast tumor and the node most likely to contain tumor cells

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40
Q

Sentinel node biopsy definition

A

procedure in which the node is identified, removed, and examined for cancer cells.

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41
Q

Sentinel node biopsy is useful for

A

assessing axillary status (spread to lymph nodes)

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42
Q

When cancer cells are in the lymph nodes there is a risk for metastasis to other parts such as ……………….

A

bone, lung, brain, liver

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43
Q

Steps in sentinel node biopsy (3 steps)

A
  1. blue dye and/or radioactive tracer is injected near or into primary tumor. Dye or tracer travels through lymphatic channels to sentinel nodes
  2. Use gamma detecting probe to detect tracer
  3. sentinel nodes are removed
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44
Q

The TNM system was developed by

A

AJCC (American joint committee on cancer)

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45
Q

TNM stand for ?

A

T - primary tumor size in MM
N - regional node involvement
M - absence or presence of distant metastasis

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46
Q

Major Designations of Primary Tumor (T)

A

TX, T0, Tis, T1, T2, T3, T4

47
Q

TX means

A

primary tumor can’t be assessed

48
Q

T0 means

A

no evidence of primary tumor

49
Q

Tis

A

carcinoma in situ

50
Q

T1

A

Tumor equal or less than 20mm in its greatest dimension

51
Q

T2

A

Tumor greater than 20mm but equal or less than 50mm

52
Q

T3

A

Tumor is greater than 50mm

53
Q

T4

A

tumor of any size with direct extension to the chest wall or skin (includes inflammatory carcinoma)

54
Q

Regional node designations

A

NX, N0, N1, N2, N3

55
Q

NX means

A

regional nodes cannot be assessed

56
Q

N0 means

A

no regional node metastasis

57
Q

N1

A

metastasis to ipsilateral level I, II axillary nodes that are moveable

58
Q

N2

A

Metastasis to ipsilateral level I, II axillary nodes are clinically fixed or matted or to other structures

59
Q

N3

A

Metastasis to ipsilateral infra clavicular (level III axillary) nodes or clinically detected ipsilateral internal mammary nodes with supraclavicular nodes

60
Q

Designations of distant metastases (M)

A

M0 and M1

61
Q

M0

A

no clinical or radiographic evidence of distant metastases

62
Q

M1

A

Distant detectable metastases larger than .2mm

63
Q

A patients stage at diagnosis is a very important …….. factor

A

prognostic

64
Q

5 year survival rate if confined to primary site

A

98.6%

65
Q

5 year survival rate if spread to regional lymph nodes

A

84.4.%

66
Q

5 yr survival rate if cancer has metastasized

A

24.3%

67
Q

5 year survival rate is unstaged

A

50%

68
Q

If a patients tumor is greater than 35mm in greatest dimension what T classification would the tumor be?

A

T2

69
Q

A patients tumor is 35mm in greatest dimension, has no detectable regional node metastasis or distant metastasis. What is the stage?

A

Stage II

70
Q

A patients stage at diagnosis is a very important prognostic factor (T/F)

A

True

71
Q

A prognostic factor is a measurement that is taken at diagnosis or surgery that is associated with the patients …………

A

Outcome

72
Q

Generally prognostic factors refer to a patients anticipated outcome at the time of diagnosis with receiving …………. ……….

A

systemic therapy

73
Q

A predictive factor is a measurement that predicts a tumor’s …….. or ………. to a particular treatment

A

response or lack of response

74
Q

Some factors can have both …………….. and ………………. value

A

prognostic and predictive

75
Q

Nodal status - type of factor and significance

A

Prognostic - higher number of involved nodes is associated with a worse prognosis

76
Q

Tumor size - type of factor and significance

A

Prognostic - larger size = more chance of recurrence

77
Q

Age of patient - type of factor and significance

A

Prognostic - Younger women age 35 or less have poorer prognosis than older post menopausal women

78
Q

Histologic grade - type of factor and significance

A

Prognostic - Higher grades are associated with poor prognosis

79
Q

Histologic subtypes - type of factor and significance

A

Prognostic - subtypes carry different prognoses

80
Q

Hormone receptor positive - type of factor and significance

A

Prognostic and Predictive - Tends to grow slower and have a better prognosis, More likely to respond to hormone therapy

81
Q

HER2 positive - type of factor and significance

A

Prognostic and Predictive - corresponds to POOR prognosis.

  • Predicts response to anti-HER2 therapy
  • May also predict response to chemotherapy
82
Q

High rate of proliferation - type of factor and significance

A

Prognostic and Predictive

  • associated with poorer prognosis
  • may predict response to chemotherapy
83
Q

Histologic grading has been criticized for ………

A

poor reproducibility

84
Q

Recommended histologic grading system …..

A

Elston-Ellis modification of Scarff Bloom Richardson grading system

85
Q

In histologic grading the tumor is assessed and graded by its morphologic features which are (3 items)

A

tubule formation, nuclear pleomorphism, and mitotic count

86
Q

In histologic grading a value of …..-…… is assigned to each of the 3 features which are added together

A

1 to 3

87
Q

In histologic grading a ………. score is more favorable

A

lower

88
Q

In histologic grading a score of 3 to 5 is grade ….

A

Grade 1 favorable

89
Q

In histologic grading a score of 6 to 7 is grade ….

A

Grade 2 moderately favorable

90
Q

In histologic grading a score of 8 to 9 is grade …..

A

Grade 3 unfavorable

91
Q

The majority of cases do not fulfill the definition of any other category and are referred to as ………………

A

ductal carcinoma NOS

92
Q

Some Histologic subtypes of breast cancer exist the one with the worst prognosis is ……….

A

inflammatory carcinoma

93
Q

The continued expansion of tumors is based on the ability of cancer to ………….. and ……………..

A

Divide and replicate

94
Q

Higher rates of …………….. have been associated with a poorer prognosis and may predict response to chemotherapy

A

Proliferation

95
Q

Techniques most used to evaluate the rate of cell proliferation (3 of them)

A

Mitotic index
S phase fraction
Ki-67

96
Q

What is ploidy

A

measure of the amount of DNA in a cancer cell.

Test can help with prognosis but don’t affect treatment decision

97
Q

ER and PR have both …………. and …………….. effects

A

prognostic and predictive

98
Q

Cancer cells may have neither, one or both ……..

A

ER and PR

99
Q

Nearly ………… of breast cancers have at least one of the hormone receptors

A

2/3

100
Q

Patients whose tumors express ER and/or PR are called

A

ER positive PR positive

101
Q

ER positive and PR positive tumors have a ……….. prognosis

A

better

102
Q

Tumors with ER or PR have a …………… response and ………… respond to hormone therapy

A

Poorer / hormone

103
Q

HER2 gene amplification or protein overexpression is detected in approximately ….% of breast cancer patients

A

20%

104
Q

HER2 has been associated with higher tumor grade, ER negative tumors, higher levels of proliferation and ……. prognosis

A

poorer

105
Q

HER2 is a major predictive factor of whether a patients cancer will respond to ………………

A

anti-HER2 therapy (trastuzumab)

106
Q

HER2 may predict response to ……………… chemo

A

anthracycline based

107
Q

Molecular subtypes - 4 main breast cancer subtypes (list)

The subtypes carry different prognosis and respond to different types of therapy

A
  1. Luminal A
  2. Luminal B
  3. HER2 positive
  4. Basal-like (also called triple negative)
108
Q

Gene assays developed for the goal of creating accurate prognostic and predictive assessments of a patients cancer based on the genes expressed by their tumors.
2 main types commercially available

A

OncotypeDX

MammaPrint

109
Q

Goal of Gene Assay tests is to determine whether or not a patient would benefit from ………………… following surgery

A

adjuvant chemotherapy

110
Q

Hormone receptor status is what type of factor?

A

Predictive

111
Q

** HER2 Positive means

A

Response to anti-HER2 therapy

112
Q

** Hormone receptor positive means

A

Response to hormone therapy

113
Q

** Medullary breast cancer is associated with

A

Favorable clinical outcome

114
Q

** Basal like (triple negative) is associated with

A

No response to hormone or anti-HER2 therapy

Detection and diagnosis of breast cancer (1 decks)

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