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Early Stage Breast cancers Flashcards

(67 cards)

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1
Q

AB exam

Paget’s breast disease examination

A

Axilla + Breast examination

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2
Q

Define Paget’s disease of the nipple

A

A rare condition presenting as a persistent roughening, scaling, ulcerating or eczematous change to the nipple. Majority will have underlying ductal carcinoma in situ (DCIS) or invasive breast cancer

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3
Q

Paget’s disease of the nipple clinical presentations

A
  • itching or redness in the nipple and/or areola
  • flaking
  • thickened skin on or around the nipple
  • painful and sensitive
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4
Q

Paget’s breast disease Ix

A

Imaging: USS, MRI, Mammogram
Invasive: Bx

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5
Q

Paget’s breast disease Mx

A

1st line: Surgery (nipple and areola will need to be removed)

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6
Q

Concerning nipple changes

A
  • sudden nipple retraction
  • ezmatous changes extending to areola
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7
Q

Non-concerning nipple changes

A
  • Ezematous changes (nipple sparring)
  • slit nipple (aging - normal entity)
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8
Q

what is tamoxifen indicated for in breast ca

A

Premenopausal women with oestrogen +ve receptor on breast ca cells

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9
Q

what is letrozole / anastraxole indicated for in breast ca

A

Postmenopausal women with oestrogen +ve receptors breast ca cells

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10
Q

what is the MoA of letrozole / anastrozole

A

Aromatase inhibitor

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11
Q

what is aromatase

A

An enzyme that converts androgens into estrogens

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12
Q

Tamoxifen MoA

A

selective estrogen receptor modulator (SERM) that works by blocking estrogen receptors in breast cancer cells

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13
Q

LLBB

where in the body is breast ca mostly likely to spread to

A

Lungs
Liver
Bone
Brain

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14
Q

which gene mutation is assoc. with breast ca

A

BRCA 1
BRCA 2

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15
Q

what other cancer is BRCA gene mutationm also assoc. with

A

ovarian ca

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16
Q

What biopsy is used for staging patients with early-stage, clinically node-negative breast cancer

A

sentinel lymph node
biopsy

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17
Q

Breast cancer single major risk factor

A

Being a female

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18
Q

Breast cancer modifiable risk factors

A
  • Alcohol
  • Liver cirrhosis
  • Obesity
  • unopposed oestrogen exposure (COP, HRT)
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19
Q

Breast ca non-modifiable risk factors

A
  • Aging
  • BRCA gene mutation
  • FMHx
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20
Q

In-situ VS Invasive breast ca

A

In-situ: ca cells within breast ducts
Invasive: ca cells breached out of basement membrane of the ducts

from Bx

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21
Q

what type of breast ca is a precursor of invasive breast cancer

A

Ductal carcinoma in-situ (DCIS)

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22
Q

what is the most common type of non-invasive breast malignancy

A

DCIS

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23
Q

Define DCIS

A

A malignancy of the ductal tissue of the breast that is contained within the basement membrane

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24
Q

How is DCIS mostly detected?

A

DCIS is mostly detect during screening

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25
how does DCIS appears on mammogram
microcalcification
26
how is DCIS confirmed
Bx sampling
27
DCIS Mx
- Breast conservation surgery for **well-contained carcinoma** - Mastectomy for **multifocal DCIS**
28
Define Lobular carcinoma in-situ (LCIS)
a non-invasive lesion of the **secretory lobules of the breast** that is contained within the basement membrane
29
DCIS or LCIS increases the risk of invasive breast cancer
LCIS
30
LCIS Mx
Active monitoring + survillance
31
DCIS or LCIS more likely to assoc with axillary nodal metastasis
DCIS
32
What cell does DCIS arise from
epithelial cells
33
what is the Ki67 index
A measure of **cell proliferation** used in pathology to assess proliferation of cancer cells
34
what does a high Ki67 index indicate
- Rapid tumour cell proliferation - Poor prognosis
35
what are the two hormonal receptors found on breast ca cells
- Oestrogen receptor - Progesterone receptor
36
what is the transmembrane receptor found in breast ca
Her2 receptor
37
which receptors are most common in breast ca
hormonal receptors - oestrogen - progesterone
38
when is the prognosis of breast ca poor in terms of ca cell receptors
triple -ve (Oestrogen, Progesterone, Her2 -ve)
38
when is staging imaging (CT CAP) indicated in breast ca
CT CAP - when the pt is experiencing distal spread Sx
39
what staging system does breast ca used
**T**umour size **N**odes **M**etatasis
40
how mant T stages are in breast ca
T1-T4
40
what are the T stages of breast ca
- T1 - tumour < 2cm - T2 - tumour 2-5cm - T3 - tumour > 5cm - T4 - tumour extends to skin / chest wall
41
what are the N stages of breast ca
**N0** - NO LN met **N1** - met to ipsilat. movable axillary LNs **N2** - met to ipsilat. fixed axillary or IM LNs **N3** - met to clavicular, axiallary, IM LNs
42
what are the M stages in breast ca
M0 - **No distant** met M1 - **Distant met**
43
when is sentinel lymph node bx indicated
when the axilla is **radiologically, clinically and Bx normal** in **invasive breast ca**
44
when is axiallary clearance (removal of axialla LN) indicated
- SLNB proven LN met - Axilla LN met on imaging
45
when is breast conserving surgery (BCS) indicated
- **localised disease** and **no evidence of metastatic disease** - **size** of the breast cancer is **small relative to the breast size** ## Footnote along with RT
46
what surgical technique does BCS used
**wide local excision**: removing the breast cancer with a cuff of healthy tissue around it
47
Mastectomy indications
- **multifocal**disease - **high tumour:breast tissue ratio** - disease recurrence, patient choice, or for risk-reduction (BRCA 1/2, P53 +ve)
48
what is a sentinel LN
first lymph node (or nodes) into which the breast drains
49
axilla clearance clinical relevance
Long thoracic nerve damage --> winging of the scapula
50
Breast conservation options
- implantation - local flap - free flap
51
what flap is used in **local flap reconstruction**
Latissimus Dorsi Flap
52
what flap is used in **free flap reconstruction**
Deep Inferior Epigastric Perforator (DIEP)
53
Axilla clearance complications
- Lymphoedema of the ULs - Axillary Web Syndrome
54
Tamoxifen SEs ## Footnote agonists other sites: endometrium
- increase risk of VTEs - endometrial hyperplasia
55
Anastazole / letrozole SEs
- Reduce bone density - Joint aches / pain
56
what Ix should be performed when prescribing Anastrazole / Letrazole
DEXA scan for bone desity baseline
57
what should be co-prescribed with Anastrazole / Letrazole
- Calcium + vit D supplements - Bisophonates
58
what can be used to treat Her2 receptor +ve breast ca
Immunotherapy - **Trastuzumab (Herceptin)** ## Footnote in combination w/ chemo
59
Chemotherapy indications in breast ca
- Advanced breast ca - Early breast ca w/ high risk features - **NOT** for ER +ve breast cancer
60
breast ca chemo SEs
Neutropenia N+V hair loss
61
surveillance mammograms for breast ca patients
Yearly for 5 years
62
Trastuzumab (Herceptin) SEs
cardiotoxicity (HF): SOB, peripheral oedema
63
Other than breast ca, what cancer is **BRCA 2** assoc with
Prostate ca
64
What index is used for breast ca prognosis
Nottingham Prognostic Index (NPI)
65

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