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Flashcards in Week 6 Deck (257):
1

What is the formula for screening specificity

#negative/#without cancer

2

What is the formula for screening sensitivity

#positive/#with cancer

3

What should every breast problem patient go through

Triple assessment

4

Breast secretory duct from gland to nipple

Gland --> Terminal ductules --> intralobular collecting ducts --> Lactiferous duct --> Lactiferous sinus --> nipple

5

What causes proliferation of secretory tissue in the breast during pregnancy

Estrogen
Progesteron

6

Which antibody is in breastmilk

IgA

7

What is the composition of breast milk

88% water
7% Carbohydrates (Lactose)
3.5% Lipids
1.5% Protein (Lactalbumin and Casein)

8

How is lipids secreted into breastmilk

Apocrine secretion

9

How is Protein secreted into breastmilk

Merocrine secretion
Protein is free in the milk

10

Triple assessment parts are

Clinical
Imaging
Pathology

11

What is the parts of the first part of Triple assessment

Clinical
-History
-Examination

12

What are the parts of the second part of Triple assessment

Imaging
-Mammography
-Ultrasound
-MRI

13

What are the parts of the third part of Triple assessment

Pathology
-Cytopathology
-Histopathology

14

What are the samples for Breast Cytopathology

Fine Needle Aspiration
Fluid
Nipple discharge
Nipple scrape

15

What are the FNA cytology results

C1 - Unsatisfactory
C2 - Benign
C3 - Atypia, probabl benign
C4 - Suspicious of malignancy
C5 - Malignant

16

What are the types of diagnostic Breast Histopathology

(Needle) Core biopsy
Vacuum assisted biopsy
Skin biopsy
Incisional biopsy of mass

17

Types of resection of breast cancer

Wide Local Excision
Mastectomy

18

What are the Needle Core Biopsy results

B1 - Unsatisfactory/Normal
B2 - Benign
B3 - Atypia, probably benign
B4 - Suspicious of malignancy
B5 - Malignant

19

What are the types of B5 results in Needle Core Biopsy

B5a - Carcinoma in sity
B5b - Invasive carcinoma

20

Developmental anomalies of breast

Hypoplasia --
Juvenile Hypertrophy --
Accessory breast tissue --
Accessory nipple

21

Non-neoplastic Breast disease

Gynecomastia
Fibrocystic change
Hamartoma
Fibroadenoma
Sclerosing lesions

22

Inflammatory Breast disease

Fat necrosis
Duct ectasia
Acute mastitis/abscess

23

Benign tumors of breasts

Phyllodes tumor
Intraduct papilloma

24

What is Gynecomastia

Breast development in males
Ductal growth without lobular development

25

What causes Gynecomastia

Exogenous/Endogenous hormones
Cannabis
Prescription drugs
Liver disease

26

Who gets Fibrocystic change

Women aged 20-50
Majority 40-50

27

Types of Fibrocystic changes in breast

Fibrosis --
Cysts

28

What is Fibrocystic change of breasts

Monthly change in breast, may be painful. Related to menstrual period. Subside after menopause

29

Presentation of Fibrocystic change of breasts

Smooth discrete lump
Sudden pain/Cyclic pain
Lumpiness

30

Gross pathology of cysts in Fibrocystic change

1mm-several cm
Blue doomed with pale fluid
Usually multiple
Associated with other benign changes

31

What are the cysts in Fibrocystic change lined with

Apocrine epithelium

32

Management of Fibrocystic change cysts

Exclude malignancy
Reassurance
Excise if neccessary

33

What is an Hamartoma

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution.
Benign growth

34

When is Fibroadenoma of the breast presented

Normally in women of childbearing age. 3rd decade most common

35

What is Fibroadenoma

Painless, firm, discrete mobile mass
Benign tumor of stromal and epithelial tissue

36

What is Fibroadenomas also called

Breast mouse

37

What is the appearance of Fibroadenomas on USS

Solid

38

What is the appearance of Fibroadenomas

Circumscribed
Rubbery
Grey-white color

39

What does it mean that Fibroadenomas are Biphasic tumors

That they consist of two types of cells. Stroma and Epithelial cells

40

What is the management of Fibroadenomas

Diagnose
Reassure
Excise

41

Presentation of Sclerosing Adenosis

Pain, tenderness or lumpiness/ thickening
OR asymptomatic

42

What is Sclerosing Adenosis

Extra growth of tissue within the breast lobules. Benign but looks similar to carcinoma on mammogram

43

What is the difference between Radial scar and Complex sclerosing lesion

Same. Radial scar is 1cm

44

At what age is Scerlosing adenosis presented

20-70y

45

Does Sclerosing adenosis lead to Carcinoma

No

46

When is Radial scar presented

Wide age range
Common, most are incidential findings

47

What does Radial Scars mimic radiologically

Carcinoma

48

Is Radial scar premalignant

No. But carcinoma may occur within the lesions

49

What are some Inflammatory lesions in bresat

Fat necrosis
Duct ectasia
Acute mastitis/abscess

50

What causes Fat necrosis

Local trauma
Warfarin therapy

51

Pathology of Fat Necrosis

Damage and disruption of adipocytes -- Infiltration by acute inflammatory cells -- Subsequent fibrosis and scarring

52

Management of Fat necrosis

Confirm diagnosis
Exclude malignancy

53

What does Duct ectasia affect

Sub-areolar ducts

54

Features of Duct ectasia

Pain -- Bloody and/or purulent discharge -- Nipple retraction and distortion

55

What is Duct ectasia associated with

Smoking

56

Pathology of Duct ectasia

Sub-areolar duct dilation -- Periductal inflammation -- Periductal fibrosis -- Scarring and distortion

57

Management of Duct ectasia

Treat acute infections --
Exclude malignancy --
Stop smoking --
Excise ducts

58

What are two main causes of acute mastitis/abscess

Duct ectasia AND Lactation

59

Which organism causes Acute mastitis/abscess in Duct ectasia

Mixed organisms
Anaerobes

60

What organisms causes Acute mastitis/abscess in Lactation

Staph aureus
Strep pyogenes

61

Management of Acute mastitis/abscess

Antibiotics
Percutaneous drainage
Incision&drainage
Treat underlying cause

62

Features of Phyllodes Tumor

Slow growing unilateral breast mass
Biphasic tumor
Stromal overgerowth

63

What age group gets Phyllodes Tumor

Age 40-50

64

Is Phyllodes Tumor benign

Borderline malignant but considered benign.
Rarely metastasize

65

What happens if Phyllodes Tumor is excised

Prone to local recurrence if not adequately excised

66

Who gets intraduct papilloma

Age 35-60

67

Symptoms of Intraduct papilloma

Nipple discharge +/- blood

68

Features of Intraduct papilloma

Sub-areolar ducts
2-20 mm diameter
Epithelium may show proliferation

69

Levels of Epithelial proliferation in Intraduct papilloma

None -- Usual type hyperplasia -- Atypical ductal hyperplasia -- Ductal carcinoma in situ

70

Is Angiosarcoma mailignant

Yes

71

Which carcinomas metastasize to the Breast

Broncial --
Ovarian serous carcinoma --
Clear cell carcinoma of kidney

72

Which soft tissue tumor metastasize to the breast

Leiomysarcoma

73

What is the definition of Breast Carcinoma

A malignant tumor of breast epithelial cells

74

Where does Breast Carcinoma arise

Glandular epithelium of hte terminal duct lobular unit (TDLU)

75

What type of carcinoma is Breast Carcinoma

Adenocarcinoma

76

What are the precursor lesions of Breast Carcinoma

Ductal proliferations
Lobular proliferations

77

Where is In sity Carcinoma confined

Within Basement membrane of Acini and Ducts

78

Is Lobular in sity neoplasia ER postive or negative

Positive

79

Is Lobular in situ neoplasia E-cadherin positive or negative

Negative

80

Features of Lobular in situ neoplasia

Frequently multifocal and bilateral --
Incidence decrease after menopause --
Not palpable or visible grossly --
May calcify - mammography --

81

What is the significance of Lobular in situ neoplasia

Marker of subsequent risk --
Also a true precursor lesion

82

Management of Lobular in situ Neoplasia

Vaccum or excision biopsy --
Follow up

83

Which has higher risk of subsequent invasive carcinoma, Lobular in situ neoplasia OR Atypical Ductal Hyperplasia

Lobular in situ Neoplasia (8xRR)

84

Which has higher risk of subsequent invasive carcinoma, Lobular in situ neoplasia OR Ductal Carcinoma in Situ

Ductal Carcinoma in Situ (10xRR)

85

How common is Ductal Carcinoma in Situ

15-20% of all breast malignancies are DCIS

86

Where does Ductal Carcinoma in Situ arise

Terminal Duct Lobular Unit (TDLU)

87

What happens if Ductal Carcinoma in Situ involves the nipple

It is termed Paget's disesae of the nipple

88

What is Paget's disease of the nipple

High grade DCIS extending along ducts to reach the epidermis of the nipple

89

Is Paget's disease invasive

No, It is still considered In Situ Carcinoma

90

How is DCIS Classified

Cytological grade --
Histological type --
Presence of necrosis (comedo)

91

What is Microinvasive Carcinoma

Rare --
DCIS (high grade) with invasion

92

How is Ductal Carcinoma in Situ managed

Diagnosis --
Surgery --
Radiotherpy --
Chemoprevention is under trial

93

What is Invasive Carcinoma

Maligant epithelial cells which have breached the Basal Membrane

94

Risk factors for Carcinoma

Age
Reproductive history
Hormones
Previous breast disease
Life style
Genetics

95

What are the Life style risk factors for Breast Carcinoma

Bodyweight
Physical activity (Protective)
Alcohol consumption
Diet
NSAID
Smoking

96

What are the Reproductive history risk factors for Breast Carcinoma

Younger age at menarche
Older age at first birth
Higher Parity
Breastfeeding (protective)
Older age at menopause

97

What types of Exogenous hormones increase risk of breast cancer

Oral Contraceptive Pill
Hormone replacement therapy

98

What are the genes mostly associated with Breast Carcinoma

BRCA1 and BRCA2

99

What cancer syndrome may lead to Breast carcinoma

Li Fraumeni --
Cowden's --
Peutz-Jeghers --
Ataxia telengiextasia

100

What is the risk increase if a first degree relative has Breast Cancer

Doubles the risk

101

BRCA1 and BRCA2 carries a __ % life-time risk of breast cancer

45-64%

102

1 in __ will develop breast cancer

8

103

What are the Local invasion levels of Invasive Breast Carcinoma

Stroma of breast --
Skin --
Muscles of Chest wall

104

Where does Breast Cancer metastasize too

Bone, liver, brain, lungs, abdominal viscera, female genital tract

105

What does Tumor grade measure

Tumor differentiation
How similar is the tumor to the parent tissue
Well differentiated= Very similar =Good prognosis

106

Breast carcinoma Grading three categories

Tubular differentiation
Nuclear Pleomorphism
Mitotic activity
(1-3 on each category)

107

Breast carcinoma Grades

Grade 1 - Score 3-5
Grade 2 - Score 6-7
Grade 3 - Score 8-9

108

what system is used for Breast Carcinoma staging

TNM score
T0-T4
N0-N3
M0-M1

109

What are Hormone predictive and prognostic factors of Invasive Carcinoma

ER positivie or negative
PgR positive or negative
HER2 Positive or negative

110

What does ER positive tumor mean

Predicts good response to Anti-estrogen therapy

111

What are some types of Anti-estrogen therapy

Oophorectomy
Tamoxifen
Aromatase inhibitors (Letrozole)
GnRH antagonists (Goserilin)

112

HER2 postivie tumor means

Predicts a good response to Trastuzamab (Herceptin)

113

Prognostic indices - PREDICT looks at

Histopathology + ER +clinical factors + HER2 + Mode of detection

114

Prognostic indices - Adjuvant! Online looks at

Histopathology + ER + Clinical factors

115

Prognostic indices - Nottingham Prognostic Index looks at

Histopathology only (grade & Stage)

116

More fat equals _____ levels of Estrogen

Higher

117

What is persistent unilateral breast pain called

Mastalgia

118

Triple Assessment involves

Clinical
Radiological
Cyto-pathological

119

Why is mammography sensitivity reduced in young women

Increased glandular tissue

120

What are the modalities of breast imaging

Mammography
USS
MRI

121

Which is the most sensitive type of Breast imaging

Mammography

122

What are the samples that are done in Histology during triple assessment

Fine needle Aspiration AND
Core Biopsy

123

What is the limitation of Fine Needle Aspiration

Can only do Cytology on it. Not Histo-pathology

124

Most common Invasive Breast Carcinoma

Ductal Carcinoma

125

Mangagment of Breast Carcinoma

Diagnose the disease
Staging the disease
Definitive treatment

126

TNM Classifications
Classes of T

T0 - Not palpable
T1 - 5cm
T4 - Invading skin/chest wall

127

TNM Classifications
Classes of N

Lymphnodes
N0 - Non palpable
N1 - Mobile
N2 - Fixed

128

Local metastasis of Breast cancer is considered

Chest wall
Skin
Nipple

129

Treatment of Breast Cancer

Surgical
+/- Radiotherapy
+/- Chemotherapy
+/- Hormonal Therapy

130

Types of Surgical options for Breast

Mastectomy (Mx)
Wide Local Excision (WLE)

131

Types of Surgical options for Axilla

Axillary Node Clearance (ANC)
Axillary Node Sampling (ANS)
Sentinel Lymph Node Biopsy (SNBx)

132

Who should always receive Radiotherapy

Wide Local Excision patients
Mx patients if local involvement

133

Complications of Radiotherapy

Skin reaction - Skin telangiextasis
Radiation Pneumonitis

134

Who receives greatest benefit from Chemotherapy

Younger women

135

Example of Hormone Therapy drugs

Tamoxifen
Aromatase inhibitors

136

Example of Surgical Hormone Therapy

Oophorectomy

137

Examples of Aromatase inhibiotrs

Arimidex
Letrozole
Exemestane

138

Where does Tamoxifen act

Pro-drug
Metabolites act on ER receptors and block them

139

Where does aromatase inhibitors act

Inhibits Estrogen synthesis

140

Aromataste inhibitors are only effective on

Post menopausal women
Most effective in HER2+ women

141

Side effect of Aromatase inhibitors

Osteoperosis

142

Most common benign breast tumor

Fibroadenoma

143

Does Breast cysts lead to cancer

No

144

What can Duct Papilloma cause

Blood stained nipple discharge

145

How is Duct Papilloma treated

Excision by Microdochectomy or Total Duct Excision

146

What is Breast pain called

Mastalgia

147

What are the two types of Mastalgia

Cyclical AND
Non-Cyclical

148

Who gets Cyclical Mastalgia

Premenopausal women
Average age 34

149

Symptoms of Cyclical Mastalgia

Heightened awareness, discomfort, fullness, heaviness
Classically outer half of each breast.
May be unilateral

150

Who gets Non-cyclical Mastalgia

Older women
Average age 43

151

Symptoms of Non-cyclical Mastalgia

Pain can arise from chest wall, breast or outside breast.
Continuous or Random

152

Etiology of Mastalgia

Unclear
?Hormonal changes?
?Plasma fatty acid levels?

153

Treatment of Mild/Moderate Mastalgia

Reassurance
Well fitting bra
Topcial NSAIDs

154

Treatment of Severe Mastalgia

Reassurance
Consideration of drug treatment

155

Drug options for Mastalgia

Evening Primrose Oil
Gamolenic acid (up to 6/12)
Stop OCP
Danazol
Bromocriptine
Tamoxifen

156

Which type of Mastaliga is more responsive to drug treatment

Cyclical mastalgia

157

Side effects of Danazol

Weight gain, acne, hirsutism

158

Is Physiological Nipple discharge common

Yes, 2/3 of pre-menopausal women can produce nipple discharge

159

Bilateral milky discharge is called

Galactorrhea

160

Bilateral milky discharge, thoughts go to

Drug history
Prolactin levels (Pituitary tumor)

161

What is Gynecomastia

Enlargement of man's breast tissue

162

Causes of Gynecomastia

Puberty -- Idiopathic -- Drugs -- Cirrhosis -- Primary hypogonadism -- Testicular tumors -- Renal disease -- Hyperthyroidism

163

What drugs may cause Gynecomastia

Cimetidine
Digoxin
Spinorolactone
Androgens
Anti-estrogens

164

Prevalence of Gynecomastia

30-60% boys aged 10-16y
80% resolves within 2y

165

Most common cause of Gynecomastia of men 50-80y old

Idiopathic
Normal endocrine functions

166

Who gets Breast Abscess

Lactating post partum women

167

Symptoms of Breats Abscess

Pain, swelling tenderness

168

Treatment of Breast Abscess

Flucloxacillin
+/- aspiration

169

Who gets Periductal Mastitis +/- abscess

Female smokers

170

Treatment of Periductal Mastitis

Antibiotics
Aspiration if Abscess
Investigate ALL persisting lesions

171

Management of Fat necrosis

Triple assessment

172

Most common cause of Fat necrosis

Trauma

173

Treatment of Fat necrosis

Often resolve spontaneously

174

Where is the breast base/bed

Over 2nd - 6th ribs
Sternum-Midaaxillary line

175

The Breast is anterior to___. Lower part overlies _____

Deep pectoral fascia.
Lower part overlies serratus anterior

176

Breast is enclosed within ____

Superficial fascia

177

Breast is made up of

Gland tissue, fat, fibrous tissue

178

What is the axillary extension of the breast also called

Axillary tail of spence

179

Is Pain alone an indicator for Breast Imaging

No

180

Imaging modality if

Ultrasound scan

181

Imaging modalities available in breast imaging (most common)

Mammography
Ultrasound
MRI

182

What is mammography

A low dose xray designed specifically to maximise contrast between the breast tissues

183

Mammography is the only technique that reliably visualises ______.

Microcalcifications

184

Microcalcifications are associated with

~30% of invasive cancers
Almost all screen-detected Ductal Carcinoma in Situ

185

Types of Mammography

Film/Screen (Conventional)
Digital (Full Field Digital Mammography, FFDM)

186

Advantages of Digital Mammography

Improved contrast
Works better in dense breast than conventional
Shorter exam
Easier storage and transfer

187

Difference between detection and Diagnosis

Detection - Found in asymptomatic patient
Diagnosis - Found in symptomatic patient

188

How well can Mammography detect cancers

Sensitivity - 90% in >50y
Detects most impalpable cancers
10% palpable cancers not detectable on mammograms

189

What happens to the breast during mammogram in order for best detection

It is compressed

190

In a mammogram, what has higher density: Fat or Glandular tissue

Glandular tissue

191

What views are most commoly used in mammogram

Mediolateral oblique (MLO)
Craniocaudal (CC)

192

What is the table position for mediolateral oblique view

45 degrees

193

What is the table position for Craniocaudal view

Horizontal

194

What are the Breast density pattern scale

BIRADS parenchymal patterns
a- nearly all fat
b- scattered fibroglandular densities
c- heterogeneously dense (51-75% glandular)
d- extremely dense (>75% glandular)

195

Malignant calcification features

Distribution
Cluster shape/size
Individual particle shape
Pleomorphic nature

196

Malignant calcification features: Distribution

Cluster or segmental vs scattered or diffuse

197

Malignant calcification features: Individual particle shape

Linear/ branching/ Y shaped forms

198

Indications for Ultrasound scan of breast

Differentiation of cystic and solid lesions
Women

199

How does a cyst look like on a USS

Fluid is black
possible echo behind it

200

Features of Benign solid nodule

Circumscribed
Hypoechoic/hyperechoic
Wider than tall
Homogeneous
Peripheral/no vascularity
Often multiple

201

Features of Malignant solid nodule

Poorly circumscribed
Hypoechoic
Heterogeneous
Taller than wide
Spiculate
Edema/Peritumoral fat

202

When do you deploy a marker after Vacuum assisted biopsy

During complete lesion removal, check for cure afterwards

203

What device is used during Vacuum Assisted Bipsy

Mammotome

204

When is MRI used in breast imaging

When mammography or Ultrasound runs short

205

Benefits of MRI in breast imaging

No ionising radiation
Accuracy independent of breast density
Use of contrast for malignant disease

206

How is Contrast interpretated on MRI of breast

% enhancement
Uptake of contrast quickly n 120s = malignant or suspicious malignancy

207

What contrast is used in MRI

Gadolinium

208

Absolute contraindications for MRI

Pacemakers, ferromangetic aneurysm clips, cochlear implants, renal impairment

209

Relative contraindications of MRI

Pregnancy
Lactation

210

Indications for MRI

Implants (integrity)
Residual disease post WLE
Response to chemo
Recurrent diease
Screening in high risk groups

211

What are the high risk groups that needs Breast MRI screening

Previous irradiation
BRCA 1, 2 or TP53 mutation (Li Fraumeni)
Personal history of breast cancer

212

How often is Breast MRI screening in high risk genetic groups

Annually
BRCA 30-49y (carrier or probable carrier)
TP53 20-49y (carrier or probable carrier)

213

What is treatment prior to breast surgery excision called

Neoadjuvant treatment

214

Types of breast surgeries

Lumpectomy
Wide Local Excision
Wire guided Local Excision
Mastectomy

215

Types of Mastectomy

Traditional transverse
Skin sparing with immediate reconstruction

216

Does a Mastectomy reduce the chance of cancer coming back?

No difference against Breast conserving surgery plus radiotherpay

217

What is the margin needed for local excision and what is the margin used for safety in WLE

>1mm needed
>1cm used

218

What type of incision is made in breast conservation surgeries

Semicircular on the skin
Periareolar incision
Radial incision (below nipple straight down)
Inframammary fold incision

219

What types or Neoadjuvant treatments are available to achieve breast conservation

Chemotherapy +/- Herceptin
Endocrine therapy

220

What Endocrine therapies are used as Neoadjuvant treatment to breast surgery

Aromatase inhibitors
Tamoxifen

221

What is the investigation of response to neoadjuvant chemotherapy for breast cancer

Mammography
Ultrasound
MRI

222

What is mammaplasty

A group of surgical procedures, the goal of which is to reshape or otherwise modify the appearance of the breast.

223

When is breast reconstruction done after mastectomy

Immediate or delayed or never

224

Types of reconstructions post mastectomy

Implant only
Latissiumus dorse pedicled flap +/- implant
Deep Inferior epigastric artery perforator free flap
Inferior gluteal artery perforator free flap

225

What does DIEP free flap stand for

Deep inferior epigastric artery perforator

226

What does IGAP free flap stand for

Inferior gluteal artery perforator

227

Reconstruction options groups

Immediate OR Delayed
Implant based OR Autologous

228

Goals of breast reconstruction

Restore symmetry
-Volume -- Shape -- Position -- Compare to opposite breast

229

Problems with Implant based reconstruction

-Infection
-Capsular contracture
-Implant migration
-40% require revision

230

How is implant reconstruction done

2 steps
-Mastectomy with expander insertion
-Exchange expander for permanent implant

231

Complications in arm of axillary lymph node clearance

Severe edema due to loss of drainage through lymphatic system

232

Axillary treatment options

Pre-operative axillary staging
Sentinel node biopsy
Axillary clearance
Axillary radiotherapy

233

What is the sentinel node

The first lymph node that the tumor would drain into

234

When is Radiotherapy used as palliative care

Painful bony metastases, skin deposits, brain metastases

235

Who gets postoperative radiotherapy

All patients being treated conservatively
Mastectomy patients IF:
-Large tumor
-Extensive nodal involvement 4 or above
-Involved margings

236

Acute side effects of Radiotherapy

Skin erythema to moist desquamation --
Tiredness --
Mild dysphagia if irradiating supraclavicular fossa

237

Late side effects of Radiotherapy

Local fibrosis and telangectasia --
Lung fibrosis (rarely symptomatic) --
Cardiac damage (rare)

238

Systemic adjuvant therapy types

Hormone therapy
Cytotoxic chemotherapy
Immunotherapy

239

Types of Hormone therapy used as Adjuvant to breast cancer

Ovarian ablation
Tamoxifen
Aromatase inhibitors

240

Types of Cytotoxic chemotherapy used as adjuvant to breast cancer

Epirubicin
Taxanes

241

Types of Immunotherapy used as adjuvant to breast cancer

Trastuzumab

242

What is the action of Tamoxifen

Competitive inhibitor of Estrogen receptors

243

Side effects of Hormone therapy as adjuvant therapy to breast cancer

Infertility
Menopausal symptoms
Weight gain
Endometrial cancer
Deep Venous Thrombosis

244

Side effects of Chemotherapy as adjuvant therapy to breast cancer

Nausea and Vomiting
Infertility
Alopecia
Neutropenia
Mouth Ulcers
Lassitude

245

Aromatase Inhibitors mode of action

Blocks Aromatase action.
Aromatase converts Androgens from the Adrenal glands and ovaries into estrogen.

246

In which type of breast cancer is Brain metastasis relatively common

HER-2-positive breast cancer

247

Systemic therapy for Metastatic breast disease

Hormone therapy if ER/Pg +ve
Chemotherapy
Trastuzumab if HER2 +ve
Bisphosphonates for bony mets

248

When is Hormone therapy not used in metastatic breast disease

When there is liver metastases or lymphangitis carcinomatosa.
Chemotherapy is used instead for a more rapid response

249

Who gets radiotherapy after breast surgery

Anyone who has had lumpectomy, those with higher risk tumors after mastectomy

250

What is teh absolute benefit in survival of adjuvant chemotherapy in breast cancer

Between 0% and 15%

251

What is the major difference between aromatase inhibitors and tamoxifen

Aromatase inhibitors lower ciculating estrogen in post-menopausal women, tamoxifen is partial agonist at receptor.

252

What is the benefit of neo-adjuvant chemotherapy in breast cancer

It decreases the number of people who need mastectomy

253

Is there a proven overall survival advantage for Aromatase inhibitors over tamoxifen in the adjuvant setting

No, the overall survival advantage for both drugs is the same, but 10y of TAM is 3% better than 5y

254

What is the standard sequence of treatment for early breast cancer

Surgery, radiotherapy, chemo, adjuvant hormonal treatment (if applicable)

255

What is the blood supply to the breast

Medially, from branches of the internal thoracic and anterior intercostal arteries (3rd and 4th)
Laterally, Superior thoracic, thoraco-acromical and lateral thoracic branches of the axillary artery.

256

What cells secretes Estrogen

Granulosa cells in the ovarian follicle

257

Done with lectures week 6

Yes