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A - MSRA Cancer Care [1] > [1] Breast Cancer > Flashcards

[1] Breast Cancer Flashcards

1
Q

What proportion of women are affected by breast cancer?

A

1/10

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2
Q

How many cases of breast cancer are there a year in the UK?

A

20,000

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3
Q

How does the mortality of breast cancer compare to other cancers?

A

It is the most common cause of cancer death in females 15-54, and the second most common cause of cancer deaths overall

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4
Q

What % of breast cancer cancers are familail?

A

10%

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5
Q

By how much does having a first degree relative with breast cancer increase the risk?

A

2x

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6
Q

What % of cases of breast cancers are associated with BRCA mutations?

A

5%

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7
Q

What are the risk factors for breast cancer?

A 
Family history 
Oestrogen exposure
Proliferative breast disease with atypia
Previous breast cancer
Older age
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8
Q

What factor is protective against breast cancer?

A

Breast feeding

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9
Q

What factors can increase a persons oestrogen exposure?

A

Early menarche, late menopause
HRT and OCP
First child >35 years
Obesity

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10
Q

What is DCIS/LCIS?

A

A non-invasive pre-malignant condition

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11
Q

How is DCIS/LCIS discovered?

A

Microcalcification on mammography

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12
Q

How much does DCIS/LCIS increase the risk of invasive breast cancer?

A

10x

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13
Q

What are the subtypes of breast cancer?

A 
Invasive ductal carcinoma
Invasive lobular
Medullary
Colloid/mucinous
Inflammatory
Papillary
Phyllodes tumour
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14
Q

What is the most common subtype of breast cancer?

A

Invasive ductal carcinoma

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15
Q

What % of breast cancers are invasive ductal carcinoma?

A

70%

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16
Q

How does a invasive ductal carcinoma feel on palpation?

A

Hard (scirrhous)

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17
Q

What % of breast cancers are invasive lobular?

A

20%

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18
Q

Who do medullary breast cancers affect?

A

Younger patient

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19
Q

How do medullary breast cancers feel on palpation?

A

Soft

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20
Q

Who do colloid/mucinous breast cancers affect?

A

Elderly

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21
Q

What are the features of inflammatory breast cancers?

A

Pain
Erythema
Swelling
Peau d’orange

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22
Q

What is a Phyllodes tumour?

A

Stromal tumour

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23
Q

How does a Phyllodes tumour present?

A

Large, non-tender, mobile lump

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24
Q

How can breast cancer spreadd?

A

Direct extension
Lymph
Blood

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25
Q

Where might breast cancer spread by direct extension?

A

Muscle and/or skin

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26
Q

What are the signs of lymphatic involvement in breast cancer?

A

P’eau d’orange

Arm oedema

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27
Q

Where does breast cancer commonly spread to in the blood?

A

Bones
Lungs
Liver
Brain

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28
Q

How does breast cancer that has spread to bones present?

A

Bone pain
Increased calcium
Fractures

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29
Q

How does breast cancer that has spread to lungs present?

A

Dyspnoea

Pleural effusion

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30
Q

How does breast cancer that has spread to brain present?

A

Headache

Seizures

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31
Q

How does breast cancer that has spread to the liver present?

A

Abdominal pain

Hepatic impairment

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32
Q

How often is breast cancer screening done?

A

Every 3 years from 50-70

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33
Q

What views are taken in breast cancer screening?

A

Craniocaudal and oblique views

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34
Q

By how much does breast cancer screening reduce breast cancer death?

A

25%

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35
Q

What is the false negative rate of breast cancer screening?

A

10%

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36
Q

How might breast cancer present?

A

Lump
Skin changes
Nipple problems
Symptoms of mets

Presentation through screenin

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37
Q

What is the most common presentation of breast cancer?

A

Lump

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38
Q

Is the lump in breast cancer painful or painless?

A

Painless

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39
Q

Should elliot buy mollie a present for making all the brainscape cards?

A

Yes

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40
Q

What % of breast cancer lumps occur in the upper outer quadrant?

A

50%

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41
Q

What skin changes might be seen in breast cancer?

A

Paget’s

Peau d’orange

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42
Q

What is Paget’s skin change in breast cancer?

A

Persistent eczema

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43
Q

What nipple problems might breast cancer present with?

A

Discharge

Inversion

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44
Q

What symptoms of mets might breast cancer present with?

A

Pathological fractures
Abdominal pain
SOB
Seizures

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45
Q

What are the differential diagnoses of breast cancer?

A

Cysts
Fibroadenomas
DCIS
Duct ectasia

46
Q

When is a triple assessment required?

A

For any breast lump

47
Q

What is involved in the triple assessment of breast lumps?

A

Hx and clinical examination
Radiology
Pathology

48
Q

What radiology technique is used in the triple assessment of a breast lump?

A

If <35 years, ultrasound. If >35 years, ultrasound and mammography

49
Q

How is a biopsy carried out in the triple assessment if it is a solid lump?

A

Tru-cut core biopsy

50
Q

How is a biopsy carried out in the triple assesment if it a cystic lump?

A

FNAC with 18G needle

51
Q

What should be done if clear fluid is extracted from cystic lump in FNAC?

52
Q

What should be done if bloody fluid is extracted from cystic lump in FNAC?

A

Send cytology

53
Q

When should a core biopsy be done in a cystic lump?

A

If there is a residual mass

If +ve cytology

54
Q

What other investigations might be done in suspected breast cancer?

A

Bloods
Imaging
Wire-guided excision biopsy

55
Q

What bloods should be done in breast cancer?

A

FBC
LFTs
ESR
Bone profile

56
Q

What constitutes clinical stage 1 breast cancer?

A

Confined to breast, mobile, to LNs

57
Q

What constitutes clinical stage 2 breast cancer?

A

Stage 1 + nodes in ipsilateral axilla

58
Q

What constitutes clinical stage 3 breast cancer?

A

Stage 2 + fixation to muscle (not chest wall)
LNs matted and fixed
Large skin involvement

59
Q

What constitutes clinical stage 4 breast cancer?

A

Complete fixation to chest wall

Mets

60
Q

Who should be involved in the MDT management of breast cancer?

A 
Oncologist 
Breast surgeon 
Breastcare nurse
Radiologist
Histopathologist
61
Q

What factors should be considered when determining treatment for breast cancer?

A

Age
Fitness
Wishes
Clinical stage

62
Q

What is the aim of surgery in breast cancer?

A

Gain local control

63
Q

What are the options for surgery in breast cancer?

A

Wide local excision and radiotherapy

Mastectomy

64
Q

What % of surgical breast cancer patients are treated with wide local excision and radiotherapy?

65
Q

When is mastectomy used in breast cancer treatment?

A

Large tumours >4cm
Multifocal or central tumours
Nipple involvement
Patient choice

66
Q

What is the difference in effectiveness between wide local excision and mastectomy?

A

No difference in survival, but WLE has increased recurrence rates

67
Q

What is the sentinel node?

A

The first node that a section of breast drains into

68
Q

What is the significance of a clear sentinel node?

A

If the sentinel node is clear, there is no need for further axillary dissection

69
Q

How is a sentinel node biopsy carried out?

A

Blue dye/radiocolloid is injected into the tumour. In surgery, a visual inspection/gamma probe is used to identify the sentinel node, which is removed and sent for frozen section

70
Q

What is done if the sentinel node is not clear?

A

Axillary clearance or radiotherapy

71
Q

How does sentinel node biopsy compare to axillary clearance?

A

There is no difference overall, or in disease free survival, but sentinel node biopsy has reduced morbidity in terms of lympoedema, pain, and numbness

72
Q

What are the surgical complications of axillary node clearance?

A 
Haematoma
Seroma
Frozen shoulder
Long-thoracic nerve palsy
Lymphoedema
73
Q

What is the purpose of the Nottingham Prognostic Index in breast cancer?

A

It predicts survival and risk of relapse

74
Q

What does the Nottingham Prognostic Index guide in breast cancer?

A

Appropriate adjuvant systemic therapy

75
Q

How is the Nottingham Prognostic Index calculated?

A

(0.2 x tumour size) + histological grade + nodal status

76
Q

What is used to determine the histological grade in breast cancer?

A

The Bloom-Richardson system

77
Q

What are the non-surgical/adjuvant options for the management of breast cancer?

A

Radiotherapy
Chemotherapy
Endocrine therapy
Supportive

78
Q

What is the purpose of radiotherapy post-wide local excision?

A

Reduce the chance of local recurrence

79
Q

When is radiotherapy used post-mastectomy?

A

When there is a high risk of local recurrence, e.g. when large, poorly differentiated, node +ve cancer

80
Q

When is axillary radiotherapy used in breast cancer?

A

Node +ve disease

81
Q

When can axillary radiotherapy be used palliatively?

A

For bone pain

82
Q

When is chemotherapy used in breast cancer?

A

In pre-menopausal, node +ve, high grade or recurrent tumours

83
Q

What is the advantage of neo-adjuvant chemotherapy in large tumours?

A

Improves survival

84
Q

What chemotherapy regime is used in breast cancer?

A

6x FEC (5-FU, epirubicin, cyclophosphamide)

85
Q

What is trastuzumab?

A

Anti-Her 2 antibody

86
Q

When is trastuzumab used in breast cancer?

A

If the cancer is Her2 +ve

87
Q

What is the side effect of trastuzumab?

A

Cardiac toxicity

88
Q

When is endocrine therapy used in breast cancer?

A

In ER or PR +ve disease

89
Q

What is the purpose of endocrine therapy in breast cancer?

A

Improves survival

90
Q

How long is endocrine therapy given in breast cancer?

A

5 years of adjuvant therapy

91
Q

What are the options for adjuvant endocrine therapy in breast cancer?

A

Tamoxifen

Anastrazole

92
Q

What is the mechanism of action of tamoxifen?

A

It is a selective oestrogen reuptake modulator, which is antagonistic in the breast and an agonist in the uterus

93
Q

What are the potential adverse effects of tamoxifen?

A

Menopausal symptoms

Endometrial cancer

94
Q

What is the mechanism of action of anastrazole?

A

It is an aromatase inhibitor, and so decreases oestrogen

95
Q

When is anastrazole better than tamoxifen?

A

If she is post-menopausal

96
Q

What can be considered if a patient is pre-menopausal and ER +ve?

A

Ovarian ablation or GnRH analogues e.g. goserelin

97
Q

How is advanced breast cancer managed?

A

Tamoxifen if ER +ve

Chemotherapy

98
Q

What is involved in the supportive management of bone pain?

A

DXT
Bisphosphonates
Analgesia

99
Q

What is involved in the support management of brain mets?

A

Occasionally surgery can be performed

100
Q

What is involved in the supportive management of lymphoedema?

A

Decongestion

Compression

101
Q

When can reconstruction be offered in breast cancer?

A

Either at original surgery, or as delayed procedure

102
Q

What are the options for reconstruction in breast cancer?

A

Implants
Latissimus dorsi myocutaneous flap
Transverse rectus abdominis myocutaneous flap
Nipple tattoo

103
Q

What implants can be used in reconstruction in breast cancer?

A

Silastic or saline inflatable

104
Q

What is the flap made of in a latissimus dorsi myocutaneous flap?

A

A pedicled flap, made up of the skin, fat, muscle, and blood supply

105
Q

What artery supplies the latissimus dorsi myocutaneous flap?

A

The thoracodorsal, via the subscapular artery

106
Q

What is the gold standard reconstruction option in breast cancer?

A

Transverse rectus abdominis myocutaneous flap

107
Q

Is the flap in a transverse rectus abdominis myocutaneous flap pedicled or free?

A

It can be pedicled, supplied by the inferior epigastric artery, or free, supplied by the internal thoracic artery

108
Q

What is the advantage of a transverse rectus abdominis myocutaneous flap?

A

No implant necessary

Combined tummy tuck

109
Q

When is a transverse rectus abdominis myocutaneous flap contraindicated?

A

Smokers
Obese
PVD
DM

110
Q

What is there a risk of in transverse rectus abdominis myocutaneous flap?

A

Abdominal hernia

A - MSRA Cancer Care [1] (47 decks)

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