1: Breast Carcinoma Flashcards
(102 cards)
1
Q
What is the most common type of breast cancer
A
Adenocarcinoma
2
Q
Where do adenocarcinomas most commonly arise
A
Ductule (80%)
3
Q
Aside from ductal tissue, where may adenocarcinomas arise
A
Lobule (20%)
4
Q
How can breast carcinomas be divided
A
- Non-Invasive Carcinoma. (Carcinoma in situ) = not invaded past basement membrane
- Invasive Carcinoma
5
Q
What is the most common type of non-invasive breast carcinoma
A
Ductule Carcinoma in Situ (DCIS)
6
Q
Where does DCIS originate
A
Terminal Ductule Lobular Unit (TDLU)
7
Q
What % of DCIS will become invasive ductal carcinoma
A
20-30%
8
Q
What is lobular carcinoma in situ
A
Adenocaricnoma that originates from secretory lobule
9
Q
How does the risk of LCIS compare to DCIS for invading the basement membrane
A
Higher risk of transforming to invasive cancer
10
Q
What % of invasive cancers are ductal carcinomas
A
85%
11
Q
Where do invasive ductal carcinomas arise
A
Terminal Ductule Lobular Unit (TDLU)
12
Q
What % of invasive adenocarcinomas are invasive lobular carcinomas
A
15%
13
Q
Where do invasive lobular carcinomas arise
A
Terminal Ductule Lobular Unit (TDLU)
14
Q
Describe the epidemiology of breast carcinoma
A
Most common cancer in women
15
Q
Which population does breast carcinoma typically occur
A
Post-menopausal women
16
Q
What are three genetic syndromes that increase the risk of breast cancer
A
- BRCA I and II
- Peutz-Jegher
- Li Fraumeni
17
Q
What percentage of women with BRCA genes develop breast cancer
A
70%
18
Q
What is the inheritance pattern of BRCA
A
Autosomal Dominant
19
Q
What is different to BRCA positive women with breast cancer, compared to BRCA negative
A
Develop breast cancer 15-20 years younger
20
Q
What other cancer does BRCA increase the risk of
A
Ovarian
21
Q
What 4 cancers does Li Fraumeni Syndrome increase the risk of (SBLA)
A
- Sarcoma
- Breast
- Lung
- Adrenal
22
Q
What are 5 risk factors for breast cancer
A
- Increased Oestrogen
- Obesity
- Smoking
- Alcohol
- Radiation
- FH
- Breast cancer in contralateral breast
23
Q
What are 5 factors that increase oestrogen, increasing the risk of breast cancer
A
- Early menarche
- Late menopause
- Nulliparous
- First pregnancy >35
- HRT
- COCP
24
Q
Why does obesity increase the risk of breast cancer
A
Adipocytes covert androgens to oestrogen
25
How may breast cancer present
- Lump
- Asymmetry
- Skin dimpling
- Skin tethering
- Peu d'orange
- Paget's disease
- Mastalgia
- Palpable axillary lump
26
If the GP suspects breast cancer what time-frame should they be referred for triple assessment
2W
27
What are the three stages of triple assessment
1. Exam
2. Imaging
3. Biopsy
28
What imaging is used for females <35
USS
29
What imaging is used for females >35
Mammography
30
What imaging is used for males
USS
31
What is used to take a biopsy
Core needle biopsy and fine needle aspiration
32
Why is a core biopsy preferred to fine needle aspiration
Core biopsy can provide histology. Whereas FNA can only provide cytology
33
If suspicous of cancer on FNA what should be performed and why
Core needle biopsy = to distinguish whether invasive or non-invasive. As cannot tell from FNA alone
34
Explain scoring of triple assessment
Individual is given a score from 1-5 based on:
Exam (P)
Imaging (M or U)
Biopsy (B)
35
In triple assessment what does P stand for
Exam
36
What is P1
Normal
37
What is P2
Benign
38
What is P3
Unsure - likely benign
39
What is P4
Unsure - likely malignant
40
What is P5
Malignant
41
What is M1
Normal
42
What is M2
Benign
43
What is M3
Unsure - Likely Benign
44
What is M4
Unsure - Likely Malignant
45
What is M5
Malignant
46
What is B1
Normal
47
What is B2
Benign
48
What is B3
Unsure - Likely Benign
49
What is B4
Unsure - Likely Malignant
50
What is B5
Malignant
51
Who should BRCA gene testing be offered to
All women under 50-years presenting with breast cancer
52
What other imaging is used in diagnostic work-up of breast cancer
CT scan used to stage disease (TNM)
53
If micro calcifications is seen on breast screening (US or mammography) what type of cancer is it likely to be?
More likely to be DCIS, opposed to LCIS which does not present with micro calcifications.
54
Outline NHS screening program for breast cancer
Mammography is offered to women aged 50 - 70 every 3-years. Now trialling 47-73.
After 70 women can request screening appointment.
Positive results are referred for triple assessment
55
How is DCIS managed
Wide local excision
56
How is LCIS managed
Observation
57
If individuals are found to have BRCA genes what is performed
Prophylactic bilateral mastectomy
58
What is offered to all patients following WLE
Radiotherapy
59
What are indications for mastectomy
- Multi-Focal Disease
- High-Grade
- BRCA1/2
- Disease recurrence
- Patient Choice
60
What is sentinel node biopsy surgery
The sentinel node = first node cancer will pass too, is identified by injecting blue radio-isotrope. Then is removed and sent for histology
61
What is axillary node clearance and when is it done
Removal of all axillary lymph nodes = done if the sentinel node biopsy is positive.
62
Why may hormonal therapy be used as an adjuvant
prevent recurrence or those unfit for surgery
63
What hormonal adjuvant is used for PRE-MENOPAUSAL patients
Tamoxifen
64
How does tamoxifen work
Binds and inhibits oestrogen receptors at the breast
65
What are two risks of tamoxifen
Increased risk of:
- Endometrial Cancer
- VTE
66
Why does tamoxifen increase risk of endometrial cancer
Due to being pro-oestrogenic on endometrial tissue
67
What hormonal medication is used in POST-MENOPAUSAL WOMEN
Aromatase inhibitors
68
What are three aromatase inhibitors
- Anastrozole
- Letrozole
- Exemestane
69
How do aromatase inhibitors work
Decrease peripheral conversion of androgens to oestrogen
70
When may Herceptin be given as adjuvant therapy
If HER2 receptor positive
71
When may Herceptin be used as mono therapy
Metastatic disease not responded to at least two rounds of chemotherapy
72
What is the purpose of oncoplastic breast surgery
To reconstruct breast following mammectomy
73
What are the two techniques of oncoplastic breast reconstruction
1. Mammoplasty
| 2. Flaps
74
What is a mammoplasty
WLE with breast reduction technique. Results in smaller, uplifted breast with preserved nipple and areolar
75
What three flaps can be used to reconstruction breast
1. Latissimus Dorsi Flap
2. Transversus Rectus and abdominal muscle (TRAM) flap
3. Deep inferior epigastric perforator (DIEP) flap
76
What is latissimus dorsi flap
Uses latissimus dorsi muscle and overlying skin to reconstruct breast
77
When are latissimus dorsi flaps used and why
Smaller breast - only take portion of muscle
78
What is a TRAM flap
Transversus rectus and fat are used to reconstruct the breast
79
What is deep inferior epigastric perforator flap
tissue from abdomen and overlying skin used to reconstruct breast
80
What is the most important prognostic factor for breast cancer
Node status
81
What else can influence prognosis of breast cancer aside from node status
Grade
Size
Receptor Status
82
What should all breast cancers undergo and why
Receptor status (PR, ER, HER2) as this can influence prognosis
83
What scoring system is used to predict prognosis of breast cancer
Nottingham prognostic index
84
What is the Nottingham prognostic index score
(Size x 0.2) + Node Status + Grade
85
What are 6 causes of nipple discharge
- Physiological (Breast Feeding)
- Galactorrhoea
- Carcinoma
- Intraductal Papilloma
- Hyperprolactinaemia
- Mammary ductal ectasia
86
What is the most common pathological cause of nipple discharge
Galactorrhoea - occurs around breast feeding
87
What is a distinguishing feature of hyperprolactinaemia
May have bitemporal hemianopia due to pressure on optic chasm
88
How will nipple discharge present in mammary ductal ectasia
Thick yellow-green discharge
89
Which population is mammary ductal ectasia common in
Post-menopausal women
90
If a post-menopausal women smoker presents with green-yellow nipple discharge, what is it
Mammary ductal ectasia
91
What type of discharge is present in carcinoma
Blood-stained
92
What can cause blood-stained nipple discharge in younger patients
Intraductal papilloma
93
What are three factors protective from breast cancer
- Physical activity
- Breastfeeding
- NSAIDs
94
Explain NHS advice for self-examination of breasts
5 Steps to be breast aware
95
What are the 5 steps for self-breast examination
1. Know Normal
2. Look and Feel your breasts
3. Know what changes to look for
4. Report concerns without delay
5. Attend routine screening if >50
96
What are 5 differentials for breast lump in a male
1. Gynaecomastia
2. Lipoma
3. Cyst
4. Breast cancer
5. Fat necrosis
97
What is Paget's disease of the nipple
Ductal carcinoma that infiltrates the nipple
98
How will the nipple present in paget's disease
- Erythematous
- Thickened, Flaking skin
- Vesicular rash
- Pruritus
- Bloody discharge
99
What is a contraindication of tratszumab
heart disease
100
What are 4 indications for mastectomy
- Large lesion in small breast
- DCIS >4
- Central tumour
- Multifocal lesion
101
What are 4 indications for WLE
- Small lesion
- DCIS <4
- Peripheral tumour
- Solitary tumour
102
What is possible complication of axillary node clearance
Lymphoedema and functional arm impairment
