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Breast > 1: Breast Carcinoma > Flashcards

1: Breast Carcinoma Flashcards

1
Q

What is the most common type of breast cancer

A

Adenocarcinoma

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2
Q

Where do adenocarcinomas most commonly arise

A

Ductule (80%)

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3
Q

Aside from ductal tissue, where may adenocarcinomas arise

A

Lobule (20%)

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4
Q

How can breast carcinomas be divided

A
  1. Non-Invasive Carcinoma. (Carcinoma in situ) = not invaded past basement membrane
  2. Invasive Carcinoma
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5
Q

What is the most common type of non-invasive breast carcinoma

A

Ductule Carcinoma in Situ (DCIS)

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6
Q

Where does DCIS originate

A

Terminal Ductule Lobular Unit (TDLU)

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7
Q

What % of DCIS will become invasive ductal carcinoma

A

20-30%

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8
Q

What is lobular carcinoma in situ

A

Adenocaricnoma that originates from secretory lobule

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9
Q

How does the risk of LCIS compare to DCIS for invading the basement membrane

A

Higher risk of transforming to invasive cancer

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10
Q

What % of invasive cancers are ductal carcinomas

A

85%

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11
Q

Where do invasive ductal carcinomas arise

A

Terminal Ductule Lobular Unit (TDLU)

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12
Q

What % of invasive adenocarcinomas are invasive lobular carcinomas

A

15%

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13
Q

Where do invasive lobular carcinomas arise

A

Terminal Ductule Lobular Unit (TDLU)

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14
Q

Describe the epidemiology of breast carcinoma

A

Most common cancer in women

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15
Q

Which population does breast carcinoma typically occur

A

Post-menopausal women

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16
Q

What are three genetic syndromes that increase the risk of breast cancer

A
  • BRCA I and II
  • Peutz-Jegher
  • Li Fraumeni
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17
Q

What percentage of women with BRCA genes develop breast cancer

A

70%

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18
Q

What is the inheritance pattern of BRCA

A

Autosomal Dominant

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19
Q

What is different to BRCA positive women with breast cancer, compared to BRCA negative

A

Develop breast cancer 15-20 years younger

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20
Q

What other cancer does BRCA increase the risk of

A

Ovarian

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21
Q

What 4 cancers does Li Fraumeni Syndrome increase the risk of (SBLA)

A
  • Sarcoma
  • Breast
  • Lung
  • Adrenal
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22
Q

What are 5 risk factors for breast cancer

A
  • Increased Oestrogen
  • Obesity
  • Smoking
  • Alcohol
  • Radiation
  • FH
  • Breast cancer in contralateral breast
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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
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24
Q

Why does obesity increase the risk of breast cancer

A

Adipocytes covert androgens to oestrogen

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25
Q

How may breast cancer present

A
  • Lump
  • Asymmetry
  • Skin dimpling
  • Skin tethering
  • Peu d’orange
  • Paget’s disease
  • Mastalgia
  • Palpable axillary lump
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26
Q

If the GP suspects breast cancer what time-frame should they be referred for triple assessment

A

2W

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27
Q

What are the three stages of triple assessment

A
  1. Exam
  2. Imaging
  3. Biopsy
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28
Q

What imaging is used for females <35

A

USS

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29
Q

What imaging is used for females >35

A

Mammography

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30
Q

What imaging is used for males

A

USS

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31
Q

What is used to take a biopsy

A

Core needle biopsy and fine needle aspiration

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32
Q

Why is a core biopsy preferred to fine needle aspiration

A

Core biopsy can provide histology. Whereas FNA can only provide cytology

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33
Q

If suspicous of cancer on FNA what should be performed and why

A

Core needle biopsy = to distinguish whether invasive or non-invasive. As cannot tell from FNA alone

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34
Q

Explain scoring of triple assessment

A

Individual is given a score from 1-5 based on:
Exam (P)
Imaging (M or U)
Biopsy (B)

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35
Q

In triple assessment what does P stand for

A

Exam

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36
Q

What is P1

A

Normal

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37
Q

What is P2

A

Benign

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38
Q

What is P3

A

Unsure - likely benign

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39
Q

What is P4

A

Unsure - likely malignant

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40
Q

What is P5

A

Malignant

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41
Q

What is M1

A

Normal

42
Q

What is M2

A

Benign

43
Q

What is M3

A

Unsure - Likely Benign

44
Q

What is M4

A

Unsure - Likely Malignant

45
Q

What is M5

A

Malignant

46
Q

What is B1

A

Normal

47
Q

What is B2

A

Benign

48
Q

What is B3

A

Unsure - Likely Benign

49
Q

What is B4

A

Unsure - Likely Malignant

50
Q

What is B5

A

Malignant

51
Q

Who should BRCA gene testing be offered to

A

All women under 50-years presenting with breast cancer

52
Q

What other imaging is used in diagnostic work-up of breast cancer

A

CT scan used to stage disease (TNM)

53
Q

If micro calcifications is seen on breast screening (US or mammography) what type of cancer is it likely to be?

A

More likely to be DCIS, opposed to LCIS which does not present with micro calcifications.

54
Q

Outline NHS screening program for breast cancer

A

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
Q

How is DCIS managed

A

Wide local excision

56
Q

How is LCIS managed

A

Observation

57
Q

If individuals are found to have BRCA genes what is performed

A

Prophylactic bilateral mastectomy

58
Q

What is offered to all patients following WLE

A

Radiotherapy

59
Q

What are indications for mastectomy

A
  • Multi-Focal Disease
  • High-Grade
  • BRCA1/2
  • Disease recurrence
  • Patient Choice
60
Q

What is sentinel node biopsy surgery

A

The sentinel node = first node cancer will pass too, is identified by injecting blue radio-isotrope. Then is removed and sent for histology

61
Q

What is axillary node clearance and when is it done

A

Removal of all axillary lymph nodes = done if the sentinel node biopsy is positive.

62
Q

Why may hormonal therapy be used as an adjuvant

A

prevent recurrence or those unfit for surgery

63
Q

What hormonal adjuvant is used for PRE-MENOPAUSAL patients

A

Tamoxifen

64
Q

How does tamoxifen work

A

Binds and inhibits oestrogen receptors at the breast

65
Q

What are two risks of tamoxifen

A

Increased risk of:

  • Endometrial Cancer
  • VTE
66
Q

Why does tamoxifen increase risk of endometrial cancer

A

Due to being pro-oestrogenic on endometrial tissue

67
Q

What hormonal medication is used in POST-MENOPAUSAL WOMEN

A

Aromatase inhibitors

68
Q

What are three aromatase inhibitors

A
  • Anastrozole
  • Letrozole
  • Exemestane
69
Q

How do aromatase inhibitors work

A

Decrease peripheral conversion of androgens to oestrogen

70
Q

When may Herceptin be given as adjuvant therapy

A

If HER2 receptor positive

71
Q

When may Herceptin be used as mono therapy

A

Metastatic disease not responded to at least two rounds of chemotherapy

72
Q

What is the purpose of oncoplastic breast surgery

A

To reconstruct breast following mammectomy

73
Q

What are the two techniques of oncoplastic breast reconstruction

A
  1. Mammoplasty

2. Flaps

74
Q

What is a mammoplasty

A

WLE with breast reduction technique. Results in smaller, uplifted breast with preserved nipple and areolar

75
Q

What three flaps can be used to reconstruction breast

A
  1. Latissimus Dorsi Flap
  2. Transversus Rectus and abdominal muscle (TRAM) flap
  3. Deep inferior epigastric perforator (DIEP) flap
76
Q

What is latissimus dorsi flap

A

Uses latissimus dorsi muscle and overlying skin to reconstruct breast

77
Q

When are latissimus dorsi flaps used and why

A

Smaller breast - only take portion of muscle

78
Q

What is a TRAM flap

A

Transversus rectus and fat are used to reconstruct the breast

79
Q

What is deep inferior epigastric perforator flap

A

tissue from abdomen and overlying skin used to reconstruct breast

80
Q

What is the most important prognostic factor for breast cancer

A

Node status

81
Q

What else can influence prognosis of breast cancer aside from node status

A

Grade
Size
Receptor Status

82
Q

What should all breast cancers undergo and why

A

Receptor status (PR, ER, HER2) as this can influence prognosis

83
Q

What scoring system is used to predict prognosis of breast cancer

A

Nottingham prognostic index

84
Q

What is the Nottingham prognostic index score

A

(Size x 0.2) + Node Status + Grade

85
Q

What are 6 causes of nipple discharge

A
  • Physiological (Breast Feeding)
  • Galactorrhoea
  • Carcinoma
  • Intraductal Papilloma
  • Hyperprolactinaemia
  • Mammary ductal ectasia
86
Q

What is the most common pathological cause of nipple discharge

A

Galactorrhoea - occurs around breast feeding

87
Q

What is a distinguishing feature of hyperprolactinaemia

A

May have bitemporal hemianopia due to pressure on optic chasm

88
Q

How will nipple discharge present in mammary ductal ectasia

A

Thick yellow-green discharge

89
Q

Which population is mammary ductal ectasia common in

A

Post-menopausal women

90
Q

If a post-menopausal women smoker presents with green-yellow nipple discharge, what is it

A

Mammary ductal ectasia

91
Q

What type of discharge is present in carcinoma

A

Blood-stained

92
Q

What can cause blood-stained nipple discharge in younger patients

A

Intraductal papilloma

93
Q

What are three factors protective from breast cancer

A
  • Physical activity
  • Breastfeeding
  • NSAIDs
94
Q

Explain NHS advice for self-examination of breasts

A

5 Steps to be breast aware

95
Q

What are the 5 steps for self-breast examination

A
  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
Q

What are 5 differentials for breast lump in a male

A
  1. Gynaecomastia
  2. Lipoma
  3. Cyst
  4. Breast cancer
  5. Fat necrosis
97
Q

What is Paget’s disease of the nipple

A

Ductal carcinoma that infiltrates the nipple

98
Q

How will the nipple present in paget’s disease

A
  • Erythematous
  • Thickened, Flaking skin
  • Vesicular rash
  • Pruritus
  • Bloody discharge
99
Q

What is a contraindication of tratszumab

A

heart disease

100
Q

What are 4 indications for mastectomy

A
  • Large lesion in small breast
  • DCIS >4
  • Central tumour
  • Multifocal lesion
101
Q

What are 4 indications for WLE

A
  • Small lesion
  • DCIS <4
  • Peripheral tumour
  • Solitary tumour
102
Q

What is possible complication of axillary node clearance

A

Lymphoedema and functional arm impairment

Breast (3 decks)

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