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Year 4 - Cancer Care > 1.05 - Breast & Cervical Cancer > Flashcards

1.05 - Breast & Cervical Cancer Flashcards

1
Q

Definition of breast cancer.

A

Neoplastic changes in the epithelial cells that line milk ducts, or in breast alveolar lobules.

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2
Q

What are the categories of breast cancer?

A

Invasive breast cancer: ductal, lobular, mucinous, papillary cancers.

Noninvasive cancer: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).

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3
Q

How is breast cancer phenotypically classified?

A

Using immunohistochemistry to determine receptor status:
- oestrogen receptor (ER)
- progesterone receptor (PR)
- HER2 receptor

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4
Q

What are the risk factors for breast cancer?

A
  • female gender
  • increasing age
  • elevated oestrogen levels (ie. early menarche, late menopause, late parity, nulliparity, prolonged HRT)
  • personal history of breast cancer
  • family history of breast cancer
  • obesity
  • germline mutation
  • alcohol
  • thoracic radiation

NB: up to 80% of newly diagnosed women with breast cancer do not have risk factors.

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5
Q

Which germline mutations are associated with breast cancer?

A
  • BRCA1
  • BRCA2

These are proteins involved in DNA repair; mutated proteins mean DNA can pass through the cell cycle unrepaired and increase the risk of breast cancer by 80%.

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6
Q

Breast cancer screening programme in UK.

A

Women aged between 50 and 71 are invited for a mammogram every 3 years.

Mammogram takes xrays of the breast tissue. If pathological tissue is identified, the women will be referred for triple assessment. Otherwise, they will be recalled in 3 years.

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7
Q

When should a GP refer down a breast cancer pathway?

A
  • aged >30 with an unexplained breast lump (with or without pain)
  • aged >50 with unilateral nipple changes (ie. discharge, retraction)
  • further investigation required following mammogram results

Consider urgent referral for people of any change with skin changes suggestive of breast cancer; or aged >30 with an unexplained lump in the axilla.

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8
Q

What happens in a triple breast assessment?

A
  1. History and examination
  2. Imaging
  3. Histology
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9
Q

What imaging modalities are used in triple assessment clinics?

A
  • mammography, allowing for detection of mass lesions or microcalcifications
  • ultrasound scanning
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10
Q

When is an ultrasound of the breast preferential over mammography?

A

Women <35 years
Men

due to higher density of breast tissue

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11
Q

What histology technique is used in breast triple assessment?

A

Core biopsy provides full histology, allowing differentiation between invasive and in-situ carcinoma.

If a woman has cystic disease, this can be aspirated using FNA for cytology and to relieve symptoms.

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12
Q

Primary prevention of breast cancer.

A
  • breastfeeding children
  • prophylactic bilateral mastectomy in BRCA germline mutation carriers
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13
Q

Secondary prevention of breast cancer.

A
  • weight maintenance and avoid obesity
  • reduce alcohol ≤1 unit per day
  • physical activity
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14
Q

Differential diagnoses to breast cancer.

A
  • fibroadenoma
  • ductal hyperplasia
  • lymphoma
  • sarcoma
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15
Q

Breast cancer history - key points.

A
  • family history of breast and ovarian cancer
  • age of menarche
  • age of menopause
  • number of years of HRT
  • exposure to mediastinal radiation
  • symptoms (ie. bloody discharge, erythema, palpable masses)
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16
Q

What is the primary goal of treatment for stages I-III breast cancer?

A

Curative intent (ie. dying of a cause other than breast cancer).

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17
Q

What hormonal therapy is given in ER/PR+ breast cancer?

A

Tamoxifen if premenopausal / perimenopausal

Aromatase inhibitors if postmenopausal (anastrazole)

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18
Q

What hormonal therapy is given in HER2+ breast cancer?

A

Trastuzumab / Herceptin

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19
Q

What tumour marker is associated with breast cancer?

A

CA 15-3

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20
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma.

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21
Q

When is mastectomy used for surgical treatment of breast cancer?

A
  • multifocal tumour
  • central tumour
  • large lesion in small breast
  • DCIS >4cm
  • patient preference
22
Q

When is a wide local excision used for surgical treatment of breast cancer?

A
  • solitary lesion
  • peripheral tumour
  • small lesion in a large breast
  • DCIS <4cm
  • patient preference
23
Q

What score is used to give an indication of survival of breast cancer?

A

Nottingham Prognostic Index

(Tumour Size * 0.2) + Lymph node score + Grade score

24
Q

MOA of anastrazole.

A

Aromatase inhibitor.

Aromatisation accounts for majority of oestrogen production in post-menopausal women, therefore effective in ER / PR + breast cancer.

25
Q

Side effects of tamoxifen.

A

Increased risk of endometrial cancer.

VTE

Menopausal symptoms

26
Q

Which condition of the breast is blood stained discharge most likely to be associated with?

A

Intraductal papilloma

27
Q

Why can tamoxifen cause abnormal vaginal bleeding?

A

Agonises endomtrial tissue, resulting in endometrial hyperplasia.

28
Q

Lifetime risk of breast cancer in the UK.

A

1/7

29
Q

When is axillary lymph node clearance performed?

A

When nodal spread is confirmed on biopsy during initial investigations.

30
Q

Inheritance pattern of BRCA1/BRCA2.

A

Autostomal dominant

31
Q

What are the most common sites of metastases in breast cancer?

A
  • lungs
  • bone
  • liver
  • brain
32
Q

During axillary node clearance, which structures of the brachial plexus are at risk of injury?

A

Medial cord - therefore the median and ulnar nerve.

33
Q

What complication is axillary node clearance associated with?

A

Arm lymphoedema and functional arm impairment (median n. and ulnar n.)

34
Q

Risk factors for cervical cancer.

A
  • HPV infection
  • smoking
  • multiparity
  • long term oral contraceptive use
35
Q

Primary prevention of cervical cancer.

A

HPV vaccination

36
Q

Presentation of cervical cancer.

A

Cervical screening programme OR:

  • bleeding
  • dyspareunia
  • back pain
  • risk factors
37
Q

Treatment of cervical cancer.

A
  • loop excision of transitional zone (LETZ)
  • hysterectomy
  • chemoradiation
  • sentinel node biopsy
38
Q

Appearances of the cervix that may suggest cervical cancer.

A
  • ulceration
  • inflammation
  • bleeding
  • visible tumour
39
Q

How is cervical cancer screened for?

A

Speculum examination and a smear to collect cells from the cervix using a small brush.

The samples are initially tested for high-risk HPV.

If the HPV test is negative, the cells are not examined; if the HPV test is positive, the cells are examined for dyskaryosis.

40
Q

Cervical cancer screening ages and intervals.

A

25-49: invited for smear every three years.

50-64: invited for smear every 5 years.

41
Q

Management of smear results (PHE 2015):

a) inadequate sample

b) HPV negative

c) HPV positive + normal cytology

d) HPV positive + abnormal cytology

A

a) repeat after 3 months

b) continue routine screening

c) repeat HPV test after 12 months

d) refer for colposcopy

42
Q

Can the body clear HPV?

A

Usually, the body’s immune system clears HPV infection naturally within 2 years.

43
Q

When is colposcopy used to investigated cervical cancer?

A

Smear showing HPV positive and cytology shows dyskaryosis.

44
Q

What stains are used in colposcopy?

A

Acetic acid

Iodine solution

45
Q

What are the staining results for acetic acid on colposcopy?

a) normal cells

b) abnormal cells

A

a) no change

b) stained acetowhite

46
Q

What are the staining results for iodine on colposcopy?

a) normal cells

b) abnormal cells

A

a) stained brown

b) no change

47
Q

LLETZ procedure.

A

Local anaesthetic using diathermy to remove abnormal epithelial tissue on the cervix.

48
Q

Complications of LLETZ.

A
  • increases the risk of preterm labour
49
Q

Risks of cone biopsy.

A
  • pain
  • bleeding
  • infection
  • scar formation with stenosis of the cervix
  • increased risk of miscarriage
  • increased risk of premature labour
50
Q

Staging of cervical cancer.

A

FIGO staging

51
Q

HPV vaccination programme.

A

HPV vaccine is given to boys and girls before they become sexually active, at around age 13 years.

Protects against strains:
- 6 and 11 (genital warts)
- 16 and 18 (cervical cancer)

Year 4 - Cancer Care (13 decks)

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