Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oncology > 11 & 12 - Breast Cancer > Flashcards

11 & 12 - Breast Cancer Flashcards

1
Q

Most common cancer among women in the US

A

Breast Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Leading cause of cancer death among women in the US

A

Lung Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Second leading cause of cancer death among women in the US

A

Breast Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lifetime risk a woman has of developing breast cancer

A

1 in 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Biggest risk factor for developing breast cancer (other than being a woman)

A

Age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Breast Cancer - Stage 0

A

DCIS - Cancer cells present in either lining of a breast lobule or a duct, but have not spread to the surrounding fatty tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Breast Cancer - Stage 1

A

Tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Breast Cancer - Stage 2

A

Tumor can range from 2 - 5 cm in diameter

OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Breast Cancer - Stage 3

A

Locally advanced cancer
Tumor may be larger than 5 cm in diameter
OR >4 lymph nodes are involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Breast Cancer - Stage 4

A

Known as metastatic

Cancer has spread to other parts of the body such as bone, liver, lung or brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-Metastatic Breast Cancer - Local Therapy

A

Surgery (lumpectomy)
Radiation therapy

If contraindications to this, then total mastectomy is treatment of choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non-Metastatic Breast Cancer - Systemic Therapy

A

Endocrine manipulations
Chemotherapy
Novel Therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Adjuvant Therapy

A

Chemotherapy after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neo-Adjuvant Therapy

A

Chemotherapy before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sentinel Lymph Node Biopsy

A

During surgery, surgeon injects dye

See lymph nodes that have uptake of that dye

Remove those lymph nodes to see if the cancer has spread there.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adjuvant Systemic Therapy for Breast Cancer - Prognostic Factors

A

Estimate outcome independent of systemic treatment

Reflect tumor biology - Who should be treated?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Adjuvant Systemic Therapy for Breast Cancer - Predictive Factors

A

Reflect relative resistance or sensitivity to specific therapy
What specific treatments should be offered to an individual?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Breast Cancer Prognostic Factors

A 
TNM Stage
Axillary nodal status
Tumor size
Tumor Grade
Lymphatic or vascular invasion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Breast Cancer Predictive Factors

A

Age
Estrogen Receptor
Grade
HER2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Estrogen Receptor (+)

A

Estrogen Dependent
That means on immunohistochemistry, you have Estrogen & Progesterone recepters >1%
More slow-growing
Can recur decades later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Estrogen Receptor (-)

A

Estrogen Independent
Commonly recurs within the first 5 years
If you hit the 5 year point without recurring, your likelihood of recurrence is very low.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tamoxifen

A

PO
Once per day
Can give regardless of menopausal status

Selective Estrogen Receptor Modulator (SERM)

Risks:
Increased risk of endometrial cancer (1/1000)
Thromboembolic phenomena
Cataracts

Benefits:
Bone health
Lipid
Decreases risk of breast cancer recurrence of 50%

Also likelihood of this helping your breast cancer is directly proportional to how much Estrogen Receptor is found in your immunohistochemistry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Aromatase Inhibitors (Anastrozole)

A

Decrease amount of systemic estrogen
Aromatase converts precursors to estradiol
Can only give to post-menopausal patients

Side effects:
Hot flashes
Vaginal dryness
Fractures (unless their bone density was normal to begin with)
Joint aches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

After 5 years of Tamoxifen

A

Still see benefits 15 years later in terms of decreased rates of recurrence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tamoxifen - Who

A

Effective in all hormone receptor positive women (ER+/PR+, ER-/PR+, ER+/PR-)
Regardless of age, stage, tumor grade, menopausal state
Optimal duration: 5 years (these days it’s actually 10)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Anastrozole Vs Tamoxifen - Disease free survival

A

Anastrozole is better, when compared directly. You just can’t give it to everyone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Breast Cancer Chemo - Which Regimen?

A

Polychemotherapy is superior to single agent chemotherapy

Anthracycline-based therapy is superior to CMF-based therapy

All women gain benefit

Younger women and those with poorly differentiated hormone receptor-negative tumors are more likely to benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Triple Negative

A

ER-
PR-
HER2-

Typically are a bit more aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Oncotype test

A

Only done with hormone receptor (+) and HER2 (-)

Tells us how well we’ll do with chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Main side effect of taxanes

A

Peripheral neuropathy (microtubule inhbitors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Biologic Therapies

A

Used in HER2 type
Tyrosine Kinase TM growth factor receptor

Drugs that target HER2:
Trastuzumab (Herceptin)
Pertuzumab
TDM1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Trastuzumab - Side effects

A

Reversible decrease in cardiac function

Don’t give with doxorubicin too!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Metastatic Breast Cancer - Goals of Therapy

A 
Cure
Improve overall survival
Improve time to progression
Improve symptoms related to the disease
Improve quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Trastuzumab - Mechanism of action

A

Suppresses HER2 activity
Does not inhibit HER2 heterodimerization
Flags cells for destruction by the immune system (ADCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pertuzumab - Mechanism of action

A

Inhibits HER2-forming dimer pairs
More complete HER2 blockade
Flags cells for destruction by the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Pertuzumab - Side effect

A

Reversible impairment in pumping of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

TDM1

A

Trastuzumab (Herceptin) that is LINKED to a microtubule inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Palbociclib

A 
Hormone Receptor (+)
HER2 (-)

Give with aromatase inhibitor (Anastrozole) and it triples the time it takes for a tumor to grow
Interrupts cell cycle between G1 and S

39
Q

HR(+), HER2(-) has only metastasized to the bone

A

Gurl can live for a decade

40
Q

Functional unit of the duct

A

Terminal Duct Lobular Unit

Lined by myoepithelial cells (can contract as well as serving epithelial functions)

41
Q

If we see myoepithelial cells at the periphery

A

The cancer is bounded (in situ)

42
Q

Fibrocystic Changes - General description

A

Most common breast lesion
Misc changes of breast tissue involving ducts, lobules, stroma in any combination
Manifests in 40 - 50% of patients as lumps
Pathological incidence greater than 60 - 80%
Path - Reflects exaggerated changes occurring normally in menstrual cycle

43
Q

Fibrocystic changes - Specifics

A 
Fibrosis
Cysts
Apocrine metaplasia
Adenosis (enlargement of TLDU) and sclerosing adenosis (scarring of TDLU)
Intraductal and epithelial hyperplasia
44
Q

Mild Hyperplasia (2 - 4 cells) indicates

A

No increased risk

45
Q

Apocrine metaplasia indicates

A

No increased risk

46
Q

Cysts (macro & micro) indicate

A

No increased risk

47
Q

Duct ectasia indicates

A

No increased risk

48
Q

Fibroadenomas indicate

A

No increased risk

49
Q

Atypical ductal and lobular hyperplasia - borderline lesions indicate

A

Moderately increased risk (4 - 5x)

50
Q

Hyperplasia, moderate or florid (ductal and lobular) indicates

A

Mild increased risk (1.5 - 2x)

51
Q

Papilloma with fibrovascular core indicates

A

Mild increased risk (1.5 - 2x)

52
Q

Adenosis (Sclerosing or florid) indicates

A

Mild increased risk (1.5 - 2x)

53
Q

Atypical Ductal Hyperplasia

A

Borderline lesion
A proliferative lesion
Some of the cytologic and architectural criteria of carcinoma in situ are met, but not fully satisfied

Non-obligatory precursor of cancer, may or may not progress
Found in ~5% of biopsies
Indicates 4 - 5x increased risk of invasive cancer
Risk for cancer is bilateral and persists for more than 20 years
Prognosis is same as for cancers without this ADH
30% who have ADH on biopsy have cancer on excision

54
Q

Malignant - Epithelial Derived Tumors

A

Intraductal and invasive ductal carcinoma

In situ and invasive lobular carcinoma

55
Q

Malignant - Mesencymal neoplasm (sarcoma)

A

Cystosarcoma phyllodes
Angiosarcoma
Others

56
Q

Breast carcinoma pathology

A 
Most cancers (90%) show ductal epithelium differentiation
10% referred to as lobular type
In situ and invasive components
57
Q

Ductal Carcinoma In Situ (DCIS)

A

Neoplastic transformation of epithelium within ducts or lobules surrounded by myoepithelial cells
Non obligatory precursor to invasive cancer
Characterized by nuclear grade & histo patterns:
Comedo, Solid, Cribiform, Clinging, Papillary
May be detected by association with microcalcifications
May represent up to 25% of breast carcinoma
High grade and large size → multifocality & propensity for invasion
Relative risk for development of invasive carcinoma 8 - 10 fold greater than general population
Risk is primarily ipsilateral

58
Q

Invasive Ductal Carcinoma

A

Infiltrative malignant epithelial cell process
Resembles cells lining TDLU
Most common breast carcinoma
Lacks myoepithelial cells at the periphery

59
Q

Invasive Ductal Carcinoma - Histologic Classifications

A

Carcinoma no special type - Majority

Special good prognosis subtype including medullary carcinoma, colloid (mucinous) carcinoma & tubular carcinoma

Poor prognosis - inflammatory, metaplastic CA

Grade: Modified Scarff-Bloom Richardson based on extent of tubular formation, pleomorphism & mitoses

60
Q

Inflammatory Breast Carcinoma

A

Poor prognosis
Orange peel appearance to the skin
Association with dermal lymphatic invasion

61
Q

Lobular Carcinoma In Situ (LCIS)

A

Neoplastic transformation of epithelial cells lining terminal ducts and acini of small size
ER/PR+
E-cadherin negative
Surrounded by myoepithelium
Typically multifocal and bilateral
6 - 9 fold increased risk for development of invasive cancer
Bilateral risk of development of invasive cancer
3/4 of invasive cancers that ensue are DUCTAL. Weirdsies
Considered primarily a marker for invasion but is also non-obligatory precursor for invasive lobular carcinoma at a low rate.

62
Q

Invasive Lobular Carcinoma

A

Infiltrating carcinoma resembling cells of LCIS
Histo - “Indian file” pattern and targetoid “bulls eye” pattern
Small cells with scanty cytoplasm, sometimes vacuolated
E-Cadherin negative
Represents 10% of breast cancer with higher-than-usual incidence of bilaterality (20%)

63
Q

Prognostic Factors of Breast Cancer

A

Size of primary tumor (larger = worse)
Lymph node involvement and extent, distant metastasis (stage)
Grade - high grade worse
Histologic type
Oncotype Dx (for ER/PR+) predicting distant recurrence
HER2/NEU
ER/PR status

64
Q

Luminal A Breast Cancers

A 
Resembling normal luminal epithelium
CK8/18
ER+ and associated genes
Low Grade
Excellent Prognosis
Low p53 mutation rate (12%)
PIK3CA Mutation (45%)
65
Q

Luminal B Breast Cancers

A 
ER+, but less than Luminal A
Low-to-moderate expression of luminal specific genes
Tumors have higher grade
Proliferation
Worse prognosis compared to Luminal A
Some are HER2+
p53 mutation rate 29%
PIK3CA Mutation 29%
66
Q

HER2-Enriched Breast Cancers

A 
Overexpression of HER2 & associated pathway genes
ER (-)
Poor prognosis
72% mutated for p53
39% PIK3CA
67
Q

Basal-Like Cancers (Triple Negative)

A 
Primitive
High histologic grade
Highly proliferative
Pushing borders
May contain necrosis
Metaplastic changes
Atypical medullary features
Seen in the majority of BRCA1 carrier breast tumors
80% mutated for p53
68
Q

Gynecomastia

A

Button-like subareolar swelling
Generally bilateral
Corresponds to intraductal epithelial hyperplasia & increased periductal stromal cellularity & edema
Physiological gynecomastia most common in puberty and old age
No clear cut association with development of carcinoma

69
Q

Gynecomastia - Associated with

A 
Relative estrogen excess
Cirrhosis of the liver
Klinefelter's
Estrogen secreting tumor
Estrogen therapy
Digitalis therapy
70
Q

Male Breast Carcinoma

A

Rare
Ratio of Male : Female breast cancer is 1 : 125
Occurs in advanged age
Identified in peri-nipple/areolar region
Presents in advanced stage
Resembles morphologically and biologically invasive carcinomas of the female breast
Associated with BRCA2 germ line mutations

71
Q

Two benign tumors of the breast

A

Fibroadenoma

Intraductal papilloma

72
Q

Fibroadenoma

A

Most common benign tumor or the female breast
Usually appears in young women
Peak incidence in third decade of life
Benign fibroepithelial tumor usually solitary, may be multiple
Rarely associated with carcinoma

Ball-like mass
Increased stroma in lobules

73
Q

Intraductal Papilloma

A

Benign papillary neoplasm within a duct
Fibrovascular cores lined by benign epithelium and myoepithelium
Identified peripherally or centrally (nipple duct)
If central, may be associated with bloody nipple discharge
Mild increased risk (1.5 - 2x) of development of invasive cancer if you have multiple

74
Q

Breast Cancer Risk Factors - Highest to Lowest

A 
BRCA Mutation
Prior chest wall irradiation
Atypical hyperplasia
Increased breast density
Family history
Nulliparity/Age at first birth > 30
Early menarche 55
Hormone replacement therapy >5 years
Postmenopausal obesity
Alcohol servings/day >2
75
Q

Majority of breast cancer is

A

Sporadic

76
Q

Hereditary Breast Cancers

A

5 - 10% of all breast cancer
1/2 of those are BRCA1
1/3 are BRCA2

77
Q

BRCA1 & BRCA2

A
78
Q

Red flags for Hereditary Breast and Ovarian Cancer Syndrome (HBOC) - Personal

A

Breast cancer

79
Q

Red flags for Hereditary Breast and Ovarian Cancer Syndrome (HBOC) - Family History

A

Non-Ashkenazi Jewish:

2 first-degree relatives with breast cancer, 1 diagnosed

80
Q

BRCA Genetic Testing Options

A 
Multisite 3 (Ashkenazi mutations)
Comprehensive (Full sequencing)
BART (Large rearrangement test)
81
Q

BRCA+

A

High risk

82
Q

BRCA- but family member BRCA+

A

Average risk

83
Q

No known mutation in family, BRCA-

A

Moderate risk

84
Q

No known mutation & Variant of uncertain significance

A

Moderate risk

85
Q

BRCA mutation carriers are at increased risk for

A 
Breast Cancer
Ovarian Cancer
Prostate Cancer
Male breast cancer
Melanoma
Pancreatic Cancer
86
Q

Intensive screening - Self Breast Exam

A

Begin at age 18

Screen monthly

87
Q

Intensive screening - Clinical Breast Exam

A

Begin at age 25

Screen every 6 - 12 months

88
Q

Intensive screening - Mammogram

A

Begin at age 25

Screen yearly

89
Q

Intensive screening - Breast MRI

A

Begin at age 25
Screen yearly

Who?
BRCA mutation carriers
Other hereditary breast cancer syndromes (Li-Fraumeni, Cowden’s)
Lifetime breast cancer risk >20 - 25% based on family history
Prior chest irradiation

90
Q

Intensive screening - Pelvic exam

A

Begin at age 30 (No BSO)

Screen every 6 months

91
Q

Intensive screening - Transvaginal ultrasound and CA-125

A

Begin at age 30 (No BSO)

Screen every 6 months

92
Q

Risk-reducing surgery

A

Mastectomy reduces breast cancer risk by 90%

Oophorectomy reduces ovarian cancer risk by 79% and breast cancer risk by 55%

93
Q

Chemoprevention

A

Tamoxifen
Risk reduction in BRCA (-) with high risk 45%
Risk reduction in BRCA (+) without cancer 62%
Risk reduction in BRCA (+) contralateral breast cancer (50%)

Only reduces the risk of hormone receptor positive cancers

OCPs reduce risk of ovarian cancer by 50%

Oncology (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions