7.1.2 Breast Cancer Flashcards

1
Q

How common is breast cancer?

A

Most common cancer

1/7 women
Male breast cancer makes up 1% of all cases (increased risk with Klinefelter’s and trans women, as treated with oestrogen for prostate cancer)

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2
Q

What is the most common type of breast cancer?

A

95% adenocarcinomas

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3
Q

Where on the breast does cancer most commonly affect?

A

Upper outer quadrant

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4
Q

What are the risk factors of breast cancer?

A

BREAST

Breast feeding
Reproductive history, partity and age at first full term pregnancy
Exogenous oestrogens (HRT)
Age
Sex- female more likely
Time of menopause, later= more risk

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5
Q

What genes are involved in hereditary breast cancers?

A

10% of all breast cancers

BRCA1/2
p53 (Li-Fraumeni syndrome)

Tumour supressor genes- their proteins repair damaged DNA

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6
Q

How is breast carcinoma classified?

A

In sutu and invasive

Ductal or lubular

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7
Q

What is in situ carcinoma?

A

Neoplastic population of cells limited to ducts and lobules by byasement membrane

Myoepithelial cells are preserved

Does not invade into vessels, therefore cannot metastasis or kill patient

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8
Q

Why is ductal carcinoma in situ a problem?

A

Non-obligate precursor of invasive carcinoma

Presents as mammographic calcifications but can present as a mass

Can spread through ducts and lobules and can be very extensive

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9
Q

What is shown on histology of ductal carcinomas in situ?

A

Central (comedo) necrosis with calcification

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10
Q

What is Paget’s disease?

A

Cancer cells extend to nipple skin without crossing basement membrane

Causes a unilateral red and crusting nipple

Eczematous or inflammatory nipple should be investigated and biopsied to exclude pagets

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11
Q

Outline the features of invase carcinoma

A

Neoplastic cells invade beyond basement membrane into stroma

Can invade into vessels so can spread to lymph nodes and other sites

Usually presents as a mass or mammographic abnormality

By the time it is palpable patients normally have axillary lymph node metastases

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12
Q

What is Peau d’orange?

A

Involvement of lymphatic drainage of the skin

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13
Q

What are the different types of invasive breast carcinomas?

A

Invasive ductal carcinoma

Invasive lobular carcinoma

Other types- tubular, mucinous
(these have good prognosis, found often in older women)

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14
Q

Card showing normal breast tissue vs invasive ductal carcinoma

Normal breast

A

Invasive ductal carcinoma NST

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15
Q

What is this showing?

A

Invasive lobular carcinoma

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16
Q

What is this showing?

A

Mucinous carcinoma

17
Q

How does breast cancer spread?

A

Via lymphatics, usually ipsilateral axilla

Distant metastases via blood vessels

Invasive lobular carcinoma can spread to odd sites- peritoneum, retropreitoneum, lemptomeninges

18
Q

What is the most common site distant metastases spread to?

A

Bones

19
Q

What is this showing?

A

Vascular invasion

20
Q

What factors determine prognosis in breast cancer?

A

In situ or invasive
TNM stage
Tumour grade (1-3)
Histological subtype
Molecular classification and gene expression

21
Q

How does grade effect survival?

A

Grade 1-90%
Grade 3- 40%

22
Q

What is a gene expression profile?

A

Analysis of genes to identify marker genes

Those with these genes would eventually develop metastases

23
Q

How many marker genes for breast cancer are there?

A

17

24
Q

What is the triple approach for breast cancer?

A

Clinical
History
Family history
Examination

Radiographic imaging
Mammogram
USS

Pathology
Core biopsy
Fine needle aspiration cytology

25
Q

What is the aim of mammoraphic screening?

A

Identify small impalpable cancers and pre-invasive cancers

Done every 3 years for women 47-73

26
Q

What are the therapeutic approaches in breast cancer?

A

Breast surgery
Mastectomy

Axillary surgery
Use sentinel node sampling to decide whether to remove all nodes or just involved

Post-operative radiotherapy to chest and axilla

27
Q

What is sentinel lymph node biopsy?

A

Intraoperative lymphatic mapping with dye and/or radioactivity of the draining lymph nodes

Sentinel or draining nodes are most likely to contain breast cancer metastases

If negative axillary dissection can be avoided

28
Q

When is chemotherapy used?

A

If benefits thought to outweigh risks

If given before surgery= neoadjuvant (basically to shrink tumour size)

29
Q

When is tamoxifen hormone treatment given?

A

Depends on the oestrogen receptor status, approximately 80% of cancer are oestrogen receptor positive (ER positive)

Give tamoxifen if positive for oestrogen receptors

30
Q

When is herceptin hormone treatment given?

A

Depending on Her2 receptor status
(20% of cancers are Her2 positive)

If Her2 positive give Herceptin

31
Q

What is herceptin and Her2?

A

Herceptin= transtuzumab

Monoclonal antibodies against the Her2 protein

Her2 is human epidermal growth factor receptor

32
Q

How do we improve survival from breast cancer?

A

Early detection
Awareness
Neoadjuvant chemotherapy
Gene expression profiles
Prevention in familial cases e.g. prophylactic mastectomies

33
Q

What are molecular classifications in breast cancer?

A

Learn this generally

(moved to last card so it doesn’t keep popping up while learning)