Big 4 Flashcards
what is the most common female cancer in the UK
breast then endometrial then ovarian
what is the incidence of breast cancer
15% of all breast cancer
how many women in the UK in a year will develop breast cancer
1 in 8 women
how many men in the UK in a year will develop breast cancer
1 in 870
what are some RF for breast cancer
1) inc age
2) inc oestrogen exposure - nulliparious, early menarche, late menopause, obesity
3) obesity
4) oral contraceptive pill and some HRT
5) alcohol
6) obesity
7) Ionising radiation
8) FH - 1st-degree relative
which are the genes that are related to breast cancer
BRCA1/2
what other cancer is BRCA 1 related to
ovarian
what other cancer is BRCA 2 related to
early onset breast cancer
more common in male breast cancer
what are the different types of breast cancer
1) invasive ductal carcinoma - most common - 70-80%
2) lobular carcinoma - 10%
3) medullary
4) colloid
5) comedo
6) papillary
which type of breast cancer is particularly related to multi-centric breast cancer
lobular
which type of breast cancer doe ductal carcinoma in situ cause?
invasive ductal carcinoma
how does ductal carcinoma in situ cause breast cancer
atypical proliferation of the epithelial cells –> fills and plugs the ductus –> invasive ductal carcinoma
how does DCIS present on a mammogram?
calcification of the ductus
symptoms of breast cancer?
1) breast mass ( painless is a RFL)
2) nipple discharge - bloody
3) puckered/indrawn nipples
4) Peau d’ orange (can be mastitis, so will need follow up after ABx given)
5) paget’s = nipple eczema
6) swollen arm, numbness in hand –> signs of lymphadenopathy
7) symptoms of mets
where does breast cancer spread to most commonly
to lungs, liver, bone, brain and lymph nodes
Ix for breast cancer
triple assessments
- clinical exams and history
- bilateral mammogram - bilateral because of mets, multicentric
- USS guided biopsy to the suspicious area +/- axillary nodes
if high risks of mets –> isotope bone scans, CT liver scans
if discrepancy within the triple assessment then do MRI to further confirm
what modality of biopsy is done to investigate breast cancer as part of the triple assessment
fine needle aspiration cytology core biopsy incisional biopsy excisional biopsy needle biopsy
which stage system does breast cancer employ?
TNM
what the T part of the breast cancer staging like?
T0 = no primary tumour Tis = in situ disease, non-invasve T1 = invasive tumour < 2 cm T2 = invasive tumour 2-5 cm T3 = invasive tumour >5cm T4 = skin involvement
what the N part of the breast cancer staging like?
N0 = no LN involvement N1 = mobile axillary nodes N2 = fixed axillary nodes N3 = internal mammary nodes
what the M part of the breast cancer staging like?
M0 = no mets M1 = mets
what is the TNM make up of stage 0 breast cancer
Tis, N0, MO
what is the TNM make up of stage 1 breast cancer
T1, N0, M0
what is the TNM make up of stage 2 breast cancer
T2/3, N0, M0 or T0/1/2, N1, M0
what is the TNM make up of stage 3 breast cancer
T or N > stage 2, M0
what is the TNM make up of stage 4 breast cancer
any T and N but M1
when will you consider neoadjuvant cancer prior to surgery in breast cancer
when surgery not suitable
to allow for breast conservation
HER2 +ve or triple -ve breast cancer as high response rates are possible
what sort of surgery is used to treat breast cancer
mastectomy or local wide excision + adjuvant radio (depends on grades)
+ sentinel node investigation
+/- axillary clearance (if mets present before surgery or after
what other agents are used to treat microscopic disease after initial treatment
hormonal therapy
chemo
what are some consideration for using adjuvant chemo/hormonal therapy
ER/PR status HER2 status menopausal status tumour size and grade nodal involvment performance status
what age is chemo most effective in breast cancer
< 50
what is the most commonly used chemo for breast cancer
Trastuzamab (Herceptin) - effective against both localised and mets
usually given for 12 months
what receptor does trastuzamab targets for
HER2
what is one serious SE for trastuzamab
affect cardiac function and so will need regular monitoring of the heart
what special monitoring requirement is there for trastuzamab
MUGA scan - multi-gated acquisition scan - video of ventricle of the heart
what are the 2 types of hormonal/endocrine treatment for breast cancer
oestrogen antagonist - Tamoxifen
aromatas inhibitor - anastrazole, letrozole
which type of patient would tamoxifen be used on
pre-menopausal
which type of patient would letrozole be used on
post-menopausal - prove to be more effective in post-menopausal women
what is the treating regimen of tamoxifen in breast cancer
20mg per day up to 5 years of diagnosis but if high risk then 10 years
only suitable for ER/PR +ve cancer types
what are some SE for tamoxifen
inc thrombotic risks
inc risk of endometrial cancer
what is the MOA of anastrozole
stop the conversion of testosterone to oestrogen
SE of letrozole
osteoporsis - so need DEXA scans and lifestyle changes, vit D< bisphosphonate, Ca supplement
what is the role of radiotherapy in breast cancer treatment
when wide local excision - compulsory adjuvant radio
when mastectomy is done but still a high risk of recurrence or mets
lymph node involvement
palliative
what is high risk of recurrance of breast cancer
deep resection margin involvement
large primary tumour > 4 cm
multiple axillary nodes containing mets
widespread lymphovascular tumour permeation
what is the radiotherapy treatment regime of breast cancer
daily for 3 weeks
if high risk of recurrence the ‘boosts’ ie an extra week
when is hormonal therapy used as primary treatment in breast cancer
when it is a slowly progressive cancer and no visceral involvement
what does hormonal therapy include?
oestrogen antagonist
ovarian ablation - can be surgical/radio/LHRH agonist
what is the 5 years survival rate for breast cancer
Stage 1 - 95%
stage 2 - 80%
stage 3 - 60%
stage 4 - 25%
what is the screening programme of breast cancer like?
from 50 - 70 yrs old
every 3 years
mammogram
how common is lung cancer in the UK
3rd most common cancer in the UK
1 in every 13 men
1 in every 15 women
22% of cancer-related deaths in the UK
RF for lung cancer
genetic disposition cigarette smoking inc age COPD industrial exposure to asebtos, chromium, arsenic, iron oxide
what can you find chromium
coating for metals for prevention of rust
what are the 2 main subtypes of lung cancer
small cells lung cancer
none-small cell lung cancer
what is the % of SCLC in overall lung cancer
15%
what is the % of NSCLC in overall lung cancer
85%
what are the different subtype of NSCLC
squamous cell carcinoma - 42%
adenocarcinoma - 39%
large cells carcinoma - 8%
calloid, mesothelioma, sacroma, lymphoma
what are some characteristics fo squamous cell carcinoma
usually found centrally near the bronchi
due to cigarette smoking
PTH related peptide
associated with hypercalcaemia due to PTH
what are some characteristics fo adenocarcinoma
more frequent in women not associated with smoking found peripherally associated with activating mutation in EGFR and ALK (important prognostic factors) previous asbetos exposure
what are some characteristics fo large cell carcinoma
less differentiated than the other NSCLC
mets early
