Brainscape's Knowledge GenomeTM

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


See full index

Cancer Care > Breast > Flashcards

Breast Flashcards

1
Q

What are risk factors for breast cancer?

A 
Female gender
Age
Family history
Personal history of breast cancer
Genetic predispositions (e.g. BRCA 1, BRCA 2)
Early menarche and late menopause
Nulliparity
Increased age of first pregnancy
Multiparity (risk increased in period after birth, then protective later in life)
Combined oral contraceptive (still debated, effect likely minimal if present)
Hormone replacement therapy
White ethnicity
Exposure to radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How are patients with BRCA1/2 mutations treated when asymptomatic?

A

Prophylactic bilateral mastectomy

Annual MRI scans

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

What is BRCA 1?

A

Mutation on chromosome 17

Lifetime risk is 65-80%

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

What is BRCA 2?

A

Mutation on chromosome 13

Lifetime risk is 45-70%

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

What can BRCA mutations, primarily 2, also increase the risk of?

A 
Peritoneal
Endometrial
Fallopian
Pancreatic
Prostate cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does it mean if a cancer is ‘in situ’?

A

Not penetrating the basement membrane

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

What are the types of breast cancer?

A

Ductal
Ductal carcinoma in situ
Invasive ductal carcinoma

Lobular
Lobular carcinoma in situ
Invasive lobular carcinoma

Rare
Inflammatory breast cancer - erythematous oedematous breast, often mistaken for infection

Paget’s disease of the nipple
Often associated with an underlying in situ or invasive cancer

‘Special type’ - type of invasive breast cancer
Mucinous, medullary, papillary, tubular, phyllodes, metaplasia, primary lymphoma

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

What are the molecular subtypes of breast cancer?

A

Luminal A
Luminal B
Basal
HER2

Based upon receptor status of oestrogen receptors and progesterone receptors, HER2 and Ki-67

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

How can DCIS be categorised?

A

High, intermediate and low grade

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

What is a protective factor?

A

Breastfeeding

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

What is the NHS screening programme?

A

Screening from 50-71
Every 3 years

Satisfactory
Abnormal - further investigations needed
Unclear - inadequate

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

What are the clinical features?

A

Often presents with breast or axillary lump, often hard, irregular and fixed to surrounding structures

Breast pain
Changes to skin - tethering, oedema, peau d-orange
Dimpling or puckering
Nipple - inversion, discharge especially if bloody, dilated veins

Paget’s disease - rough, dry, erythematous and ulcerated skin around the nipple

Features may also reflect metastatic spread - bone pain (bone), malaise and jaundice (liver), SOB, cough (lung), confusion, seizures (brain)

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

Who should be referred on two week wait?

A

30 and over with unexplained breast lump with or without pain
50 and over with any of the following symptoms in one nipple only:
discharge, retraction, any other changes of concern

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

Who should be considered for two week wait suspected cancer pathway?

A

Skin changes than suggest breast cancer

Aged 30 and over with unexplained lump in axilla

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

Who should be given a non-urgent referral for breast cancer?

A

Those under 30 with an unexplained breast lump with or without pain

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

What occurs at a review in the one stop breast clinic?

A 
Triple assessment:
History and examination
Imaging:
Mammogram, USS modality of choice in women under 40
Histopathology:
Fine needle aspiration or core biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are additional investigations after the one stop clinic?

A

Bloods: FBC, U&Es, LFT, bone profile

Imaging: 
CXR
Breast tomosynthesis use of mammogram to make it 3D
MRI breast
CT chest abdomen pelvis
CT brain
Contrast enhanced liver USS
Bone scan
PET/CT

Receptor testing, HER2 status to see if will benefit from Herceptin (Trastuzumab) monoclonal antibody blocking HER2

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

What is a triple positive breast cancer?

A

Those that are positive for ER, PR and HER2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does breast density affect cancer risk?

A

Women with dense breast tissue in 75% or more of their. breasts, as determined by mammography, are 4-6 x more likely to develop breast cancer than those with minimal dose breast tissue

Also decreases sensitivity of mammography for detection of breast malignancies.

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

What is the classification of invasive breast cancers?

A

Stromal (rare) - phyllodes or sarcoma
Epithelium derived - invasive ductal, invasive lobular inflammatory breast carcinoma, Paget’s
Other - lymphoma, metastasis to the breast

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

What are the differentials for breast lumps?

A

Fibroadenoma - benign overgrowth of collagenous mesenchyme of lobule
Firm, non tender, mobile

Breast cyst - palpable benign, fluid filled, rounded, not fixed

Intraductal papilloma - benign warty lesion behind areola
Small sticky lump

Breast abscess - most common in breastfeeding mothers, malaise, fever, throbbing pain

Fat necrosis - fibrosis and calcification of breast tissue due to trauma, irregular craggy mass, nipple retraction

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

What is mastitis?

A

Inflammation of breast tissue, most commonly from staph aureus

Can be lactational, or non lactational
Tender, erythematous, swelling, nipple retraction

Treat with broad spectrum abx e.g. co-amoxiclav, continue milk drainage or feeding
Can become an abscess

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

What are breast cysts?

A

Epithelial lined, fluid filled cavity presents as smooth tender mass
Shows as halo on mammography, aspiration
Self-resolving
May cause fibrocystic change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is mammary duct ectasia?

A

Dilation and shortening of major lactiferous ducts
Common in menopausal women

Green/yellow coloured nipple discharge, palpable mass
Symmetrical slit like nipple retraction
Mammography - dilated calcified ducts

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

What medical management is available?

A

Endocrine therapy:
Tamoxifen - in premenopausal women with ER+ cancer, blocks oestrogen receptors
Aromatase inhibitors e.g. Letrozole, Anastrozole, only used in postmenopausal women with ER+ cancer
Blocks enzyme which converts androgens to oestrogen

Biologics
HER2 - Trastuzumab (Herceptin) monoclonal antibody targeting HER2

Chemo
Neoadjuvant before chemo
Oncotype DX breast recurrence score assay can say if cancer likely to recur and if adjuvant chemo after is needed
Gonadotropin releasing hormone agonists e.g. goserelin can protect ovaries from premature ovarian failure in chemo

Radiotherapy

26
Q

What surgical management is available?

A

Wide local excision
Mastectomy
Senitnel node sampling - radioactive technetium and blue dye to detect sentinel node, sent for analysis and surgical clearance of axillary nodes can be performed

27
Q

What are examples of adjuvant chemo regimes?

A

Contain a taxmen and anthracycline

Fluorouracil
Epirubicin
Cyclophosphamide

28
Q

How long does endocrine therapy last?

A

Commenced after any adjuvant chemotherapy

5 years

29
Q

What medications can be given in mets?

A

Denosumab and bisphosphonates to prevent lytic bone lesions and reduce bone pain and fractures

30
Q

What is DCIS?

A

Atypical proliferation of ductal epithelium that eventually plugs the duct.

It is maintained within the basement membrane

31
Q

How would DCIS present?

A

Often not palpable lump so shown as an area of microcalcification on screening

32
Q

How is LCIS found?

Where does LCIS spread to?

A

Incidentally during a biopsy since it is not palpable and won’t show as microcalcification

The contralateral breast

33
Q

Which is the most common type of breast cancer?

A

75% are invasive ductal cell carcinomas

34
Q

How do Invasive Ductal Carcinoma’s spread?

A

Regional nodes (internal mammary or axillary)

Systemically spread to bone, lung, pleura, liver, skin and the CNS

35
Q

How is Invasive Ductal Carcinoma graded?

A

Histologically based on:

Tubule formation
Nuclear Pleomorphism
Mitotic frequency

36
Q

Where can invasive Lobular Carcinoma’s spread to?

A

Peritoneum, meninges and uterus

37
Q

How can Pagets and Eczema be differentiated?

A

Eczema spares the nipple

38
Q

What is a triple negative cancer? How are they treated?

A

ER, PR and HER2 negative tumours

Respond to chemo

39
Q

What are complications of axillary surgery?

A 
lymphoedema
long thoracic nerve damage - winging of scapula
arm pain
shoulder stiffness
skin numbness
40
Q

What 3 ways can breasts be reconstructed?

A

Lat Dorsi

TRAM - uses abdominal fat, muscle and skin

DIEP - uses abdominal fat and skin but leaves muscle meaning don’t lose as much strength

41
Q

How are bone metastases in breast cancer managed?

A

Low dose radiotherapy and bisphosphonates

42
Q

How does male breast cancer present?

A

Subareolar mass
Nipple retraction
Nipple bleeding

43
Q

How is male breast cancer managed?

A

Mastectomy + SLNB/axillary clearance

Adjuvant radio, tamoxifen, chemo should be considered

44
Q

What is inflammatory breast cancer?

A

cancerous cells block the lymph drainage leading to a swollen erythematous breast

45
Q

If there are no palpable lymph nodes at presentation of breast cancer, how is she managed?

A

Pre-op USS and if +ve then SLNB at primary surgery

46
Q

When is radiotherapy used in breast cancer?

A

Always post WLE

Post mastectomy if T3/T4 tumour or if >4 axillary nodes were +ve

47
Q

What are the side effects/risks of tamoxifen?

A

endometrial cancer
VTE
menopause symptoms

48
Q

What are the side effects/risks of anastrazole?

A

osteoporosis

joint aches

49
Q

What are the side effects/risks of goserelin?

A

tumour flare initially
amenorrhoea
reduced libido
depression

50
Q

When is chemotherapy used in breast cancer management?

A

Neoadjuvant to downstage the primary lesion

After surgery if axillary node disease

51
Q

Describe the staging investigations for cancers picked up on triple assessment (7) and when is it done?)

A
  • MRI if dense breast, lobular carcinomas and for high risk screening
  • Full staging only done where chemo is an option and when higher risk/ suspicion of mets
  • ER and progesterone receptor status using monoclonal antibody assay
  • epidermal GF and HER2 receptor status
  • LFTs and other routine bloods
  • CXR for lung mets
  • CT if mets suspected (abnormal CXR, neuro symptoms, hepatosplenomegaly, lymphadenopathy, LFT derangement)
  • bone scintigraphy if distant mets, bone pain, LN mets
  • PET scan if distant mets suspected (often fails to detect mets <5mm)
52
Q

name and describe the staging system for breast cancer

A

bloom richardson staging
EARLY: T1-2= up to 5cm, N0 or N1 (up to 3 nodes)
LOCALLY ADVANCED= T3= >5 cm or T4= fixed to skin or chest wall, N2= 4 or more nodes, or fixed nodes or N3= nodes other than in axilla
METASTATIC= M1 (mets)

53
Q

What prognostic indicators are there for breast cancer?

A
  • blood richardson stage
  • axillary node status
  • tumour size
  • tumour grade
  • lymphatic or vacular grade
  • pt age and BMI
  • ER and PR status are weak prognostic factors
  • oncotype dx: microarray to look at 21 genes gives indicator of chance of re- occurrence after mastectomy and guides decision to give chemo
  • PREDICT tool online, NPI (cancer size x 0.2 + grade + node stage)
54
Q

Where does breast cancer spread to and how?

A

Lymph node- to axially nodes
Blood- to bone, liver and lung commonly but can go anywhere
Directly- into chest wall and skin

55
Q

How are lobar carcinomas in situ managed?

A

usually picked up incidentally on biopsies as usually asymptomatic and doesnt cause micro-calcifications visible on mammogram
- usually only monitored and bilateral prophylactic mastectomy offered if BRAC1 or 2 +ve

56
Q

How are DCIS managed?

A

mastectomy or wide local excision then radiotherapy

57
Q

Give 3 side effects of radiotherapy for breast cancer

A

skin reaction, chest wall pain and fatigue acutely.

fibrosis, atrophy of breast and telangiectasia later. Brachial plexopathy is rare now

58
Q

What chemo regime is used for breast cancer

A

FEC- T

5FU, epirubicin, cyclophosphamide +/- docetaxel

59
Q

How does tamoxifen work

A

Selectively blocks oestrogen (SERM) in breast tissue but increases oestrogens effect in bones, endometrium and blood (so prothombotic)

60
Q

When are aromatase inhibitors used over tamoxifen and what are the risks and benefits of each?

A

Aromatase inhibitors used in post menopausal women, lower risk of DVT but higher risk of osteoporosis so bone protection is given with it.
Tamoxifen used in pre and post menopausal women, less expensive but slightly less effective. It increases DVT and endometrial ca risk but is bone protective.

61
Q

What are abnormal features to look out for on mammography?

A

Irregular, spiculated
Radioopaque mass
Microcalcification

62
Q

What are the pros and cons of FNA vs core biopsy?

A

FNA - quick, less uncomfortable, but cytological assessment only so if malignant core biopsy needed

Core biopsy
Removes small amount of tissue, higher morbidity and pain, takes longer
Can determine receptor status and grade of tumour

Cancer Care (15 decks)

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