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CRO 2 > Breast > Flashcards

Breast Flashcards

1
Q

location

lies. .
extends. ..

A

lies over pectoralis muscle

extends from 2-6th rib

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2
Q

types of tissues (%)

A

80% fat

20% glandular

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3
Q

which areas of the breast contain the most glandular tissue?

A

upper half,

upper outer quadrant

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4
Q

how many lobes

A

15-20

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5
Q

how many major ducts

A

5-10

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6
Q

define tail of spence

A

axilary tail extension of breast tissue over the pectoralis major muscle into the axilla

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7
Q

3 groups of lymphatics

A

axillary
supraclav
internal mammary

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8
Q

3 levels of axillary

A

level 1 - superficial, lateral to pectoralis minor
level 2 -beneath pectoralis minor
level 3 - deep, medial to pectoralis minor

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9
Q

location of Internal mammary LN

A

edge of sternum embedded in fat within 1-3 intercostal spaces

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10
Q

quadrant with most prob of cancer? second? least?

A

upper outer
nipple
lower inner

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11
Q

multicentric vs multifocal

A

focal - all contained within on quadrant

centric - appears in several

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12
Q

why has death rate been declining

A

better tx

better screening

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13
Q

some risk factors?

A 
early menarche
late menopause
obesity
excessive drinking
kid before 25
nulliparity
not breast feeding
hormone replacement therapy
genetics
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14
Q

genetic risk factors

A

BRCA 1 + BRCA 2 - tumour supressor gener; produce protein which repairs/destroys damaged dna; mutated means protein not made

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15
Q

most common pathology? 2nd?

A

IDC - 70%

ILC - 5-10%

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16
Q

IBC? characterization? stage? prognosis?

A 
inflammatory breast cancer
rare and aggressive 
skin changes -  eythema, increased warmth, tender, enlarged
stage t4d
pooooooor

fyi - usually not detectable via screening and often misdiagnosed as an infection

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17
Q

paget’s disease?

A

rare
involves nipple and areola
presents as eczema like rash on nipple, or sore that doesnt heal
usually implies another tumour inside the breast

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18
Q

clinical pres

A 
palpable breast mass
painless lump
changes in breast
enlarged LN (axillary
nipple discharge
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19
Q

detection/screening

most common

A 
BSE
CBE
mammography - 75%
ultrasound
mri
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20
Q

Diagnostic procedures?

A 
biopsy 
fine needle, core, image guided
stereotactic needle biopsy
excisional/lumpectomy, incisional
sentinel node
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21
Q

why would we do incisional instead of excisional

A

mass too large
multicentric
+ margins upon surgery

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22
Q

why are +/- margins significant for RT

A

will determine need for boost

+ margins = boost

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23
Q

most common ways to give boost

A

electron
photons
tageting seroma

24
Q

sentinel node biopsy process?

A

area around tumour injected with blue dye
then take the first LN that shows with dye near tumour area

fyi- can do the same thing with radioactive dye and a radioactive detector

25
Q

met sites

A

bone
brain
lung
liver

26
Q

moveable vs free LNs

A

fixed give impression that they are glued to underying tissues
moveable - move

27
Q

size T1

A

=<20mm

28
Q

size T2

A

> =20, =<50mm

29
Q

size T3

A

> 50mm

30
Q

T4

A

direct extension to chestwall

31
Q

nodes most often involved? 2nd?

A

axillary

internal mam

32
Q

supraclav involvment indicates…

A

extensive axillary mets

33
Q

most important prog factory

A

LN status - # of axil involved

34
Q

prog factors

A 
LNI - axillary levels
tumour size
histology
inflam
ER/PR receptor status
35
Q

allred score is?

A

percentage of cells that test positive for hormone receptors
how well receptors show up after staining
higher score, more receptors, more dye

36
Q

what does allred score have to do with prognosis

A

higher = more receptors = more estrogen uptake
estrogen associated with cell growth
if high score it means we are able to treat with hormone therapy as we can just deprive tumour of estrogen via blockers/decrease the levels

37
Q

% of tumours er/pr +

A

70%`

38
Q

HER2 + means

A

over amplification of HER2 receptors on cell surface, causing cells to grow quicker and divide

39
Q

what does HER2 +/- have to do with prognosis

A

+ : found in 20% of cases, cancers found to be more aggressive
- : better prog, less aggressive

fyi - status can change, prob upon reccurance

40
Q

what does triple negative indicate

A 
dont have ER/PR or HER2 receptors
grow and spread faster than most other types
higher reccurance
hormone therapy not helpful
prognosis/survival poor
41
Q

what are the pt’s surgical options

A

lumpectomy + LN biopsy-breast conserving

mastectomy -radical, modified, simple

42
Q

what does a radical mastectomy involve

A

remove pectoralis minor and major muscles

levels 1-3 axillary LN

43
Q

what does a modified radical mastectomy involve?

A

preserve the pectoralis major muscle with removal of levels 1-2 axillary nodes

44
Q

what does a simple mastectomy involve

A

removal of entire breast leaving nodes

45
Q

what is the difference between tamoxifen, letrozol, and herceptain

A

Hormone therapy
t - blocks estrogen receptors
l - lowers estrogen levels in the body

immunotherapy
h - blocks HER2 protein from being over-expressed

46
Q

what do CDK4/6 inhibitors do?

A

immunotherapy treatment involving an enzyme that causes cell cycle arrest in cancer cells preventing proliferation

47
Q

when is chemo administered?

A

for high risk patients to prolong survival or to downsize disease

48
Q

when in the treamtment process is RT given

A

usually post surgery/chemo

49
Q

what are the pros to using APBI technique

A

decreased high dose to irradiated breast volume
decreased lung and heart dose
decreased number of fractions and treatment time

50
Q

what are the cons to using APBI technique

A 
optimum dose, volume, and schedule are unknown
can miss occult multicentric disease
no level 1 nodal irradiation
limited to tumours <3cm
increased planning and resources
51
Q

whats the typical dose for WBRT

A

4256/16

52
Q

whats the typical dose for supraclav

A

4500/25

53
Q

what percentage of mets will occur within 5 years

A

75%

54
Q

what is the median survival for met disease

A

2 years

55
Q

what test can be done to detect met disease

A

CEA carcinoembryonic antigen

56
Q

whats the most common met site

A

bone - 50%

CRO 2 (8 decks)

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