Breast, bowel and lung cancer Flashcards
Classifications of breast cancer
Ductal carcinoma in situ
Lobular carcinoma in situ
Invasive ductal carcinoma
Invasive lobular carcinoma
Genetic associations with breast cancer
BRCA1, BRCA2
HER2
TP53
PTEN
Risk factors of breast cancer
Family history
Hx of ovarian/ endometrial
Combined HRT
Smoking
Increased oestrogen exposure: obesity, early menarches, late menopause
First line investigations for breast cancer
Triple assessment
- Mammogram
- Fine need biopsy and histology
- Lymph node biopsy
What receptors are screened for in breast cancer
Oestrogen receptor
Progesterone receptor
HER2
__________ tend to be detected on mammograms by forming microcalfications
ductal carcinoma
Examples of benign breast tumours
Fibroadenoma
Adenoma
Papilloma
Lipoma
Breast cancer screening starts from age _____ and occurs every _____ years until age ____
Age 50, every 3 years until age 70
Family history High risk factors for breast cancer
1st degree relative affected <40 or bilateral <50.
1st degree male affected
Two 1st degree relatives affected.
Patients with high risk family history for breast cancer are….
Offered annual mammograms
Given chemoprevention/ can have surgery
Chemoprevention for breast cancer
Tamoxifen (for premenopausal)
Anastrozole (post-menopausal)
2-week referral indications for breast cancer
Unexplained breast/ axillary lump in age >30
Unilateral nipple changes in age >50
Breast cancer skin changes
_________ index is used for staging breast cancer
Nottingham prognostic index
______ is the therapy used to target HER2 in breast cancer
Herceptin
_______ is the therapy used to target oestrogen-receptor positive breast cancer
Tamoxifen (pre-menopausal)
Anastrozole (post-menopausal)
______ is a labelling protein used for breast cancer that is associated with proliferation
Ki67
Breast cancer subtypes (immunohistochemistry)
Eostrogen receptor positive (Luminal)= 75%
- Luminal A= PR also strongly positive. Low grade and proliferation.
- Luminal B= high grade and proliferation
HER2 positive= 15%
- 50% also ER+
Triple negative
- ER, PR and HER2 negative.
Examples of breast conserving surgery for breast cancer
Lumpectomy
Mammoplasty
Wide-local excision
Short term risks of radiotherapy for breast cancer
Skin erythema
Rare: Skin necrosis, lymphoedema, pneumonitis, oesophagitis
Long term risks of radiotherapy for breast cancer
Smaller breast
Telangiectasia
Rib fracture
Secondary malignancy
Adjuvatn chemotherapy is used for ________ breast cancer
HER2 + and triple negative breast cancer
Tamoxifen works by…
Anti-oestrogen
- Inhibits oestradiol from acting on oestrogen receptor.
Side effects of tamoxifen
Menopausal symptoms
- Vasmotor
- Joint pain
- Mood changes
- VTE, endometrial cancer
Aromatase inhibitors act as anti breast cancer therapy by…
Preventing peripheral production of oestrogen via aromatase enzymes
Side effects of aromatase inhibitors
Arthralgia
Reduced bone density/ Increased fracture risk
Anti-HER2 monoclonal antibodies are associated with what complication?
Heart failure
Adjuvant bisphosphonatese reduced risk of… in _____ women
Reduces recurrence and death risk
In post-menopausal women
Breast cancer typically metastases to what areas?
Lung
Bone
Brain
Liver
Luminal breast cancers typically spreads to…
Bone
Skin
Lymph nodes
_____ inhibitors describe targeted therapy for HER2+ and HR+ breast cancer
CDK4/6
_______ is an adjunct that can be given to minimise the cytotoxic effects of chemotherapy
Antibody-drug conguates (ADCs)
The most type of aggressive type of breast cancer is…
Triple negative breast cancer
Management of bone mets in breast cancer
Bisphosphonates
RANKL inhibitor
Triple negative breast cancer is treated with..
Chemo/ immunotherapy
PARP-inhibitors (BRCA+)
Mutations involved in bowel cancer pathogenesis
APC
KRAS
DCC
TP53
NICE guidelines for bowel cancer 2-week wait
> 40, unexplained weight loss + abdo pain
> 50, unexplained rectal bleeding
> 60, unexplained iron deficient anaemia/ change in bowel habit.
______ as used for the bowel cancer screening programme
FIT tests
What age group are screened for bowel cancer?
60-74
What age group are screened for bowel cancer?
60-74
Risk factors that indicate frequent bowel cancer screen
FAP
HNPCC
IBD
High risk groups that are screened more frequently for colorectal cancer
Previous colerectal cancer
Colonic adenoma
IBD
Acromegaly
FMHs HNPCC/ FAP, Peutz jagher
Strong bowel cancer FHx
- 2 first degree relatives
- 1 first degree, <45.
