Breast, bowel and lung cancer Flashcards by aderonke adesanoye

Classifications of breast cancer

Ductal carcinoma in situ

Lobular carcinoma in situ

Invasive ductal carcinoma

Invasive lobular carcinoma

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Genetic associations with breast cancer

BRCA1, BRCA2

HER2

TP53

PTEN

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Risk factors of breast cancer

Family history

Hx of ovarian/ endometrial

Combined HRT

Smoking

Increased oestrogen exposure: obesity, early menarches, late menopause

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First line investigations for breast cancer

Triple assessment

Mammogram
Fine need biopsy and histology
Lymph node biopsy

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What receptors are screened for in breast cancer

Oestrogen receptor

Progesterone receptor

HER2

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__________ tend to be detected on mammograms by forming microcalfications

ductal carcinoma

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Examples of benign breast tumours

Fibroadenoma

Adenoma

Papilloma

Lipoma

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Breast cancer screening starts from age _____ and occurs every _____ years until age ____

Age 50, every 3 years until age 70

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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.

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Patients with high risk family history for breast cancer are….

Offered annual mammograms

Given chemoprevention/ can have surgery

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Chemoprevention for breast cancer

Tamoxifen (for premenopausal)

Anastrozole (post-menopausal)

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2-week referral indications for breast cancer

Unexplained breast/ axillary lump in age >30

Unilateral nipple changes in age >50

Breast cancer skin changes

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_________ index is used for staging breast cancer

Nottingham prognostic index

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______ is the therapy used to target HER2 in breast cancer

Herceptin

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_______ is the therapy used to target oestrogen-receptor positive breast cancer

Tamoxifen (pre-menopausal)

Anastrozole (post-menopausal)

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______ is a labelling protein used for breast cancer that is associated with proliferation

Ki67

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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.