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Finals Revision Flashcards > Breast - Breast Cancer > Flashcards

Breast - Breast Cancer Flashcards

1
Q

Breast Cancer - what re the RFs?

A

Increased exposure to oestrogen
Obesity
Smoking
Family History

HRT - increases risk, especially combined HRT (both oestrogen and progesterone)

Combined contraceptive pill - small increase in risk

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2
Q

Breast Cancer - what is BRCA?

A

BRCA refers to BReast CAncer gene

BRCA genes are tumour suppressor genes

Mutations in these genes lead to an increased risk of breast cancer

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3
Q

Breast Cancer - where is BRCA1 located?

A

Chromosome 17

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4
Q

Breast Cancer - where is BRCA2 located

A

Chromosome 13

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5
Q

Breast Cancer - what are the different types of breast cancer?

A
  1. Ductal Carcinoma In Situ (DCIS)
  2. Lobular Carcinoma In Situ (LCIS)
  3. Invasive Ductal Carcinoma (NST, No Special Type)
  4. Invasive Lobular Carcinomas (ILC)
  5. Inflammatory Breast Cancer
  6. Paget’s Disease of the Nipple
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6
Q

Breast Cancer - what is DCIS?

A

Localised in a single area

Potential to become an invasive breast cancer (around 30%)

Basement membrane not breached

Good prognosis if full excised

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7
Q

Breast Cancer - what is LCIS?

A
  • Pre-cancerous condition occurring typically in pre-menopausal women
  • Usually asymptomatic and undetectable on a mammogram
  • Increased risk of invasive BC in future (30%)
  • Managed with close monitoring (6 monthly examination and yearly mammograms)
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7
Q

Breast Cancer - what is LCIS?

A
  • Pre-cancerous condition occurring typically in pre-menopausal women
  • Usually asymptomatic and undetectable on a mammogram
  • Increased risk of invasive BC in future (30%)
  • Managed with close monitoring (6 monthly examination and yearly mammograms)
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8
Q

Breast Cancer - what is Invasive Ductal Carcinoma (NST)?

A

NST means no special/specific type, where it is not more specifically classified

  • Originate in cells from the breast ducts
  • 80% of invasive breast cancers fall into this category
  • Can be seen on mammograms
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9
Q

Breast Cancer - what is Invasive Lobular Carcinoma?

A

Invasive Lobular Carcinomas (ILC)

  • Invasive → vast majority are oestrogen receptor-positive
  • Originate in cells from the breast lobules
  • Not always visible on mammograms
  • In situ → incidentally found on biopsy (often managed
    with close monitoring, 6 month checks)
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10
Q

Breast Cancer - what is Paget’s Disease of the nipple?

A

Commonly associated with ductal carcinoma in situ.

  • Erythematous eczema-like rash
  • Unilateral
  • Itchy, inflamed nipple
  • Ulceration that can cause blood-stained
  • *discharge**
  • Burning sensation

Indicates breast cancer involving the nipple

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11
Q

Breast Cancer - how often is breast cancer screening and what age is it for?

A

Mammogram

Aged 50 to 70

Every 3 years

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12
Q

Breast Cancer - what are the clinical features?

A

Lumps that are hard, irregular, painless or fixed in place

Lumps may be tethered to the skin or the chest wall

Nipple retraction

Skin dimpling or oedema (peau d’orange)

Lymphadenopathy, particularly in the axilla

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13
Q

Breast Cancer - what is the criteria for the two week wait referral for BC?

A

An unexplained breast lump in patients aged 30 or above

Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

An unexplained lump in the axilla in patients aged 30 or above

Skin changes suggestive of breast cancer

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14
Q

Breast Cancer - what are the different types of imaging used and on who are they used?

A

Ultrasound - younger women as they have more dense breasts, hep distinguish solid from cystic lumps

Mammograms - used in older women, better at picking up calcifications missed from US

MRI Scans

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15
Q

Breast cancer - what investigations are done on the lymph nodes?

A

If a women has been diagnosed with BC, they are offered:

  • US of the axilla and ultrasound-guided biopsy of any abnormal nodes
  • Sentinel lymph node biopsy - used during BC surgery where initial US does not show abnormal nodes
16
Q

Breast Cancer - what are the receptors, and why are they important in management?

A

Breast cancer cells may have receptors that can be targeted with breast cancer treatments:

Oestrogen receptors (ER)

Progesterone receptors (PR)

Human epidermal growth factor (HER2)

17
Q

Breast Cancer - what is Triple-negative breast cancer?

A

Triple-negative breast cancer is where the breast cancer cells do not express any of the three receptors

Worse prognosis, as limits treatment options for targeting cancer

18
Q

Breast Cancer - where will it most likely metastasise?

A

2 Ls and 2 Bs:

  • L – Lungs
  • L – Liver
  • B – Bones
    • B – Brain
19
Q

Breast Cancer - where will it most likely metastasise?

A

2 Ls and 2 Bs:

  • L – Lungs
  • L – Liver
  • B – Bones
    • B – Brain
20
Q

Breast Cancer - what is the staging system called?

A

The TNM system is used to stage breast cancer

This grades the tumour (T), nodes (N) and metastasis (M)

21
Q

Breast Cancer - what are the 5 different types of management options?

A
  • surgery
  • radiotherapy
  • hormone therapy
  • biological therapy
    • chemotherapy
22
Q

Breast Cancer - Management, Surgery

A

Majority of patients with breast cancer diagnosed offered surgery

Prior to surgery, presence/absence of axillary lymphadenopathy determines management

23
Q

Breast Cancer - which surgical option do you choose?

A

Depending on the characteristics of the tumour women either have a wide-local excision or a mastectomy

24
Q

Breast Cancer - radiotherapy

A

Whole breast radiotherapy recommended after a woman has had a wide-local excision

Reduce risk of recurrence by around two-thirds

25
Q

Breast Cancer - Hormone Treatment

A

Patients with oestrogen-receptor positive breast cancer are given treatment that disrupts the oestrogen stimulating the breast cancer.

1st line:

  • Tamoxifen for premenopausal women
  • Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)
26
Q

Breast Cancer - how does tamoxifen work?

A

Tamoxifen is a selective oestrogen receptor modulator (SERM)

It blocks oestrogen receptors in breast tissue and stimulates oestogren
receptors in the uterus and bones

Helps prevent osteoporosis

Increases risk of endometrial cancer

27
Q

Breast Cancer - how does aromatase inhbitors work?

A

Aromatase is an enzyme found in fat (adipose) tissue that converts androgens to oestrogen

Aromatase inhibitors work by blocking the creation of oestrogen in
fat tissue

After menopause, the action of aromatase in fat tissue is the primary source of oestrogen

28
Q

Breast Cancer - what are the biological therapies that you can use if they are HER2 receptor positive?

A

HER2 Positive

Trastuzumab - monoclonal antibody targets HER2 receptor
Can affect heart function, cannot be used in patients with a history of heart disorders

Pertuzumab is another monoclonal antibody that targets the HER2
receptor, used in combination with trastuzumab

Neratinib is a tyrosine kinase inhibitor, reducing the growth

29
Q

Breast Cancer - what does Neoadjuvant therapy mean?

A

Neoadjuvant therapy – intended to shrink the tumour before surgery

30
Q

Breast Cancer - what does Adjuvant chemotherapy mean?

A

Adjuvant chemotherapy – given after surgery to reduce recurrence

Finals Revision Flashcards (49 decks)

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