Breast - Breast Cancer Flashcards
Breast Cancer - what re the RFs?
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
Breast Cancer - what is BRCA?
BRCA refers to BReast CAncer gene
BRCA genes are tumour suppressor genes
Mutations in these genes lead to an increased risk of breast cancer
Breast Cancer - where is BRCA1 located?
Chromosome 17
Breast Cancer - where is BRCA2 located
Chromosome 13
Breast Cancer - what are the different types of breast cancer?
- Ductal Carcinoma In Situ (DCIS)
- Lobular Carcinoma In Situ (LCIS)
- Invasive Ductal Carcinoma (NST, No Special Type)
- Invasive Lobular Carcinomas (ILC)
- Inflammatory Breast Cancer
- Paget’s Disease of the Nipple
Breast Cancer - what is DCIS?
Localised in a single area
Potential to become an invasive breast cancer (around 30%)
Basement membrane not breached
Good prognosis if full excised
Breast Cancer - what is LCIS?
- 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)
Breast Cancer - what is LCIS?
- 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)
Breast Cancer - what is Invasive Ductal Carcinoma (NST)?
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
Breast Cancer - what is Invasive Lobular Carcinoma?
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)
Breast Cancer - what is Paget’s Disease of the nipple?
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
Breast Cancer - how often is breast cancer screening and what age is it for?
Mammogram
Aged 50 to 70
Every 3 years
Breast Cancer - what are the clinical features?
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
Breast Cancer - what is the criteria for the two week wait referral for BC?
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
Breast Cancer - what are the different types of imaging used and on who are they used?
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
Breast cancer - what investigations are done on the lymph nodes?
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
Breast Cancer - what are the receptors, and why are they important in management?
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)
Breast Cancer - what is Triple-negative breast cancer?
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
Breast Cancer - where will it most likely metastasise?
2 Ls and 2 Bs:
- L – Lungs
- L – Liver
-
B – Bones
- B – Brain
Breast Cancer - where will it most likely metastasise?
2 Ls and 2 Bs:
- L – Lungs
- L – Liver
-
B – Bones
- B – Brain
Breast Cancer - what is the staging system called?
The TNM system is used to stage breast cancer
This grades the tumour (T), nodes (N) and metastasis (M)
Breast Cancer - what are the 5 different types of management options?
- surgery
- radiotherapy
- hormone therapy
- biological therapy
- chemotherapy
Breast Cancer - Management, Surgery
Majority of patients with breast cancer diagnosed offered surgery
Prior to surgery, presence/absence of axillary lymphadenopathy determines management
Breast Cancer - which surgical option do you choose?
Depending on the characteristics of the tumour women either have a wide-local excision or a mastectomy
Breast Cancer - radiotherapy
Whole breast radiotherapy recommended after a woman has had a wide-local excision
Reduce risk of recurrence by around two-thirds
Breast Cancer - Hormone Treatment
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)
Breast Cancer - how does tamoxifen work?
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
Breast Cancer - how does aromatase inhbitors work?
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
Breast Cancer - what are the biological therapies that you can use if they are HER2 receptor positive?
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
Breast Cancer - what does Neoadjuvant therapy mean?
Neoadjuvant therapy – intended to shrink the tumour before surgery
Breast Cancer - what does Adjuvant chemotherapy mean?
Adjuvant chemotherapy – given after surgery to reduce recurrence
