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OB/Gyn > Breast CA and Genetics > Flashcards

Breast CA and Genetics Flashcards

1
Q

Cancer of the cells that line the milk ducts of the breast and have not spread into the surrounding breast tissue?

A

Ductal Carcinoma in Situ (DCIS) – Stage 0.

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2
Q

Cancer that began in the milk ducts and has spread to the surrounding breast tissues?

A

Invasive ductal carcinoma (IDC).

*The cancer has broken through the wall of the milk duct and began to invade the tissues of the breast.

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3
Q

Cancer of the breast that tests negative for estrogen receptors, progesterone receptors or the excess of HER2 protein?

A

Triple Negative Breast Cancer (TNBC).

*Accounts for 10-15% of all breast cancers.

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4
Q

Breast cancer that has spread to another part of the body?

A

Metastatic Breast Cancer

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5
Q

What is the clinical presentation of breast cancer?

A

Breast mass/lump, nipple discharge (not breast milk), nipple inversion, breast pain or tender spots, changes in breast size or shape, dimpled skin – flaky, thickened or discolored skin, swollen areas of the breast, lumps/swelling near armpit or collarbone.

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6
Q

Risk factors for breast cancer?

A
  1. Age >50 yrs old.
  2. Female.
  3. Genetic mutations – BRCA family of tumor suppressor genes.
  4. Early menses (<12) or menopause after 55 yrs old.
  5. DES exposure – med given to women to prevent miscarriages; 1940-1971.
  6. Prior breast cancer.
  7. Dense breast tissue – difficult to detect tumors.
  8. Family History – 50% of all breast cancers occur in the 12% of women at highest genetic risk.
  9. Alcohol consumption, high dietary fat intake, lack of exercise.
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7
Q

Modalites of screening and diagnosing

A
  1. Mammography.
  2. Self-palpated.
  3. Ultrasound – could be better than mammo if nothing was picked up on.
  4. MRI of breast.
  5. Biopsy – only performed if a mass/lump was found.
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8
Q

What is Stage 0?

A

Carcinoma in situ – early form.

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9
Q

What does TNM System of Staging stand for?

A
  1. Tumor size.
  2. Node - Lymph – # and location of LNs w/cancer.
  3. Metastases – whether it has spread to other parts of the body.

*This is the most widely used method of pathologic staging of breast cancer and describes the extent of cancer within the body.

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10
Q

What is Stage I?

A

Localized cancer to the area.

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11
Q

What is Stage II?

A

Early, locally advanced.

  • -outside of the main structure originally involved.
  • -ex: started in the milk ducts then invaded to surrounding tissues of breast; no LN involved.
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12
Q

What is Stage III?

A

Late, locally advanced.

–Stage II with LN involvement.

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13
Q

What is Stage IV?

A

Metastasized cancer.

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14
Q

What is Stage IV?

A

Metastasized cancer.

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15
Q

What increases your risk of breast and ovarian cancer at a young age?

A

BRCA positive finding.

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16
Q

An aggressive form of locally advanced breast cancer?

A

Inflammatory breast cancer (IBC).

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17
Q

Why is IBC called what it is?

A

The breast often looks read and inflamed; other Sx include swelling.

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18
Q

Most IBC are what type of cancer?

A

Invasive Ductal Carcinoma because it begins in the milk ducts.

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19
Q

What is DCIS considered to be?

A

A non-invasive cancer or pre-cancerous breast cancer.

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20
Q

What is DCIS considered to be?

A

A non-invasive cancer or pre-cancerous breast cancer.

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21
Q

Which is the most common type of breast cancer?

A

Invasive ductal carcinoma (IDC) – aka”infiltrating ductal carcinoma.”

22
Q

Name for any cancer that begins in the skin or other tissues that cover internal organs?

A

Carcinoma.

23
Q

What does TNBC results mean?

A

The growth of the cancer is not fueled by the hormones estrogen and progesterone, or by the HER2 protein.

**It will not respond to hormonal therapy or meds that target the HER2 protein receptors.

24
Q

What are the most common sites where breast cancer metastasized to?

A

Liver, Brain, Bones or lungs.

25
Q

How does metastatic cancer develop?

A

Cancer can break away from the original tumor in the breast or wherever, and travel to other parts of the body through the bloodstream or the lymphatic system, which is a large network of nodes and vessels that work to remove bacteria, viruses and cellular waste products.

26
Q

Breast cancer evaluation should follow what?

A

An ordered inquiry that begins with symptoms and a general clinical history followed by a triple assessment.

27
Q

What is involved in the triple assessment of diagnosing breast cancer?

A
  1. Clinical examination.
  2. Imaging – mammography, US or both.
  3. Needle biopsy.
28
Q

What test is used for screening of breast cancer?

A

Mammography – starts at age 50, biennial, stops at 74.

29
Q

What imaging test is best for detecting breast cancer at an early stage?

A

Mammography – a low-dose x-ray used to image the breast.

30
Q

A useful adjunct to mammography generally employed to assist the clinical examination of a suspicious lesion detected on mammography or physical examination?

A

Ultrasound – is limited due to failure to detect microcalcifications and its poor specificity (34%).

31
Q

When is biopsy used in the work-up of breast cancer?

A

To examine all suspicious lesions found on physical exam, imaging or both.

32
Q

What is the diagnostic procedure of choice for both palpable and image-detected lesion/mass/abnormalities of the breast?

A

Large-needle core biopsy.

33
Q

When is MRI used in the work-up of breast cancer?

A

For detecting breast cancer in women at high risk and in younger women.

34
Q

Indications for MRI in breast cancer?

A
  1. Characterize an indeterminate lesion after full assessment.
  2. Detect occult breast carcinoma in a pt. w/carcinoma in an axillary LN.
  3. Suspected multifocal or bilateral tumor.
  4. Invasive lobular carcinoma since high incidence of multifocality.
  5. Recurrent breast cancer.
  6. Monitoring response to neoadjuvant chemotherapy.
  7. Extensive high-grade intraductal carcinoma.
35
Q

An estimated 44% of women with what will develop Ovarian Ca by age 80?

A

BRCA 1

36
Q

An estimated 17% of women with what will develop Ovarian Ca by age 80?

A

BRCA 2

37
Q

40% chance of developing this 20 yrs after initial breast Ca with BRCA mutation?

A

Developing breast cancer in the contralateral side.

38
Q

What are the contributions of genetics to breast, ovarian and endometrial cancer?

A
  1. 20-25% of all ovarian cancers have a single gene hereditary cause.
  2. There is an estimated 2-fold increased risk of Endometrial cancer with one first degree relative diagnosed after age 50.
39
Q

Identify the red flags suggesting risk for BRCA 1/2 mutation?

A
  1. Early onset of breast cancer; < age 50.
  2. Triple Negative breast cancer.
  3. Multiple cases of breast and/or ovarian cancer in the same family.
  4. Breast and Ovarian CA in the same woman.
  5. Bilateral Breast CA.
  6. Male Breast CA.
  7. Ashkenazi Jewish Heritage.
40
Q

What are the mgmt strategies associated with BRCA 1/2?

A
  1. Early clinical surveillance (begin at at 20-25) annual or semi-annual:
    - -clinical breast exam, mammogram, Breast MRI.
    - -CA125, Transvaginal US.
  2. Chemoprevention – Tamoxifen, OCPs.
  3. Prophylactic Mastectomy – 90% + reduction in breast cancer risk.
  4. Prophylactic Bilateral Salpingo-Oophorectomy:
    - -80-96% reduction in ovarian/fallopian tube cancer risk.
    - -50% + reduction in breast cancer risk.
41
Q

What is Tamoxifen and what is is used for?

A
  1. SERM - Selective-Estrogen Receptor Modulator.
  2. It is used to treat HR+, early-stage cancer after surgery, advanced stage or mets HR+ cancer, and prevention of HR+ cancers in women who are at high-risk of developing HR+ cancers.
42
Q

What is Tamoxifen and what is is used for?

A
  1. SERM - Selective-Estrogen Receptor Modulator.
  2. It is used to treat HR+, early-stage cancer after surgery, advanced stage or mets HR+ cancer, and prevention of HR+ cancers in women who are at high-risk of developing HR+ cancers.
43
Q

What are the current recommendations for genetic testing and counseling for ovarian cancer?

A
  1. 20-25% of all ovarian cancers have a single gene hereditary cause.
  2. All pt’s with ovarian cancer should be offered genetic counseling and testing.
  3. All pt’s with a 1st and 2nd degree relative with ovarian cancer should be offered genetic counseling.
44
Q

What are the current recommendations for genetic testing and counseling for ovarian cancer?

A
  1. 20-25% of all ovarian cancers have a single gene hereditary cause.
  2. All pt’s with ovarian cancer should be offered genetic counseling and testing.
  3. All pt’s with a 1st and 2nd degree relative with ovarian cancer should be offered genetic counseling.
45
Q

What are the current recommendations for genetic testing and counseling for ovarian cancer?

A
  1. 20-25% of all ovarian cancers have a single gene hereditary cause.
  2. All pt’s with ovarian cancer should be offered genetic counseling and testing.
  3. All pt’s with a 1st and 2nd degree relative with ovarian cancer should be offered genetic counseling.
46
Q

Clinical presentation of Ovarian Cancer?

A

Bloating or pressure in the belly, Abd/pelvic pain, feeling full too quickly during eating (early satiety), urinating more frequently.

*No effective screening strategies.

47
Q

Clinical presentation of Ovarian Cancer?

A

Bloating or pressure in the belly, Abd/pelvic pain, feeling full too quickly during eating (early satiety), urinating more frequently.

*No effective screening strategies.

48
Q

Established risk factors for Endometrial/Uterine Cancer?

A

Obesity, High BP, Diabetes, Unopposed Estrogen.

49
Q

Symptoms of Endometrial Cancer?

A
  1. Vaginal bleeding, spotting, discharge when it should not be happening.
  2. Pain or difficulty when emptying bladder.
  3. Painful intercourse.
50
Q

Benefits and limitations to the BCRAT?

A

Breast Cancer Risk Assessment Tool:

BENEFITS:
–Easy access/use, incorporates reproductive factors, adjusts for race, well-validated.

LIMITATIONS:

  • -Does not incorporate 2nd degree relatives with CA Hx.
  • -May over-estimate risk with multiple benign breast BX.
  • -Lower accuracy for individual risk prediction.
  • -Uses older population prevalence data.
51
Q

What is the genetic breakdown of types of cancer?

A

70-75% are sporadic, 15-20% Familial, 5-10% Hereditary.

52
Q

What is the cause of cancer or prevention of cancer?

A

It is always an interaction between multiple factors – genes, environment/lifestyle and chance.

OB/Gyn (14 decks)

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