Breast Cancer Flashcards
Describe how a patient with Brest cancer would present.
Painless breast lump
Name 3 genetic mutations that are important in the risk factors for breast cancer.
- BRCA1
- BRCA2
- HER2 Receptor
Describe the pattern of mutation in the anti-oncogenes BRCA1 and BRCA2.
Autosomal dominant
Name the transmembrane glycoprotein that plays a key role in cell survival, proliferation and differentiation.
HER2 Receptor
Where do the lymphatics of the breast run?
Sub-mammary space
Name the Non-invasive types of breast cancer.
- DCIS
- LCIS
Name the 4 subtypes of DCIS.
- Papillary
- Cribriform
- Solid
- Comedo
What types of cells are affected in LCIS?
Acini cells
Describe the differences between DCIS and LCIS.
LCIS predominantly occurs in pre-menopausal women and is more often found in both breasts compared to DCIS which is usually unilateral.
Name the invasive types of breast cancer.
- Invasive ductal carcinoma
- Invasive lobular carcinoma
Name the rare types of breast cancer.
- Inflammatory breast cancer
- Paget’s disease of the nipple
- Mucinous
- Medullary
- Papillary
- Tubular
- Phyllodes
- Metaplastic
- Basal-like
- Primary breast lymphoma.
Describe how inflammatory breast cancer can be distinguished from an infection.
Patients will not have a fever, chills or elevated white cell count.
Describe some factors which would increase a patient risk oestrogen exposure.
- Nulliparity and increasing age of first childbirth
- Early menarche (menstruation starting in girls under 12 years old): causing early exposure to oestrogen
- Late menopause (>55-years-old): increasing the length of exposure to oestrogen
- Hormone replacement therapy (HRT) with oestrogen and progestogen
- Obesity: increases oestrogen levels because more adipose tissue leads to increased expression of an enzyme called aromatase which increases the synthesis of oestrogen
Name some risk factors of developing breast cancer.
- Age: risk increases with age
- Female gender
- Family history: first degree relative with breast cancer
- Previous breast cancer
- Genetics: BRCA1 and BRCA2 mutations
- Radiation therapy to the chest
- Not having breastfed
- Lifestyle: excessive alcohol and fat intake
Name one protective factors for breast cancer.
Breast feeding
Describe an examination of a patient with breast cancer.
- Hard with a gritty texture
- Ill-defined, irregular margins
- Tethered (attached to the surrounding breast tissue or skin) or fixed (attached to the chest wall)
- Most breast cancers arise in the upper outer quadrant of the breast
- A suspicious lump felt in the axilla may indicate metastasis to the lymph nodes.
Describe the skin changes seen in association with breast cancer.
- Rough, dry, erythematous, and ulcerated skin surrounding the nipple can be caused by Paget’s disease
- A cancerous breast lump beneath the skin can cause dimpling or puckering of the skin.
- Peau d’orange: the skin looks like the surface of an orange. This occurs when the lymphatic system that drains the skin is blocked by cancer cells causing the skin to become oedematous.20 This can be easily misdiagnosed as an infection.
Describe the components of the triple assessment.
- Clinical history and examination by a breast surgeon
- Radiological imaging
- Core biopsy or fine-needle aspiration (see below)
Why is a USS used in breast cancer imaging in women under 40?
Younger women tend to have denser breast tissue, this makes mammography less sensitive for detecting breast cancers.
What two views are mammograms usually taken?
mediolateral oblique and craniocaudal
Describe the breast cancer screening available in the UK.
There is a breast cancer screening program in the UK for women aged 50 to 70 in which a two-view mammogram is performed every 3 years.
Describe the endocrine medical therapy available to women with oestrogen reducing activity.
- Tamoxifen: used in premenopausal women with ER+ cancer, works by blocking oestrogen receptors
- Aromatase inhibitors (Letrozole, Anastrozole, Exemestane): only used in postmenopausal women with ER+ cancer. They work by blocking the enzyme aromatase which converts androgens into oestrogen.
What type of medical management is available to use in patients with breast cancer with it HER2 receptor positive?
Herceptin
What is the Oncotype DX breast recurrence score assay?
The patient’s breast cancer cells are sent for genetic testing, where a 21 gene panel is used to analyse the cells and produces a score between 0 and 100. The higher the score the more likely the cancer will recur. So, it is used to decide if adjuvant chemotherapy is warranted, helping to avoid patients from being subject to chemotherapy that they may not benefit from.
What can be used in premenopausal omen to help protect their ovaries form premature ovarian failure?
Gonadotropin-releasing hormone agonists like goserelin
Name the surgical management available to patients with breast cancer.
- Wide local excision
- Mastectomy
- Sentinel node sampling
- Reconstruction
- Ovarian ablation
Name the 3 routes of metastatic spread of breast cancer.
- Direct spread: into skin and muscle, causing skin ulceration
- Lymphatic spread: the axillary nodes are the commonest initial site of metastasis
- Haematogenous spread: blood-borne metastasis often occurs to the lungs, bones, liver and brain
Name the most common 4 sites of haematogenous spread of breast cancer.
- Lungs
- Bone
- Liver
- Brain
