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cancer > breast cancer > Flashcards

breast cancer Flashcards

1
Q

development of breast buds

anatomy

A

both sexes 6-9th fetal life
fianl maturation during first pregnancy
regression following menopause

ER-VE>2CM
HER2+VE >2CM
<2CM SPREAD TO LYMPH NODES

2nd-6th rib
 Sternal edge to
anterior axillary line
 15-20 lobes
 Supported by
Cooper’s suspensory
ligaments
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2
Q

signs and symptoms of breast cancer

A
  • lump or thickening in
    breast. Often painless
  • discharge (20% DCIS intraductal papilloma, duct ectasia) or bleeding
  • change in size or contours of breast
  • change in colour or appearance or areola
  • redness or pitting of skin over the breast, like orange
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3
Q

fibrocystic breast changes

A 
20%+ of premenopausal women
Discomfort/Cysts
treatment rarely required
• More likely to not detect a
developing cancer
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4
Q

fibroadenoma

features

A 
 Most common benign
breast tumor
 Young women
 Can be multiple
 Excision recommended
if growing

firm and mobile
hormone dependent

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5
Q

breast cyst

A 
 Benign
- middle aged - just before menopause
- due to involutionary changes
 May be aspirated if
large
 Usually multiple
 Commonly reoccurs
following aspiration
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6
Q

epidemiology of breast

A

most common cancer in women in UK

1 in 8

 Screening programme
50-71yrs 3 yearly

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7
Q

what is the triple assessment its what you get in the 2 week referral pathway

A

Clinical
 Inspection
 Palpation

Radiological
 Mammograms - caudio-cranial, medio-lateral - reported by 2 independent radiologists
 USS
 MRI

Pathological
 FNA Cytology
 Core Biopsy
 VACB - vacuum assisted core biopsy of the breast
 Excisional biopsy
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8
Q

RFs of breast cancer

A
  • early menarche
  • late menopause
  • late first pregnancy
  • female
  • not Breast Feeding long term
  • current use HRT
  • no children or fewer
    previous Hx
  • atypical ductal or lobular hyperplasia
  • FH of BRCA1, 2, p53
  • obesity in post-menopausal women
  • high consumption of alcohol
  • previous Hx of cancer - as it increases in 5 years
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9
Q

what is triple negative

A

cells don’t have oestrogen or progesterone receptors

dotn profuce loads of HER2

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10
Q

high screening programmes

A

FH BRCA mutation

high risk FH

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11
Q

how to differentiate between pagets and eczema

A

eczema started from nipple or radially -> Pagets disease
oozing
destruction of nipple
if left neglected

areolar to nipple -> simple eczema
Hx of eczema

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12
Q

classification of breast cancer

A

invasive ductal carcinoma

lobular in situ - surveillance

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13
Q

classification of breast cancer

A

invasive ductal carcinoma - most common type

  • Invasive lobular carcinoma - harder to detect as it has a diffuse multifocal pattern - large by the time its detected
  • Ductal carcinoma-in-situ (DCIS)
  • Lobular carcinoma-in-situ (LCIS)

lobular in situ - surveillance

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14
Q

her2 Mx

A

oestrogen
- HER2 - positive - promotes the growth of cancer cells - Trastuzumab - monoclonal AB blocks HER2 - CARDIAC TOXIC

  • triple negative can metastasise early aggressive
    recur after treatment localy or systemically

biologic types ER+ HER2 - commonest types easily treated ie tamoicen or letrizole p67 differentiating factor high staining luminal B

trNSUMAB her2 blocker if given with chemo efficacy is better

inflammatory breast cancer adjuvant reduce the size

T4 - involving pec muscle or
B- overlying skin or C- both or
D- inflammatory
post mastecomty radiotherapy

T3 >5cm
N2 4-9 LNs
R1 - positive margins

tamoxifen oestrogen receptor positive

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15
Q

Mx surgery

no palpable lymphadenopathy what do we do

palpable lymphadenopathy what do we do

WLE v MASTECTOMY

A
  • > women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery
  • if positive then they should have a sentinel node biopsy to assess the nodal burden
  • > in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery
  • this may lead to arm lymphedema and functional arm impairment

breast

  1. wide local excision
    - solitary lesion
    - peripheral tumour
    - small lesion in large breast
    - DCIS <4cm
  2. mastectomy
    - multifocal tumour
    - central tumour
    - large lesion in small breast
    - DCIS > 4cm

axilla

  • sentinel LN biopsy/sample
  • axillary dissection/clearance
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16
Q

Radiotherapy

A
  • > after Wide Local Excision (WLE)
  • to chest wall after mastectomy - T3/T4 tumours + four or more positive axillary nodes

SEs
acute
- skin reaction
- fatigue, chest wall pain

chronic

  • fibrosis
  • atrophy
  • telangiectasia
  • angiosarcoma
17
Q

Mx Hormone therapy

A

offered if tumours are positive for hormone receptors

Oestrogen antagonists

  • tamoxifen more premenopausal
  • mixed agonist/antagonist at ER
  • pre-menopausal and postmenopausal
  • increased risk of DVT
  • increased incidence of endometrial Ca
  • bone protective
  • hot clushes, weight gain, fatigue

Aromatose inhibitors used in post menopausal women if given in premenoposul suppress ovaries give olodex
- anastrozole/letrozole/exemestane
- blocks enzyme aromatase
- prevents oestrogne production in post menopausal women
- can only be used following menopause
- less risk of DVT
- increased risk of osteoporosis - bisphosphonates
- joint ache/bone thinning
we cant give aromatose unless we stop ovaries from working
pathologoical fractures

BOTH causes hot flushes and swelling

18
Q

Prognosis of breast cancer

what scale predicts recurrence

A

NPI cancer size x 0.2 + grade (1-3) + node stage (1-3)
10 year survival

oncotype DX

19
Q

what is paget’s disease

A

eczematoid change of the nipple associated with an underlying breast malignancy

bone disrupts the normal cycle of bone renewal, causing bones to become weakened and possibly deformed.

Sx

  • constant, dull bone pain
  • joint pain, stiffness and swelling
  • a shooting pain that travels along or across the body, numbness and tingling, or loss of movement in part of the body

Mx

  • bisphosphonates - help bone regeneration
  • painkillers
  • supportive therapies - PT, OT
  • surgery

complications

  • broken bones -> sudden severe pain, swelling or tenderness, bleeding
  • bone deformities
  • hearing loss
  • Sx of hypercalcaemia
  • heart failure
20
Q

what is adjuvant chemo

A

after another definitive treatment, such as surgery or radiotherapy to improve survival of the patient and reduce the risk of recurrence of the cancer.

given before another treatment such as surgery, aiming to shrink the cancer and kill micro-metastases (small areas of cancer cells). This would be used in breast cancer to try and shrink a larger tumour and mean a patient could have breast conserving surgery (wide local excision) instead of a mastectomy.

aim to decrease symptoms, increase survival of the patient and improve QoL

21
Q

what FH RFs will be needed to be referred

A

age of diagnosis < 40 years
bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in a relative younger than age 45 years
glioma or childhood adrenal cortical carcinomas
complicated patterns of multiple cancers at a young age
paternal history of breast cancer (two or more relatives on the father’s side of the family)

22
Q

when will one be referred via 2 weeks pathway

A
  • aged 30 and over and have an unexplained breast lump with or without pain or
  • aged 50 and over with any of the following symptoms in one nipple only:
    • discharge
    • retraction
    • other changes of concern.
23
Q

Biological Mx of

A

HER2 - positive - promotes the growth of cancer cells - Trastuzumab - monoclonal AB blocks HER2 - CARDIAC TOXIC - check left ventricular ejection
problem give ACEi and beta blocker
doesnt get to the brain

lymphangitis - SOB

24
Q

why neoadjuvant before

A

improves outcomes
shrink it
see if Mx works

CHEMO DRUG anthracyclines - cardiac toxicity - cardiomyopathy - peripheral neuropathy

common SEs
N/V
immunosuppression
fatigue
hair loss 
mucositis
allergic reactions
premature menopause 
infertility
25
Q

ER+VE HER2-ve go to brain

A

treatment

premenoapusal zoldex

HER2+VE chemo and herceptin

triple negative test for PDL1 predictor to immunotherapy

26
Q

immunotherapy SEs

A

colitis hepatits pneumonitis thyroid prob addison cushing

cancer (10 decks)

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