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Y4 - Surgery - Breast > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

EPIDEMIOLOGY

Lifetime incidence

A

1 in 8 woman

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2
Q

EPIDEMIOLOGY

Ranks where in list of most common cancers

A

Most common cancer

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3
Q

AETIOLOGY

Risk factors

A
  • Female
  • Increased oestrogen exposure (earlier onset of periods and later menopause)
  • More dense breast tissue (more glandular tissue)
  • Obesity
  • Smoking
  • FH
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4
Q

AETIOLOGY

Common drugs that increase oestrogen exposure so increase risk

A
  • Combined contraceptive pill
  • Hormone replacement therapy
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5
Q

AETIOLOGY

Associated genes

A
  • BRCA1 gene
  • BRCA 2 gene
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6
Q

What are BRCA genes

A

Tumour suppresor genes, mutations in these leads to increased risk of breast cancers as well as ovarian and others

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7
Q

Where is BRCA1 and 2 genes located

A

1 - chromosome 17

2 - chromosome 13

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8
Q

EPIDEMIOLOGY

Lifetime prevalence of breast cancer in BRCA1 an 2 genes

A

1 - 70% by 80

2 - 60% by 80

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9
Q

EPIDEMIOLOGY

Lifetime prevalence of ovarian cancer in BRCA 1 and 2 genes

A

1 - 50% by 80

2 - 20% by 80

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10
Q

AETIOLOGY

Other than BRCA genes, what are other rarer mutations associated with breast cancer

A
  • TP53 and PTEN genes
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11
Q

Types of breast cancer

A
  • Ductal carinoma in situ
  • Lobular carcinoma in situ
  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Inflammatory breast cancer
  • Paget’s disease of nipple
  • Rarer
    • Medullary breast cancer
    • Mucinous breast cancer
    • Tubular breast cancer
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12
Q

CLINICAL FEATURES

Presentation

A
  • Lumps that are hard, irregular, painless or fixed in place
  • Lumps may be tethered to skin or chest wall
  • Nipple retraction
  • Skin dimpling or oedema
  • Lymphadenopathy, particularly in axilla
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13
Q

CLINICAL FEATURES

Referral criteria

A
  • 2 week wait referral for suspected breast cancer for
    • Unexplained breast lump in patients >30
    • Unilateral nipple changes in patients >50
    • Unexplained lump in axilla patients >30
    • Skin changes suggestive of breast cancer
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14
Q

INVESTIGATIONS

Primary investigations

A
  • Triple diagnostic assessment
    • Clinical assessment
    • Imaging (US or mammography)
    • Biopsy (fine needle or core)
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15
Q

INVESTIGATIONS

When is each different form of imaging used

A
  • US
    • Aged <30
    • Good to distinguish solid lumps from cystic lumps
  • Mammogram
    • More effective older woman
    • Pick up calcifications missed by US
  • MRI
    • Screening woman of higher risk
    • Further assess size and features of tumour
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16
Q

INVESTIGATIONS

Lymph node assessment

A
  • Diagnosis of breast cancer requires US of axilla and US guided biopsy of any abnormalities
  • Sentinel lymph node biopsy may be used during breast surgery when initial US shows no abnormalities
17
Q

3 type of breast cancer receptors

A
  • Oestrogen receptors (ER)
  • Progesterone receptors (PR)
  • Human epidermal growth factor (HER2)
18
Q

What is triple negative breast cancer

A

Cells carry none of the 3 usual receptors, worse prognosis as limits treatment options

19
Q

Where does breast cancer usually metastasise

A
  • Remember 2Ls and 2Bs
    • Lungs
    • Liver
    • Bones
    • Brain
20
Q

INVESTIGATIONS

What other investigations might be required to stage cancer after triple assessment

A
  • Lymph node assessment and biopsy
  • MRI of breast and axilla
  • Liver US - for metastasis
  • CT thorax, abdomen and pelvis - for metastasis
  • Isotope bone scan - for bony metastasis
21
Q

INVESTIGATIONS

What system is used to stage tumour

A

TNM system

22
Q

MANAGEMENT

Treatment options

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Hormone treatment
  • Targeted treatment
23
Q

MANAGEMENT

Surgical options

A
  • Tumour removal
    • Breast conserving surgery - usually with radiotherapy
    • Masectomy - usually with breast reconstruction
  • Axillary clearance
24
Q

What is possible consequence of axillary clearance with surgery

A

Chronic lymphoedema

25
Q

MANAGEMENT

Non-surgical options for chronic lymphoedema

A
  • Massage techniques to manually drain the lymphatic system
  • Compression bandages
  • Specific exercises to improve drainage
  • Weight loss
  • Good skin care
26
Q

MANAGEMENT

Common side effects of radiotherapy

A
  • Fatigue
  • Local skin and tissue irritation and swelling
  • Fibrosis of breast tissue
  • Shrinking of breast tissue
  • Long term skin colour changes
27
Q

MANAGEMENT

What are the 3 scenarios of chemotherapy being used

A
  • Neoadjuvant therapy
    • Intended to shrink tumour before surgery
  • Adjuvent surgery
    • Given after surgery to reduce recurrence
  • Treatment
    • Of metastatic or recurrent breast cancer
28
Q

MANAGEMENT

Who is hormone treatment given to

A

Patients with oestrogen-receptor positive breast cancer

29
Q

MANAGEMENT

First line hormonal treatment options

A
  • Tamoxifen for premenopausal
  • Aromatase inhibitors for postmenopausal
    • Such as letrozole, anastrozole or exemestane
30
Q

MANAGEMENT

Targeted treatment options

A
  • Trastuzumab
  • Pertuzumab
  • Neratinib
31
Q

MANAGEMENT

Follow up plan

A
  • Suveillance mammogram yearly for 5 years
  • Individual written care plan
32
Q

MANAGEMENT

2 options for reconstructive surgery

A
  • Immediate reconstruction (done at time of masectomy)
  • Delayed reconstruction
33
Q

MANAGEMENT

Options after breast conserving surgery

A
  • Partial reconstruction (using flap or fat tissue to fill gap)
  • Reducing and reshaping (removing tissue and reshaping both breasts to match)
34
Q

MANAGEMENT

Options for reconstruction after masectomy

A
  • Breast implants
  • Flap reconstruction
35
Q

What are different kinds of flaps used for reconstructive surgery

A
  • Latissimus dorsi flap
    • Reconstructed with portion of lat and associated skin and fat
  • Transverse rectus abdominus flap (TRAM flap)
  • Deep inferior epigastric perforator flap (DIEP)
    • Skin and subcutaneous fat from abdomen (no muscle), uses the deep inferior epigastric artery which is attached to internal mammary artery

Y4 - Surgery - Breast (5 decks)

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