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Exam - M - Reproduction System (Megan and Rachel) > breast cancer > Flashcards

breast cancer Flashcards

1
Q

what are the two types of breast cancer

A

invasive

non-invasive

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2
Q

what are the types of invasive carcinoma

A 
No special type (NST ) includes Invasive Ductal carcinoma 
Invasive Lobular carcinoma
special types (25%)
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3
Q

what are key features of ductal carcinoma

A

makes up 80% of invasive breast cancers

originates in breast duct cells

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4
Q

what are key features of lobular carcinoma

A

makes up 10% of invasive cancers

originates in breast lobule cells

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5
Q

what are some special types of invasive breast carcinomas

A

tubular
cribriform
mucinous

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6
Q

what are some special types of invasive breast carcinomas

A

tubular
cribriform
mucinous

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7
Q

what are features of ductal carcinoma in situ (DCIS)

A

pre-cancerous/cancerous cells of breast ducts
localised
good prognosis if fully excised + adjuvant treatment

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8
Q

what are features of lobular-carcinoma in situ (LCIS)

A 
pre-cancerous condition 
usually in pre-menopausal women 
usually asymptomatic 
mammograms are not effective for imaging LCIS - usually diagnosed incidentally on a breast biopsy
managed with close monitoring
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9
Q

what are features of inflammatory breast cancer

A

very poor prognosis
presents similarly to breast abscesses or mastitis
key feature: peu d’orange

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10
Q

what are key features of paget’s disease of the nipple

A

looks like eczema
erythematous scaly rash
indicated breast cancer involving the nipple

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11
Q

what are risk factors for breast cancer

A 
age (screening for 50-70yrs) 
early menarche and late menopause
BRCA1
BRCA2
family history 
HRT for 10+ years 
alcohol 
increased weight 
post radiotherapy for hogkin's
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12
Q

what are signs of breast cancer

A 
!usually painless!
lumps 
inverted nipple 
retracted nipple 
oedema 
skin dimpling 
mastalgia
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13
Q

what are the triple diagnostic assessments for suspected breast cancer

A

clinical - history + exam
imaging - mammograms, US
biopsy - FNA for cytology and core biopsy for pathology

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14
Q

when is a mammogram not indicated?

what is the alternative?

A

for lobular cancer - it is not as likely to show up
if breast tissue is denser (usually younger woman <40, pregnant, breast implants)
use MRI

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15
Q

what is the significance of HER2, PR, ER

A

HER2 is a human epidermal GF receptor so it promotes cell division, in breast cancer it is usually over expressed

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16
Q

what is the significance of PR and ER tumours

A

some breast cancers have progesterone or oestrogen receptors which makes them divide faster in the presence of the hormones

17
Q

what is the ‘T’ part of TNM staging in breast cancer

A 
Tx primary tumour cannot be assessed 
T0 primary tumour not palpable 
T1 clinically palpable, <2cm
T2 tumour 2-5cm
T3 tumour size >5 
T4a tumour invading skin 
T4b tumour invading chest wall 
T4c invading both 
T4d inflammatory
18
Q

what is the ‘N’ part of TNM staging in breast cancer

A

N0 no regional lymph nodes palpable
N1 palpable and mobile
N2 palpable and fixed

19
Q

what is the ‘M’ part of TNM staging in breast cancer

A

Mx distal metastases can not be assessed
M0 no distant metastasis
M1 distant metastasis

20
Q

what investigations are involved in TNM staging

A 
lymph node assessment and biopsy 
MRI 
liver US 
CT of thorax, abdomen, pelvis 
isotope bone scan
21
Q

what investigations are done for the sentinel lymph nodes

A

biopsy of sentinel node using isotope contrast with blue dye to find it
if it is cancerous remove it

22
Q

what is an NPI score

A

nottingham prognostic index

uses tumour grade, size, lymph node involvement to give a score

23
Q

what prognosis does an NPI score >3.4 give

A

> 3.4 is poorer prognosis, high risk of recurrence

<3.4 is lower risk

24
Q

what is the difference between adjuvant and neo-adjuvant therapy

A

adjuvant has treatment after surgery

neo-adjuvant is treatment before surgery

25
Q

who is given radiotherapy

A

used as adjuvant treatment for everyone who has had a wide local excision
given is there is significant lymph node involvement

26
Q

what are side effects of radiotherapy

A 
fatigue 
local skin and tissue irritation and swelling 
fibrosis of breast tissue 
shrinking of breast tissue 
skin colour changes 
telangiectasias 
angiosarcoma 
radiation pneumonitis 
osteonecrosis
27
Q

what are side effects of lymph node removal/breast surgery

A

chronic lymphoedema

28
Q

how is chemotherapy given

A

as neoadjuvant treatment to shrink the tumour before surgery

as adjuvant treatment after surgery to reduce recurrence

as treatment of metastatic or recurrent breast cancer

29
Q

who is hormone therapy for

A

for patients with ER breast cancer

disrupts stimulation of cancer cell growth

30
Q

what are the two main first line options for hormone therapy

A

tamoxifen for premenopausal women

aromatase inhibitors for post menopausal women (letrozole, arimidex)

31
Q

what are the two types of surgery

A

breast conservation using onco-plastic techniques

mastectomy

32
Q

when is chemo a good option

A

women <50
increased poor prognostic factors
ER negative
HER2 positive

33
Q

what is the follow up for breast cancer

A

clinical examination for 1-5 years
mammogram annually for 3-10 years
patient education so thy can check their own breasts

34
Q

what is the significance of PR and ER tumours

A

some breast cancers have progesterone or oestrogen receptors which makes them divide faster in the presence of the hormones

35
Q

what are side effects of lymph node removal/breast surgery

A

chronic lymphoedema

36
Q

what are side effects of lymph node removal/breast surgery

A

chronic lymphoedema

37
Q

What is the 1st lymph node breast cancer would spread to?

A

The sentinel lymph node

Exam - M - Reproduction System (Megan and Rachel) (45 decks)

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