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Peri-op > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

List 4 risk factors for breast cancer

A
  1. Female
  2. Earlier menarche, late menopause
  3. Family history (first-degree relatives)
  4. COCP
  5. HRT

+ More dense breast tissue, obesity, smoking

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2
Q

BRCA 1 and 2 are what type of genes?

A

Tumour suppressor genes

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3
Q

What chromosome is BRCA 1 vs 2 located on?

A
  1. BRCA1 gene is on chromosome 17
  2. BRCA2 gene is on chromosome 13
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4
Q

What cancers are associated with BRCA 1?

A

Breast, Ovarian, Bowel and Prostate cancer

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5
Q

What cancers are associated with BRCA 2?

A

Breast and Ovarian cancer

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6
Q

List the various types of breast cancer

A
  1. Ductal Carcinoma In Situ (DCIS)
  2. Lobular Carcinoma In Situ (LCIS)
  3. Invasive Ductal Carcinoma – NST
  4. Invasive Lobular Carcinomas (ILC)
  5. Inflammatory Breast Cancer
  6. Paget’s Disease of the Nipple
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7
Q

What is DCIS?

A

Pre-cancerous or cancerous epithelial cells of the breast ducts which are localised to a single area

Often picked up by mammogram screening

Potential to become invasive (30%)

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8
Q

Prognosis of DCIS?

A

Good if full excised and adjuvant treatment is used

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9
Q

What is LCIS

A

Pre-cancerous condition which typically occurs in pre-menopausal women (↑ risk of invasive breast cancer ~30%)

Asymptomatic and undetectable on a mammogram → usually incidental diagnosis on biopsy

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10
Q

Management of Lobular Carcinoma In Situ (LCIS)?

A

Close monitoring eg. 6 monthly examination and yearly mammograms

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11
Q

What is a Invasive Ductal Carcinoma – NST

A
  • Originate in cells from the breast ducts
  • Includes 80% of invasive breast cancers
  • Can be seen on mammograms
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12
Q

What is an Invasive Lobular Carcinomas (ILC)?

A
  • Originate in cells from the breast lobules
  • Around 10% of invasive breast cancers
  • Not always visible on mammograms
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13
Q

What is Inflammatory Breast Cancer?

A
  • 1-3% of breast cancers
  • Presents as a swollen, warm, tender breast with pitting skin (peau d’orange)
  • Does not respond to antibiotics
  • Worse prognosis than other breast cancers
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14
Q

What is Paget’s Disease of the Nipple?

A
  • Presents as an Erythematous, scaly rash around the nipple (looks like eczema)
  • May represent DCIS or invasive breast cancer
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15
Q

List 4 Rarer Types of Breast Cancer

A
  1. Medullary breast cancer
  2. Mucinous breast cancer
  3. Tubular breast cancer
  4. Multiple others
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16
Q

Breast cancer screening?

A

Mammogram every 3 years to women aged 50 – 70 years

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17
Q

List 4 downsides of breast cancer screening?

A
  1. Anxiety and stress
  2. Exposure to radiation, with a very small risk of causing breast cancer
  3. Missing cancer, leading to false reassurance
  4. Unnecessary further tests or treatment where findings would not have otherwise caused harm
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18
Q

Screening recommendations for high risk patients

A

High risk patients: strong family history, BRCA mutation, previous radiotherapy treatment for lymphoma

Annual MRI offered from age 30

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19
Q

List 2 examples of a significant family history which may warrant genetic testing

A
  • First-degree relative with breast cancer < 40 years
  • First-degree male relative with breast cancer
  • First-degree relative with bilateral breast cancer, diagnosed < 50 years
  • Two first-degree relatives with breast cancer
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20
Q

List 2 things which must be done before performing genetic tests

A

Genetic counselling and pre-test counselling to discuss the benefits and drawbacks ie. implications for family members and offspring

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21
Q

List 2 examples of chemoprevetion which may be offered for women at high risk

A
  • Tamoxifen if premenopausal
  • Anastrozole if postmenopausal (except if severe osteoporosis)
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22
Q

List 2 preventative options for women at a high risk of breast cancer

A

Chemoprevetion:

  • Tamoxifen if premenopausal
  • Anastrozole if postmenopausal (except if severe osteoporosis)

Surgery (suitable for only a small number of women):

  • Risk-reducing bilateral mastectomy
  • bilateral oophorectomy
23
Q

How may breast cancer present?

A
  • Hard, irregular, painless or fixed lump
  • Lumps may be tethered to the skin or the chest wall
  • Nipple retraction
  • Skin dimpling or oedema (peau d’orange)
  • Lymphadenopathy, particularly in the axilla
24
Q

NICE 2 week wait referral criteria for suspected breast cancer?

A
  • Unexplained breast lump in patients ≥ 30
  • Unilateral nipple changes in patients aged ≥ 50 (discharge, retraction or other changes)
25
Q

Non urgent referral for suspected breast cancer?

A

unexplained breast lumps in patients < 30 years

26
Q

What is the Triple Diagnostic Assessment once reffered?

A
  • Clinical assessment (history and examination)
  • Imaging (USS or mammography)
  • Biopsy (Core biopsy)
27
Q

What imaging is recommended to who in the triple assessment and why?

A

USS scans < 30 because younger women have more dense breasts with more glandular tissue (↓ mammogram sensitivity)

Mammograms in older women

28
Q

How is lymph node involvement assessed in women diagnosed with breast cancer?

A

USS of the axilla and ultrasound-guided biopsy of any abnormal nodes

Sentinel lymph node biopsy may be used during surgery where the initial ultrasound does not show anyone abnormal nodes

29
Q

List the 3 types of breast cancer receptors

A
  1. Oestrogen receptors (ER)
  2. Progesterone receptors (PR)
  3. Human epidermal growth factor (HER2)
30
Q

What is triple negative breast cancer?

A

Breast cancer does NOT express ER, PR or HER2 receptors

Worse prognosis and treatment limitations

31
Q

What is Gene expression profiling?

A

Assessing which genes are present on histology

Helps predict the probability that the breast cancer will reoccur as a distal metastasis within 10 years

32
Q

When is Gene expression profiling recommended by NICE?

A

For women with early breast cancers that are ER+ but HER2 and lymph node negative

Helps guide whether to give additional chemotherapy

33
Q

List the 4 common locations of breast cancer metastasis

(2L’s, 2B’s)

A
  • Lungs
  • Liver
  • Bones
  • Brain
34
Q

Investigations required for staging breast cancer steps

A
  1. Triple assessment
  2. Lymph node assessment and biopsy
  3. MRI of the breast and axilla
  4. Investigate for metastasis
35
Q

List 3 investigations to check for specific breast metastases

A
  1. Liver USS for liver mets
  2. CT TAP for thorax, abdo or pelvic mets
  3. Isotope bone scan for bony mets
36
Q

What staging system is used in breast cancer?

A

TNM system

37
Q

Surgical options for breast cancer

A
  • Wide local excision + radiotherapy (breast conserving)
  • Mastectomy + immediate or delayed breast reconstruction

+/- Axillary Clearance if required

38
Q

What is Chronic Lymphoedema?

A

Caused by impaired lymphatic drainage of an area. May occur in an entire arm after axillary node clearance

Areas of lymphoedema are prone to infection

39
Q

List 4 potential management options for chronic lymphoedema

A
  • Massage techniques
  • Compression bandages
  • Specific lymphoedema exercises to improve drainage
  • Weight loss if overweight
  • Good skin care
40
Q

What MUST be avoided in patients who have had breast cancer surgery?

A

Avoid taking blood or putting a cannula in the arm on the side of the surgery

41
Q

What adjuvant therapy may be used alongside breast removal surgery?

A

Radiotherapy

Course after surgery and sessions every day for 3 weeks

42
Q

List 4 side effects of Radiotherapy

A
  • General fatigue
  • Local skin and tissue irritation and swelling
  • Fibrosis of breast tissue
  • Shrinking of breast tissue
  • Long term skin colour changes (usually darker)
43
Q

What are the 3 used of chemotherapy in breast cancer?

A
  1. Neoadjuvant therapy – shrink tumour before surgery
  2. Adjuvant chemotherapy – after surgery to reduce recurrence
  3. Treatment of metastatic or recurrent breast cancer
44
Q

Hormone treatment for ER+ breast cancer?

A

Tamoxifen for premenopausal women

Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole)

45
Q

What is Tamoxofen?

List one potential benefit and risk

A

SERM - blocks oestrogen receptors in breast tissue, and stimulates oestrogen receptors in the uterus and bones

  • Benefit: helps prevent osteoporosis
  • Risk: increase risk of endometrial cancer
46
Q

What is letrozole or anastrozole?

A

Aromatase inhibitors

  • Aromatase (found in adipose tissue) converts androgens to oestrogen.
  • After menopause, action of aromatase in fat is the primary source of oestrogen
  • Letrozole and anastrozole block this
47
Q

How long are Tamoxifen or an aromatase inhibitors given for in ER+ breast cancer?

A

5 – 10 years

48
Q

List 2 other options for ER+ breast cancer

A
  1. Fulvestrant (selective oestrogen receptor downregulator)
  2. GnRH agonists (e.g., goserelin or leuprorelin)
  3. Ovarian surgery
49
Q

List 3 Targeted Treatments which may be used in women with HER 2 + Breast Cancer

A

Herceptin - monoclonal antibody (requires close monitoring of heart function)

Perjeta - monoclonal antibody used in combination with Herceptin

Nerlynx- tyrosine kinase inhibitor, ↓ growth of breast cancers

49
Q

Breast cancer treatment follow up?

A

Surveillance mammograms yearly for 5 years

(longer if not yet old enough for the regular screening programme).

50
Q

Who is offered reconstructive surgery?

When does this take place?

A

Offered to all patients having a mastectomy may be Immediate or Delayed reconstruction

51
Q

Reconstructive surgical options following breast-conserving surgery?

A

May not be needed. Options include:

  • Partial reconstruction (flap or fat tissue to fill the gap)
  • Reduction and reshaping
52
Q

Reconstructive surgical options following mastectomy?

A
  • Breast implants
  • Flap reconstruction (using tissue from another part of the body)
53
Q

List 3 types of Flaps which may be used in a partial reconstruction

A
  1. Latissimus Dorsi Flap
  2. Transverse Rectus Abdominis Flap (TRAM Flap)
  3. Deep Inferior Epigastric Perforator Flap (DIEP Flap)

Peri-op (22 decks)

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