breast cancer Flashcards
Where do breast cancers arise?
The epithelial lining of ducts and are called ductal.
The epithelium of the terminal ducts of the lobules and are called lobular
What is the most common type of breast cancer?
Infiltrating ductal carcinoma
What are risk factors for developing cancer?
- Age (over 50)
- Family history
- BRCA1 and BRCA2 mutation
- Never having borne a child, or having a first child after the age of 30 years.
- Not having breastfed (breastfeeding is protective).
- Early menarche and late menopause.
- Radiation to the chest
- Obesity
- HRT with oestrogen and progestogen
What is the presentation of someone with breast cancer?
Lump, with or without pain
Other presenting symptoms include nipple change, nipple discharge and skin contour changes
Cutaneous changes: erythema, peau d’orange, nipple ulcer and eczema
When, in breast cancer, would you see bloody discharge from the nipple?
Intraduct carcinoma may present as a bloody discharge from the nipple
Where does breast cancer easily spread to?
Liver, lung, brain, bone
When would you refer people with suspected breast cancer?
Using a suspected cancer pathway referral (for an appointment within two weeks), for breast cancer if they are aged 30 and over and have an unexplained breast lump with or without pain, or are aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or any other changes of concern.
What investigations would you do for breast cancer suspicion?
- Oestrogen and progesterone receptor status.
- Epidermal growth factors including, for example, human epidermal growth factor receptor 2 (HER2) status.
- Routine blood tests including LFTs.
- CXR
What does triple negative mean in breast cancer?
Triple-negativebreast tumors don’t have too much HER2 and also don’t haveestrogen or progesterone receptors. They are HER2-, ER-, and PR-negative. Hormone therapy and drugs that target HER2 are not helpful in treating these cancers
Triple-positivebreast tumorsare HER2-, ER-, and PR-positive. These cancers are treated with hormone drugs as well as drugs that target HER2.
How would you diagnose breast cancer?
- Bilateral mammography
- Ultrasound
- Core needle biopsy and cytology
How would you assess advanced breast cancer?
Combination of plain radiography, ultrasound, CT and MRI to assess presence and extent of visceral metastases.
Bone windows on CT, MRI or bone scintigraphy to assess presence and extent of metastases in the bones of the axial skeleton.
How would you manage breast cancer?
- Surgery (The choice is dictated by the location and extent of the breast mass in relation to the breast size and patient preferences; excellent prognosis)
- Local treatment (given to the conserved breast after wide local excision to reduce local recurrence)
- Endocrine treatment:
Oestrogen and progesterone receptors are expressed in one-third of all breast cancer patients and promote growth. Endocrine treatment targeted at decreasing hormone secretion or conversion increases 10-year survival
What are indications for breast cancer adjuvant radiotherapy after surgery?
- Breast-conserving surgery
- Large high-grade primary tumour
- Proximity to surgical margins
- > 2 Lymph node metastases.
What factors play into the decision for specific breast cancer therapies?
Factors influencing treatment decisions:
- Type
- Tumour size
- Diffuse, multifocality, multicentricity
- Biology
- Stage
- Patient choice
- Patient age
- Co-morbidity
What treatment is often given in advanced breast cancer?
For the majority of patients with oestrogen-receptor-positive advanced breast cancer, endocrine therapy is recommended as first-line treatment:
- Aromatase inhibitors for postmenopausal
- Tamoxifen for premenopausal
What is the prognosis for breast cancer?
- 8% survive breast cancer for at least one year.
- 0% survive for five years or more.
- 9% are predicted to survive their disease for ten years or more.
What are the treatment optinos for Ductal Carcinoma in Situ (DCIS)?
- Wide excision with/wo radiotherapy
- Wide excision with/wo tamoxifen
- Wide excision + radiotherapy + tamofixen
- Mastectomy with or without breast reconstruction
What are the treatment options for Locally advanced (LABC) and inflammatory BC (IBC)?
- Systemic treatment followed by surgery
- Followed by radiotherapy
- Sentinel lymph node biopsy contraindicated in IBC!
How would you manage stage 4 disease?
Palliative
What are the risk of axillary node clearance?
Damaging nerves and limiting shoulder movement
Lymphoedema
What is HER2 and how is it implicated in breast cancer?
HER2 is a growth-promoting protein on the outside of all breast cells.
Breast cancer cells with higher than normal levels of HER2 are calledHER2-positive. These cancers tend to grow and spread faster than other breast cancers
What oncological risks does a BRCA1 mutation carry?
- Risk 40-85% of breast cancer
- Second primary breast cancer risk up to 60%
- Ovarian cancer risk up tot 50%
- Prostate cancer → minimal increase
What oncological risks does a BRCA2 mutation carry?
- Breast cancer 60-85%
- Second primary breast cancer up to 60%
- Ovarian cancer risk up to 30%
- Pancreatic cancer 3%
- Male breast cancer 6%
- Prostate cancer 14% by age of 80
- Minimal increased risk for gastric, thyroid, gall bladder cancers and lymphomas
What oncological risks does a TP53 mutation carry?
- Breast cancer risk 80-90%
- High risk of sarcoma, childhood leukaemia
- Adrenal cancer
- Li-Fraumeni syndrome
