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6. Cancer > breast cancer > Flashcards

breast cancer Flashcards

1
Q

Where do breast cancers arise?

A

The epithelial lining of ducts and are called ductal.

The epithelium of the terminal ducts of the lobules and are called lobular

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2
Q

What is the most common type of breast cancer?

A

Infiltrating ductal carcinoma

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3
Q

What are risk factors for developing cancer?

A
  1. Age (over 50)
  2. Family history
  3. BRCA1 and BRCA2 mutation
  4. Never having borne a child, or having a first child after the age of 30 years.
  5. Not having breastfed (breastfeeding is protective).
  6. Early menarche and late menopause.
  7. Radiation to the chest
  8. Obesity
  9. HRT with oestrogen and progestogen
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4
Q

What is the presentation of someone with breast cancer?

A

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

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5
Q

When, in breast cancer, would you see bloody discharge from the nipple?

A

Intraduct carcinoma may present as a bloody discharge from the nipple

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6
Q

Where does breast cancer easily spread to?

A

Liver, lung, brain, bone

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7
Q

When would you refer people with suspected breast cancer?

A

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.

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8
Q

What investigations would you do for breast cancer suspicion?

A
  1. Oestrogen and progesterone receptor status.
  2. Epidermal growth factors including, for example, human epidermal growth factor receptor 2 (HER2) status.
  3. Routine blood tests including LFTs.
  4. CXR
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9
Q

What does triple negative mean in breast cancer?

A

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.

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10
Q

How would you diagnose breast cancer?

A
  1. Bilateral mammography
  2. Ultrasound
  3. Core needle biopsy and cytology
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11
Q

How would you assess advanced breast cancer?

A

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.

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12
Q

How would you manage breast cancer?

A
  1. 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)
  2. Local treatment (given to the conserved breast after wide local excision to reduce local recurrence)
  3. 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
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13
Q

What are indications for breast cancer adjuvant radiotherapy after surgery?

A
  1. Breast-conserving surgery
  2. Large high-grade primary tumour
  3. Proximity to surgical margins
  4. > 2 Lymph node metastases.
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14
Q

What factors play into the decision for specific breast cancer therapies?

A

Factors influencing treatment decisions:

  1. Type
  2. Tumour size
  3. Diffuse, multifocality, multicentricity
  4. Biology
  5. Stage
  6. Patient choice
  7. Patient age
  8. Co-morbidity
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15
Q

What treatment is often given in advanced breast cancer?

A

For the majority of patients with oestrogen-receptor-positive advanced breast cancer, endocrine therapy is recommended as first-line treatment:

  1. Aromatase inhibitors for postmenopausal
  2. Tamoxifen for premenopausal
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16
Q

What is the prognosis for breast cancer?

A
  1. 8% survive breast cancer for at least one year.
  2. 0% survive for five years or more.
  3. 9% are predicted to survive their disease for ten years or more.
17
Q

What are the treatment optinos for Ductal Carcinoma in Situ (DCIS)?

A
  1. Wide excision with/wo radiotherapy
  2. Wide excision with/wo tamoxifen
  3. Wide excision + radiotherapy + tamofixen
  4. Mastectomy with or without breast reconstruction
18
Q

What are the treatment options for Locally advanced (LABC) and inflammatory BC (IBC)?

A
  • Systemic treatment followed by surgery
  • Followed by radiotherapy
  • Sentinel lymph node biopsy contraindicated in IBC!
19
Q

How would you manage stage 4 disease?

A

Palliative

20
Q

What are the risk of axillary node clearance?

A

Damaging nerves and limiting shoulder movement

Lymphoedema

21
Q

What is HER2 and how is it implicated in breast cancer?

A

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

22
Q

What oncological risks does a BRCA1 mutation carry?

A
  • Risk 40-85% of breast cancer
  • Second primary breast cancer risk up to 60%
  • Ovarian cancer risk up tot 50%
  • Prostate cancer → minimal increase
23
Q

What oncological risks does a BRCA2 mutation carry?

A
  • 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
24
Q

What oncological risks does a TP53 mutation carry?

A
  • Breast cancer risk 80-90%
  • High risk of sarcoma, childhood leukaemia
  • Adrenal cancer
  • Li-Fraumeni syndrome
25
Q

How effective is a prophylactic mastectomy?

A

Efficacy of prophylactic mastectomy → over 90% risk reduction

26
Q

A 45 year old woman has pruritus, night sweats and a right supraclavicular fossa mass.

Which is the most likely malignancy?

A) Breast cancer
B) Gastric cancer
C) Lung cancer
D) Lymphoma
E) Melanoma
A

D - Lymphoma commonly causes night sweats, as does leukemia, as well as the pruritis.

27
Q

A 52 year old woman has a small breast lump for which she has a lumpectomy, following triple assessment. A sentinel lymph node biopsy is carried out during the lumpectomy.

What is the purpose of sentinel lymph node biopsy?

A) A staging procedure
B) Assessment of immune response to tumour
C) Assessment of response to neoadjuvant therapy
D) Local control of cancer spread
E) Provides material for her2 testing

A

A - A staging procedure, sentinel node biopsies are used in breast cancer and melanoma most commonly, and determine if the cancer has spread to the lymphatic system.

28
Q

A 29 year old woman has a red, hard left breast. She has had 4 weeks of treatment with flucloxacillin and erythromycin for suspected mastitis, with no effect.

Which is the most appropriate action?

A) Arrange emergency admission
B) Arrange fast track breast clinic appointment
C) Arrange ultrasound scan of breast
D) Change antibiotics to cover MRSA
E) Express pus from the nipple and send for culture

A

B – arrange fast track breast clinic appointment: patient has inflammatory breast cancer until proven otherwise, usually presents as ?mastitis. ABX didn’t work so needs work up for exclusion on BC.

29
Q

What are symptoms of inflammatory breast cancer?

A

Rapid change in the appearance of one breast, over the course of several weeks
Thickness, heaviness or visible enlargement of one breast
Discoloration, giving the breast a red, purple, pink or bruised appearance
Unusual warmth of the affected breast
Dimpling or ridges on the skin of the affected breast, similar to an orange peel
Tenderness, pain or aching
Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
Flattening or turning inward of the nipple

6. Cancer (15 decks)

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