Breast cancer Flashcards
What are the indications for performing mastectomy?
multifocal disease if mass can't be reduced by radiotherapy Size of mass BRCA1/2 gene If radiotherapy is contradindicated
Name three options for breast reconstructive surgery
- Latissimus dorsi flap
- Free flap (from epigastric perforator, same tissue for tummy tuck)
- Implants
Which nerves do surgeons need to avoid when performing breast surgery?
long thoracic nerve in axilla region (damage causes winged scapula) and thoracodorsal nerve
List three modes of diagnosing breast cancer
symptomatic
screening
surveillance (PMH, FH)
incidental
List five risk factors for breast cancer
smoking HRT oral contraceptives breastfeeding age FMH early menarche and late menopause
Why is tamoxifen termed modulator rather than antagonist?
it has antagonistic properties in the breast but agonistic properties in the endometrium, therefore small risk of endometrial cancer
What are the components of triple assessment?
history/exam
imaging: mammography/ultrasound
biopsy: excision/core biopsy
What is peau d’orange a sign of?
inflammatory breast cancer
List three nipple changes indicative of breast cancer
nipple inversion
nipple discharge
paget’s disease of the nipple- eczematous changes
How to describe breast lump?
site in breast (upper/outer quadrant) discrete lump or generalised lumpiness size in cm hard/soft, smooth/irregular mobile/fixed
What are the indications for mammography?
used for a new breast symptom over the age of 35, performed in both breasts
What are the indications for ultrasound of the breast?
to look at specific areas of clinical abnormality e.g. discrete lump. Distinguishes between cystic and solid lumps
What are the three methods of performing breast biopsy?
FNA- cytological diagnosis but difficult to get specimen
Core biopsy- histological diagnosis but takes time for result
Excision biopsy- requires surgery
What is the breast screening programme?
From 50, invited every 3 years until 71
How is breast cancer staged?
CXR
CT abdo/chest/pelvis
MRI scan
Bone scan
What are the two surgical approaches to treating breast cancer
- mastectomy +- breast reconstruction
2. wide local excision (breast conservation)
Aside from surgery, what are the other treatment options?
radiotherapy
chemotherapy
hormonal
monoclonal antibodies
What is the indication for tamoxifen?
oestrogen receptor positive patients (around 80%)
What is the MOA of herceptin/trastuzamab
Her-2 receptor blocker (growth factor) which are associated with higher risk of disease
What are the components of a triple negative breast cancer?
negative oestrogen, progesteron,e HER2 protein
What is the prognosis of triple negative breast cancers?
more aggressive and poorer prognosis
Name a breast pre-cancerous condition
DCIS/LCIS (in-situ)
Which is the most common breast cancer?
invasive ductal carcinoma
Name two sites of metastasis and state one associated symptom
Bones- bone pain
Lungs- dyspnoea, pleural effusion
Liver- abdo pain, hepatic impairment
Brain- headache, seizure
