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Year Three - Reproductive System > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is breast cancer?

A

It is defined as the proliferation of malignant cells in the breast tissue

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2
Q

What is the most common cancer in women?

A

Breast Cancer

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3
Q

Describe the pathophysiology of breast cancer

A

BRCA-1/BRCA-2 are anti-oncogenes which code for tumour suppressor proteins, which reduce the risk of breast cancer

In breast cancer, there is mutations of these genes

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4
Q

What are the two classifications of breast cancer?

A

Non-Invasive Breast Cancer

Invasive Breast Cancer

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5
Q

What is another term for non-invasive breast cancer?

A

Premalignant breast cancer

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6
Q

What is non-invasive breast cancer?

A

It is defined as those in which the tumour cells have not invaded the basement membrane

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7
Q

What are the two subclassifications of non-invasive breast cancer?

A

Ductal Carcinoma In Situ (DCIS)

Lobular Carcinoma In Situ (LCIS)

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8
Q

What is ductal carcinoma in situ (DCIS)?

A

It is defined as non-invasive breast cancer which arises from the epithelial cells lining the ducts of the basement membrane

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9
Q

What is lobular carcinoma in situ (LCIS)?

A

It is defined as non-invasive breast cancer which arises from the epithelial cells inside the lobules of the basement membrane

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10
Q

What is invasive breast cancer?

A

It is defined as those in which the tumour cells have invaded the basement membrane

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11
Q

What are the two subclassifications of invasive breast cancer?

A

Invasive Ductal Carcinoma (IDC)

Invasive Lobular Carcinoma (ILC)

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12
Q

What is another term for invasive ductal carcinoma (IDC)?

A

No special type carcinoma

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13
Q

What is the most common classification of breast cancer?

A

Invasive Ductal Carcinoma (IDC)

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14
Q

What is invasive ductal carcinoma (IDC)?

A

It is defined as invasive breast cancer in which the cells have no particular features

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15
Q

What is another term for invasive lobular carcinoma (ILC)?

A

Special type carcinoma

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16
Q

What is invasive lobular carcinoma (ILC)?

A

It is defined as invasive breast cancer which arises from the epithelial cells inside the lobules of the basement membrane

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17
Q

What is a common subclassification of invasive lobular carcinomas?

A

Mucinous Carcinoma

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18
Q

What twelve risk factors are associated with breast cancer?

A

Older Age

Female Gender

Family History

Early Menarche

Late Menopause

Nulliparity

Delayed Childbirth > 30

Combined Hormone Replacement Therapy

Combined Oral Contraception

Chest Radiotherapy

Obesity

Alcoholism

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19
Q

Which three genetic mutations are associated with breast cancer?

A

BRCA-1

BRCA-2

p53

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20
Q

What is the most common gene associated with breast cancer?

A

BRCA-1

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21
Q

What is the inheritance of BRCA1/BRCA2 genetic mutations?

A

Autosomal Dominant

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22
Q

What is a protective factor of breast cancer?

A

Breastfeeding

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23
Q

What are the seven clinical features of breast cancer?

A

Painless Breast Lump

Nipple Discharge

Nipple Inversion

Nipple Deviation

Skin Dimpling

Skin Puckering

Peau D’orange

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24
Q

Describe the breast lumps associated with breast cancer

A

They have a hard gritty texture, ill-defined irregular margins and can be tethered to the surrounding breast tissue or fixed to the chest wall

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25
Q

In which quadrant does breast cancer most commonly occur in?

A

Upper outer quadrant

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26
Q

Describe the nipple discharge associated with breast cancer

A

It is unilateral and blood stained

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27
Q

What is peau D’orange?

A

It is defined as skin surface appearance similar to an orange

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28
Q

What six investigations are used to diagnose breast cancer?

A

Breast Cancer Screening

Triple Assessment

Ultrasound Scans

Mammogram Scans

Fine Needle Aspiration (FNA)

Core Biopsy

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29
Q

Who is offerred breast cancer screening?

A

Women between 50 – 70 years old

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30
Q

What does breast cancer screening involve?

A

A mammogram scan every three years

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31
Q

What is the most appropriate next step when breast screening results are abnormal?

A

Urgent 2 week triple assessment referral

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32
Q

What is the gold standard investigation used to diagnose breast cancer?

A

Triple Assessment

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33
Q

When is non-urgent referral for triple assessment recommended?

A

In individuals < 30 years old who present with an unexplained breast lump

34
Q

When is urgent two week referral for triple assessment recommended?

A

In individuals > 30 years old who have an unexplained breast lump

In individuals > 50 years old with unilateral nipple abnormalities

35
Q

What is triple assessment?

A

Breast History/Examination

Breast Imaging

Breast Biopsy

36
Q

When are ultrasound scans used to diagnose breast cancer?

A

In individuals who present with a breast lump under 40 years old

37
Q

Why are ultrasound scans recommended to diagnose breast cancer in < 40 year olds?

A

This is due to the fact that younger women tend to have denser breast tissue, which makes mammography less sensitive

38
Q

What is the feature of breast cancer on ultrasound scans?

A

Hyperechoic mass

39
Q

When are mammogram scans used to diagnose breast cancer?

A

In individuals who present with a breast lump over 40 years old

40
Q

What is the feature of breast cancer on mammogram scans?

A

Microcalcifications

41
Q

When is fine needle aspiration used to diagnose breast cancer?

A

It is used to biopsy smaller cystic breast lumps

42
Q

What is fine needle aspiration?

A

It involves use of a single fine needle to collect cells, enabling for cytology to examine isolated cells

43
Q

What are the three features of breast cancer on fine needle aspiration?

A

Enlarged Nucleus

Irregular Nuclear Contour

Hyperchromasia

44
Q

When is core biopsy used to diagnose breast cancer?

A

It is the gold standard investigation used to biopsy breast cancer

45
Q

What is core biopsy?

A

It involves use of a wide needle to sample a core of breast tissue

46
Q

What are the three features of breast cancer on core biopsy?

A

Enlarged Nucleus

Irregular Nuclear Contour

Hyperchromasia

47
Q

What is a histological feature of ductal carcinoma in situ?

A

Comedo Necrosis

48
Q

What is the histological feature of mucinous carcinoma?

A

Grey Gelatinous Surface

49
Q

What are the four surgical management options of breast cancer?

A

Wide Local Excision

Mastectomy

Sentinel Node Sampling

Axillary Node Clearance

50
Q

When is wide local excision used to manage breast cancer?

A

It is used to manage solitary, peripheral, small tumours which measure < 4cm in diameter

51
Q

What is wide local excision?

A

It involves removal of the breast cancer with a margin of healthy tissue

52
Q

What is the most appropriate next step when wide local excision fails to resect a healthy margin?

A

Ispislateral chest wall and regional lymph node radiotherapy

53
Q

When is mastectomy used to manage breast cancer?

A

It is used to manage multifocal, central, large tumours which measure > 4cm in diameter

54
Q

What is mastectomy?

A

It involves removal of the entire breast and overlying skin

55
Q

What is the most appropriate management step in women with no palpable axillary lympadenopathy at presentation?

A

A pre-operative axillary ultrasound should be conducted before their primary surgery

56
Q

When is sentinel node sampling used to manage breast cancer?

A

It is used to manage breast cancers which have a positive axillary ultrasound result, in order to identify lymphatic involvement

57
Q

What is sentinel node sampling?

A

It involves injection of local lymph nodes with radioactive technetium into the nipple on the affected side before surgery

The technetium travels up the lymphatic vessels to the first lymph node, known as the sentinel lymph node, in order to enable identification and thus surgical removal

It is sent for lab analysis

58
Q

What is indicated when sentinel node sampling results are positive?

A

Axillary node clearance

59
Q

When is axillary node clearance used to manage breast cancer?

A

In women with palpable axillary lympadenopathy at presentation

In women with a positive sentinel node sample result

60
Q

What is axillary node clearance?

A

It involves removal of all the lymph nodes within the axilla

61
Q

What are the two risks associated with axillary node clearance?

A

Arm Lymphoedema

Functional Arm Impairment

62
Q

What should be offerred when individuals decline axillary node clearance?

A

Axillary node radiotherapy

63
Q

What are the three pharmacological management options of breast cancer?

A

Antioestrogens

Aromatase Inhibitors

Monoclonal Antibodies

64
Q

When are antioestrogens used to manage breast cancer?

A

They are used to manage oestrogen positive breast cancer in premenopausal/perimenopausal women

65
Q

How are antioestrogens used to manage breast cancer?

A

They block oestrogen receptors - in oestrogen positive breast cancer

66
Q

Name an antioestrogen used to manage breast cancer

A

Tamoxifen

67
Q

What are the three side effects of tamoxifen?

A

Endometrial Cancer

Venous Thromboembolism

Menopausal Features

68
Q

When are aromatase inhibitors used to manage breast cancer?

A

They are used to manage oestrogen positive breast cancer in postmenopausal women – which may be administered in combination with surgical management or solely in those that elderly women who decline operative treatment

69
Q

How are aromatase inhibitors used to manage breast cancer?

A

They are used to block aromatase enzyme, which converts androgens into oestrogen - in oestrogen positive breast cancer

70
Q

Name three aromatase inhibitors used to manage breast cancer

A

Letrozole

Anastrozole

Exemestane

71
Q

What are the four side effects associated with aromatase inhibitors?

A

Osteoporosis

Arthralgia

Hot Flushes

Insomnia

72
Q

When are monoclonal antibodies used to manage breast cancer?

A

They are used to manage Her2 positive breast cancers

73
Q

Name a monoclonal antibody used to manage breast cancer

A

Trastuzumab (Herceptin)

74
Q

What investigation is conducted prior to trastuzumab administration?

A

ECHO Scan

75
Q

What is a side effect of trastuzumab?

A

Cardiac toxicity

76
Q

What is a contraindication of trastuzumab?

A

Cardiovascular disease

77
Q

When is chemotherapy used to manage breast cancer?

A

It can be administered neoadjuvantly in order to downstage the primary lesion

OR

It can be administered adjuvantly when there is axillary node disease in order to reduce the recurrence risk

78
Q

What is a side effect of chemotherapy in premenopausal women? How do we prevent this?

A

Premature ovarian failure

GnRH agonists

79
Q

Do we conduct whole or partial radiotherapy when managing breast cancer?

A

Whole breast radiotherapy

80
Q

When is radiotherapy used to manage breast cancer?

A

Invasive breast cancer following wide local excision surgery

Invasive breast cancer following mastectomy with T3-T4 tumours

Invasive breast cancer with four or more positive axillary lymph nodes

Year Three - Reproductive System (52 decks)

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