Breast Cancer Flashcards
What is breast cancer?
It is defined as the proliferation of malignant cells in the breast tissue
What is the most common cancer in women?
Breast Cancer
Describe the pathophysiology of breast cancer
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
What are the two classifications of breast cancer?
Non-Invasive Breast Cancer
Invasive Breast Cancer
What is another term for non-invasive breast cancer?
Premalignant breast cancer
What is non-invasive breast cancer?
It is defined as those in which the tumour cells have not invaded the basement membrane
What are the two subclassifications of non-invasive breast cancer?
Ductal Carcinoma In Situ (DCIS)
Lobular Carcinoma In Situ (LCIS)
What is ductal carcinoma in situ (DCIS)?
It is defined as non-invasive breast cancer which arises from the epithelial cells lining the ducts of the basement membrane
What is lobular carcinoma in situ (LCIS)?
It is defined as non-invasive breast cancer which arises from the epithelial cells inside the lobules of the basement membrane
What is invasive breast cancer?
It is defined as those in which the tumour cells have invaded the basement membrane
What are the two subclassifications of invasive breast cancer?
Invasive Ductal Carcinoma (IDC)
Invasive Lobular Carcinoma (ILC)
What is another term for invasive ductal carcinoma (IDC)?
No special type carcinoma
What is the most common classification of breast cancer?
Invasive Ductal Carcinoma (IDC)
What is invasive ductal carcinoma (IDC)?
It is defined as invasive breast cancer in which the cells have no particular features
What is another term for invasive lobular carcinoma (ILC)?
Special type carcinoma
What is invasive lobular carcinoma (ILC)?
It is defined as invasive breast cancer which arises from the epithelial cells inside the lobules of the basement membrane
What is a common subclassification of invasive lobular carcinomas?
Mucinous Carcinoma
What twelve risk factors are associated with breast cancer?
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
Which three genetic mutations are associated with breast cancer?
BRCA-1
BRCA-2
p53
What is the most common gene associated with breast cancer?
BRCA-1
What is the inheritance of BRCA1/BRCA2 genetic mutations?
Autosomal Dominant
What is a protective factor of breast cancer?
Breastfeeding
What are the seven clinical features of breast cancer?
Painless Breast Lump
Nipple Discharge
Nipple Inversion
Nipple Deviation
Skin Dimpling
Skin Puckering
Peau D’orange
Describe the breast lumps associated with breast cancer
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
In which quadrant does breast cancer most commonly occur in?
Upper outer quadrant
Describe the nipple discharge associated with breast cancer
It is unilateral and blood stained
What is peau D’orange?
It is defined as skin surface appearance similar to an orange
What six investigations are used to diagnose breast cancer?
Breast Cancer Screening
Triple Assessment
Ultrasound Scans
Mammogram Scans
Fine Needle Aspiration (FNA)
Core Biopsy
Who is offerred breast cancer screening?
Women between 50 – 70 years old
What does breast cancer screening involve?
A mammogram scan every three years
What is the most appropriate next step when breast screening results are abnormal?
Urgent 2 week triple assessment referral
What is the gold standard investigation used to diagnose breast cancer?
Triple Assessment
When is non-urgent referral for triple assessment recommended?
In individuals < 30 years old who present with an unexplained breast lump
When is urgent two week referral for triple assessment recommended?
In individuals > 30 years old who have an unexplained breast lump
In individuals > 50 years old with unilateral nipple abnormalities
What is triple assessment?
Breast History/Examination
Breast Imaging
Breast Biopsy
When are ultrasound scans used to diagnose breast cancer?
In individuals who present with a breast lump under 40 years old
Why are ultrasound scans recommended to diagnose breast cancer in < 40 year olds?
This is due to the fact that younger women tend to have denser breast tissue, which makes mammography less sensitive
What is the feature of breast cancer on ultrasound scans?
Hyperechoic mass
When are mammogram scans used to diagnose breast cancer?
In individuals who present with a breast lump over 40 years old
What is the feature of breast cancer on mammogram scans?
Microcalcifications
When is fine needle aspiration used to diagnose breast cancer?
It is used to biopsy smaller cystic breast lumps
What is fine needle aspiration?
It involves use of a single fine needle to collect cells, enabling for cytology to examine isolated cells
What are the three features of breast cancer on fine needle aspiration?
Enlarged Nucleus
Irregular Nuclear Contour
Hyperchromasia
When is core biopsy used to diagnose breast cancer?
It is the gold standard investigation used to biopsy breast cancer
What is core biopsy?
It involves use of a wide needle to sample a core of breast tissue
What are the three features of breast cancer on core biopsy?
Enlarged Nucleus
Irregular Nuclear Contour
Hyperchromasia
What is a histological feature of ductal carcinoma in situ?
Comedo Necrosis
What is the histological feature of mucinous carcinoma?
Grey Gelatinous Surface
What are the four surgical management options of breast cancer?
Wide Local Excision
Mastectomy
Sentinel Node Sampling
Axillary Node Clearance
When is wide local excision used to manage breast cancer?
It is used to manage solitary, peripheral, small tumours which measure < 4cm in diameter
What is wide local excision?
It involves removal of the breast cancer with a margin of healthy tissue
What is the most appropriate next step when wide local excision fails to resect a healthy margin?
Ispislateral chest wall and regional lymph node radiotherapy
When is mastectomy used to manage breast cancer?
It is used to manage multifocal, central, large tumours which measure > 4cm in diameter
What is mastectomy?
It involves removal of the entire breast and overlying skin
What is the most appropriate management step in women with no palpable axillary lympadenopathy at presentation?
A pre-operative axillary ultrasound should be conducted before their primary surgery
When is sentinel node sampling used to manage breast cancer?
It is used to manage breast cancers which have a positive axillary ultrasound result, in order to identify lymphatic involvement
What is sentinel node sampling?
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
What is indicated when sentinel node sampling results are positive?
Axillary node clearance
When is axillary node clearance used to manage breast cancer?
In women with palpable axillary lympadenopathy at presentation
In women with a positive sentinel node sample result
What is axillary node clearance?
It involves removal of all the lymph nodes within the axilla
What are the two risks associated with axillary node clearance?
Arm Lymphoedema
Functional Arm Impairment
What should be offerred when individuals decline axillary node clearance?
Axillary node radiotherapy
What are the three pharmacological management options of breast cancer?
Antioestrogens
Aromatase Inhibitors
Monoclonal Antibodies
When are antioestrogens used to manage breast cancer?
They are used to manage oestrogen positive breast cancer in premenopausal/perimenopausal women
How are antioestrogens used to manage breast cancer?
They block oestrogen receptors - in oestrogen positive breast cancer
Name an antioestrogen used to manage breast cancer
Tamoxifen
What are the three side effects of tamoxifen?
Endometrial Cancer
Venous Thromboembolism
Menopausal Features
When are aromatase inhibitors used to manage breast cancer?
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
How are aromatase inhibitors used to manage breast cancer?
They are used to block aromatase enzyme, which converts androgens into oestrogen - in oestrogen positive breast cancer
Name three aromatase inhibitors used to manage breast cancer
Letrozole
Anastrozole
Exemestane
What are the four side effects associated with aromatase inhibitors?
Osteoporosis
Arthralgia
Hot Flushes
Insomnia
When are monoclonal antibodies used to manage breast cancer?
They are used to manage Her2 positive breast cancers
Name a monoclonal antibody used to manage breast cancer
Trastuzumab (Herceptin)
What investigation is conducted prior to trastuzumab administration?
ECHO Scan
What is a side effect of trastuzumab?
Cardiac toxicity
What is a contraindication of trastuzumab?
Cardiovascular disease
When is chemotherapy used to manage breast cancer?
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
What is a side effect of chemotherapy in premenopausal women? How do we prevent this?
Premature ovarian failure
GnRH agonists
Do we conduct whole or partial radiotherapy when managing breast cancer?
Whole breast radiotherapy
When is radiotherapy used to manage breast cancer?
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
