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Repro > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Risk factors (8)

A 
age, 
age of menarche, 
age at first birth, 
parity, 
breastfeeding,
age at menopause,
hormones (endogenous/exogenous e.g. OCP, HRT), 
previous breast disease, 
FH
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2
Q

Presentation:
what percent asymptomatic picked up on screening?
what percent symptomatic and what percent of those with lump?

A

50% asymptomatic via screening,

50% symptomatic, 50% of those with a lump

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3
Q

Breast symptoms

A

solitary breast lump,
altered shape,
….

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4
Q

Red flag

A 
lump that feels diff, 
change in nipple appearance, 
rash around nipple, 
discharge from nipple (1/both),
change in skin texture e..g puckering, dimpling, peau d'orange, 
constant pain in breast/armpit,
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5
Q

Only 10% of symptomatic patients have malignant findings from biopsy. Approx. how many patients get biopsy who are symptomatic?

A

25%

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6
Q

What system is used for breast cancers staging?

A

TNM system

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7
Q

4 histological factors used to determine type of breast cancer?

A

invasive or not,
ductal or lobular,
degree of differentiation,
receptors status

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8
Q

One-stop diagnostic breast units decrease recurrence and improve survival. T/F?

A

True

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9
Q

Medical types of treatment

A

radiotherapy (local),
chemotherapy,
hormonal therapy,
target therapy

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10
Q

aim of chemo and hormonal

A

stop metastases by stopping circulation cells

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11
Q

Non-invasive hormonal

A

SERMS, (oestrogen
AIs, (eradicate aromatase - often for menopausal? )
GnRH

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12
Q

Invasive hormonla - but phased out

A

oophorectomy

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13
Q

Targeted therapies (2)

A

human epidermal growth factor receptor 2,

monoclonal antibody trastuzumad (Herceptin)

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14
Q

late or advanced disease ? treatment?

A

bone or soft tissue metastasis,

QOL & symptom control

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15
Q

When Phyllodes tumours are malignant, what type of tissue is the malignant part?

A

sarcomatous stromal part

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16
Q

When does angiosarcoma of the breast tend to occur?

A

post radiotherapy for breast cancer treatment

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17
Q

List the 3 most common metastatic breast carcinomas

A

bronchial,
ovarian serous carcinoma,
clear cell carcinoma of the kidney

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18
Q

In addition to carcinomas, give two other examples of metastatic breast tumours

A

malignant melanoma,

leiomyosarcoma

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19
Q

Breast carcinoma definition

A

A malignant tumour of breast epithelial cells

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20
Q

Where exactly in breast tissue does breast carcinoma arise?

A

in glandular epithelium of terminal duct lobular unit therefore is actually an adenocarcinoma

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21
Q

Pathophysiology of breast carcinoma is based on epithelial proliferations. List 4 types of ductal precursor lesions AKA intraductal proliferations

A

usual type epithelial hyperplasia (UTH),
columnar cell change (+/- atypia) (CCL),
atypical ductal hyperplasia (ADH),
ductal carcinoma in situ (DCIS)

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22
Q

Pathophysiology of breast carcinoma is based on epithelial proliferations. Lobular precursor lesions are lobular in situ neoplasia, list 2 types of this

A

atypical lobular hyperplasia (ALH),

lobular carcinoma in situ (LCIS)

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23
Q

Definition of in situ carcinoma, classification (2) and are they invasive/non-invase?

A

Carcinoma confided within basement membrane of acini and ducts,
2 types lobular and ductal,
is non-invasive

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24
Q

In situ Carcinomas are non-obligate precursors of invasive carcinomas. What does this mean?

A

they could become but do not usually become invasive

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25
Q

Difference between DCIS with microinvasion and invasive ductal cancer? How is DCIS with microinvasion treated?

A

DCIS with micro invasion is DCIS with invasion <1mm. Becomes invasive ductal when is >1mm.
DCIS with micro invasion is treated as high grade DCIS

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26
Q

Difference between ALH and LCIS?

A

ALH is when <50% of lobule involved,

LCIS is when >50% of lobule involved

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27
Q

Lobular in situ neoplasia is an intra-lobular proliferation of characteristic cells. What are 5 characteristics of these cells?

A 
small-intermediate sized nuclei, 
solid proliferation, 
intra-cytoplasmic vacuoles, 
ER positive, 
E-cadherin negative
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28
Q

Incidence of lobular in situ neoplasia is 0.5-4% in benign biopsies. It’s incidence increases/decreases after menopause. It is usually symptomatic/asymptomatic because is palpable/not palpable.

A

incidence decreases after menopause,
is usually asymptomatic and so incidental finding,
not palpable

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29
Q

What does it mean in terms of investigation & treatment that lobular in situ neoplasia is often multifocal and bilateral?

A

1/5 of cases have higher grade on open diagnostic biopsy than on core biopsy. It often not worth surgery on because is in both breasts and is extensive

30
Q

Having lobular in situ carcinoma increases relative risk of invasive carcinoma by 8 times as it is a true precursor lesion. What are the individual risks of developing subsequent invasive carcinomas in 10-15yrs in ALH, ALH + FH and LCIS +/- FH?

A

ALH = 10%,
ALH + FH = 20%,
LCIS +/- FH = 20%

31
Q

Management of lobular in situ neoplasia if discovered on core biopsy?

A

excision or vacuum biopsy to exclude higher grade

32
Q

Management of lobular in situ neoplasia if discovered on vacuum or excision biopsy?

A

follow up and clinical trials

33
Q

Increase in relative risk of progression to invasive carcinoma of intraductal proliferations for UTH, ADH and DCIS (low grade)?

A 
UTH = 2x RR,
ADH = 4 x RR, 
DCIS = 10 x RR
34
Q

What percentage of breast malignancies are DCIS?

A

15-20%

35
Q

Where does DCIS arise and how many duct systems does it involve?

A

arises in TDLU and is characteristically unicentric so arises in a single duct system

36
Q

DCIS can show cancerisation. What is this?

A

It may involve the lobules

37
Q

DCIS can also cause Paget’s disease of the nipple. What is this?

A

High grade DCIS that has extended along ducts to involve the squamous epithelium if the nipple

38
Q

Paget’s disease of the nipple makes DCIS an invasive carcinoma. T/F?

A

False - is still in situ

39
Q

How is DCIS classified?

A

Cytological grade,
histological type,
presence of necrosis (comedo)

40
Q

DCIS is a true precursor lesion for invasive carcinoma. How many progress to invasion following incisional biopsy only?

A

75% progress

41
Q

Management of DCIS?

A

surgery,
adjuvant radio,
chemoprevention e.g. endocrine therapy

42
Q

UTH can develop into LG DCIS. LG DCIS can develop into low grade invasive carcinomas _, _ or _, or IG DCIS which can become intermediate grade invasive carcinomas _ or _. IG DCIS can develop into HG DCIS which can become high grade invasive carcinoma _.

A

UTH can develop into LG DCIS. LG DCIS can develop into low grade invasive carcinomas tubular carcinoma, lobular carcinoma or G1 ductal carcinoma, or IG DCIS which can become intermediate grade invasive carcinomas G2 ductal carcinoma or pleomorphic lobular carcinoma. IG DCIS can develop into HG DCIS which can become high grade invasive carcinoma G3 Ductal carcinoma.

43
Q

Definition of invasive breast carcinoma

A

malignant epithelial cells which have BREACHED the basement membrane

44
Q

Breast cancer has highest incidence of any cancer in both M and F in UK. Incidence of breast cancer has been increasing over last century but began decreasing slightly since 2013. T/F?

A

T

45
Q

Most common age groups to develop breast cancer

A

50s-60s, peaks in 60s

46
Q

Order of breast cancer incidence from highest to lowest of white females, asian females and black females

A

white females,
black females,
asian females

47
Q

For both OCP and HRT, your RR of breast cancer increases while using it but normalises/decreases >10 yrs after stopping. T/F?

A

T

48
Q

List 6 lifestyle risk factors for breast cancer

A 
BMI - increase 
physical activity levels, 
alcohol,
diet, 
NSAID use = lower risk, 
smoking
49
Q

How much does your RR of developing breast cancer increase by if first degree relative had it?

A

doubles risk

50
Q

What mutations are important in breast cancer r

A

BRCA 1 and BRCA 2- only 2% of all breast cancers but approx 50% lifetime risk if carrier

51
Q

Breast cancer incidence rates are higher in most deprived areas. True/false?

A

False - rates are lower weirdly

52
Q

Breast cancer is 2nd commonest cause of cancer death in women however, mortality is declining since breast screening. T/F?

A

T

53
Q

10yr survival of breast cancer

A

approx 75%

54
Q

1 in _ females will develop breast cancer

A

1 in 7

55
Q

Lymph nodes in the breast area (inside, outside and up) (7)

A 
internal mammary, 
intramammary, 
sentinel mammary, 
axillary, 
apical, 
infraclavicular, 
supraclavicular
56
Q

Local invasion places

A

stroma of breast,
skin,
muscles of chest wall

57
Q

Blood-borne metastasis of breast cancer locations

A 
bone, 
liver, 
brain, 
lungs, 
abdo organs, 
female genital tract
58
Q

Classification of invasive breast carcinoma

A

morphological (grade, type),
gene expression profiling, (
hormone receptor expression

59
Q

What 3 hormone receptors can be expressed by breast cancers?

A

oestrogen receptor,
progesterone receptor,
HER2

60
Q

most common - least common types of invasive breast carcinoma

A

ductal,
lobular,
rest

61
Q

Invasive breast carcinoma grading:

sections and scoring?

A 
tubular differentiation (1-3), 
nuclear pleomorphism (1-3), 
mitotic activity (1-3)
62
Q

Invasive breast carcinoma grading:
Grade 1 score?
Grade 2 score?
Grade 3 score?

A

Grade 1 - 3/4/5,
Grade 2 = 6/7,
Grade 3 = 8/9

63
Q 
What is gene expression profiling? 
intrinsic breast cancer sub-types: 
-basal-like, 
-HER2
-normal breast-like 
-Luminal A
-Luminal B
-Luminal C
A

analysing patterns of genes expressed by genetic microarray

64
Q

hormone receptors of invasive breast carcinoma:
80% __ +ve,
67% __ +ve,
14% __ +vev

A

80% ER +ve,
67% PgR +ve,
14% HER2 +ve

65
Q

ER positive predicts response to anti-oestrogen therapy. List 4 types of this therapy

A

oophorectomy,
tamoxifen,
aromatase inhibitors,
GnRH antagonists

66
Q

Human Epidermal Growth Factor Receptor 2 expression predicts response to what type of therapy?

A

trastuzamab (Herceptin)

67
Q

In terms of survival, PR +ve is more/less protective, ER +ve is more/less protective, HER2 +ve is more/less protective.

A

PR +ve more protective,
ER +ve more protective,
HER2 +ve less protective

68
Q

Best and worst hormone combos for survival outcome?

A

Best: ER+ve, PR +ve, HER2 -ve,
Worst: triple -ve

69
Q

Grading Lymph node status parameters

A

0 nodes best,
1-3 nodes bit worse,
>3 nodes lot worse

70
Q 
Name the following prognostic indices for invasive breast carcinoma: 
histopathology only (grade & stage)
A

Nottingham Prognostic Index

71
Q

Name the following prognostic indices for invasive breast carcinoma: histopathology + oestrogen receptor + clinical factors

A

Aduvant! Online

72
Q

Name the following prognostic indices for invasive breast carcinoma:
histopathology + oestrogen receptor + clinical factors + HER2 + mode of detection

A

NHS PREDICT - most used now!!

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