breast cancer

Question 1

what is the sentinal lymph node?

Answer 1

sentinel lymph node is the axillary lymph node to which the breast cancer metastasises to first

Question 2

what is the histology of most breast cancers?

Answer 2

adenocarcinoma

Question 3

how can breast cancers be catagorised?

Answer 3

site: ductal or lobular
Invasion of basement membrane (BM):
In-situ: no invasion of the BM
Invasive: invasion of the BM

Question 4

how can breast cancers be catagorised?

Answer 4

site: ductal or lobular

Invasion of basement membrane (BM):
In-situ: no invasion of the BM
Invasive: invasion of the BM

Question 5

what are the types of carcinoma insitu and what are their clinical presentions?

Answer 5

• ductal carcinoma insitu- no mass but can see calcification on mamography
• lobular carcinoma insitu- normal mamography and discovered incidentally when breast is biospied for alternative reasons

Question 6

what are the types of invasive carcinoma?

Answer 6

1. invasive ductal carcinoma (NST): most common, presents as a mass clinically or on screening
2. Invasive lobular carcinoma : not always visible on mamography. lack of E-cadherin on histology
3. inflamatory breast cancer: presents similarly to mastitis but doesnt respond to antibiotics. swollen, warm, tender with peau dorange. worse prognosis
4. pagets disease of the nipple

Question 7

which type of cancer is associated with BRACA1?

Answer 7

medullary carcinoma

Question 8

what are the risk factors for breast cancer?

Answer 8

Female (99% of breast cancers)
Increased oestrogen exposure (earlier onset of periods and later menopause)
More dense breast tissue (more glandular tissue)
Obesity
Smoking
Family history (first-degree relatives

Question 9

how does COCP affect risk of breast cancer?

Answer 9

combined contraceptive pill gives a small increase in the risk of breast cancer, but the risk returns to normal ten years after stopping the pill.

Question 10

how does HRT affect breast cancer?

Answer 10

Hormone replacement therapy (HRT) increases the risk of breast cancer, particularly combined HRT (containing both oestrogen and progesterone).

Question 11

what things are protective against breast cancer?

Answer 11

• breast feeding and multiparity

- because reduces exposure to oestrogen

Question 12

what are the different genetic risk factors for breast cancer?

Answer 12

BRCA1/ BRCA 2 mutation: tumour suppressor gene involved in DNA repair
Increased risk of breast and ovarian cancer
Most common cause of hereditary breast cancer
Male breast cancer associated with BRCA2

Li-Fraumeni syndrome: autosomal dominant p53 mutation
Breast, brain, adrenal, leukaemia/lymphoma, osteosarcoma

Peutz-Jeghers syndrome
Benign intestinal hamartomas and malignancies involving GI tract, breast, pancreas, and GU tract

Klinefelter syndrome: 47 XXY
Increased risk of breast cancer in men

Question 13

which chromososme is BRACA1 on?

Answer 13

17

Question 14

what are the different types of breast cancer receptor?

Answer 14

Oestrogen receptors (ER)
Progesterone receptors (PR)
Human epidermal growth factor (HER2)

Triple-negative breast cancer is where the breast cancer cells do not express any of these three receptors. This carries a worse prognosis, as it limits the treatment options for targeting the cancer.

Question 15

what are the different types of breast cancer receptor?

Answer 15

Oestrogen receptors (ER)
Progesterone receptors (PR)
Human epidermal growth factor (HER2)

Question 16

where do breast cancers metastasise?

Answer 16

L – Lungs
L – Liver
B – Bones
B – Brain

Question 17

what does the tripple diagnostic assessment entail when a patient is referred on a 2WW?

Answer 17

Clinical assessment (history and examination)

Imaging (ultrasound or mammography)

Biopsy (fine needle aspiration or core biopsy)

Question 18

what are the staging tests which are done after a diagnosis of breast cancer is made?

Answer 18

Lymph node assessment and biopsy

MRI of the breast and axilla

Liver ultrasound for liver metastasis

CT of the thorax, abdomen and pelvis for lung, abdominal or pelvic metastasis

Isotope bone scan for bony metastasis

Question 19

what are the surgical options for treating breast cancer?

Answer 19

Breast-conserving surgery (e.g., wide local excision), usually coupled with radiotherapy

Mastectomy (removal of the whole breast), potentially with immediate or delayed breast reconstruction

axillary clearance-> increases risk of chronic lymphodema, especially if all axilliary lymph nodes are cleared

Question 20

why should you avoided taking bloods or inseting a cannula into the side of breast surgery?

Answer 20

This is because there is a higher risk of complications and infection due to the impaired lymphatic drainage on that side.

Question 21

what is the nottingham prognostic index?

Answer 21

This is a score which can be used to estimate 5-year survival

Question 22

how does hormone status affect prognosis of breast cancer?

Answer 22

Hormone positive (ER and/or PR) carries a better prognosis than hormone negative

Triple-negative tumours are associated with a poor prognosis

Question 23

how does HER2 status affect breast cancer?

Answer 23

HER-2 positive tumours show aggressive growth compared to HER-2 negative

Question 24

who is ussually affected by tripple negative breast cancer?

Answer 24

African or Hispanic ethnicity
Younger patients
BRCA1 mutation

Question 25

what are targeted treatment options for HER2 breast cancers?

Answer 25

monoclonal antibodies:
Trastuzumab (Herceptin)
Pertuzumab (Perjeta)

tyrosine kinase inhibitor:
Neratinib (Nerlynx)

Question 26

what are the main treatments for oestrogen positive breast cancers?

Answer 26

Tamoxifen for premenopausal women

Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)

Question 27

what is the mechanism of action of tamoxifen?

Answer 27

Tamoxifen is a selective oestrogen receptor modulator (SERM).

It either blocks or stimulates oestrogen receptors, depending on the site of action.

It blocks oestrogen receptors in breast tissue, and stimulates oestrogen receptors in the uterus and bones.

This means it helps prevent osteoporosis, but it does increase the risk of endometrial cancer.

Question 28

how do aromatase inhibitors like letrozole work?

Answer 28

Aromatase is an enzyme found in fat (adipose) tissue that converts androgens to oestrogen. After menopause, the action of aromatase in fat tissue is the primary source of oestrogen.

Aromatase inhibitors work by blocking the creation of oestrogen in fat tissue.

Question 29

apart from tamoxifen what other treatments can be used for oestrogen positive breast cancers?

Answer 29

Fulvestrant (selective oestrogen receptor downregulator)
GnRH agonists (e.g., goserelin or leuprorelin)
Ovarian surgery

Question 30

after masectomy what are the options for breast reconstruction?

Answer 30

Breast implants (inserting a synthetic implant)

Flap reconstruction (using tissue from another part of the body to reconstruct the breast)