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Y3 - Repro > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the most common cancer in women?

A

Breast cancer

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2
Q

What is the average risk of breast cancer for women?

A

1 in 10

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3
Q

What are risk factors for breast cancer?

A 
Female
Increased age
Family history
Ovarian cancer
Early menopause
Late menopause
Nulliparity
Higher age at first pregnancy
Higher SE group
HRT
COCP
Not breastfeeding
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4
Q

What are the main types of breast cancer?

A

Ductal carcinoma in situ
Lobular carcinoma in situ
Invasive ductal carcinoma
Invasive lobular carcinoma

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5
Q

What is breast carcinoma in situ?

A

malignancy contained within the basement membrane

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6
Q

What is the most common non-invasive breast malignancy?

A

Ductal carcinoma in situ (DCIS)

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7
Q

What is DCIS preceded by?

A

Atypical ductal hyperplasia

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8
Q

What is ductal breast cancer?

A

Malignancy of ductal breast tissue

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9
Q

What is the risk with high grade DCIS?

A

Can progress to Paget’s disease of the nipple

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10
Q

What is Paget’s disease of the nipple?

A

Extension of carcinoma along ducts to reach the epidermis of he nipple

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11
Q

What is comedo necrosis?

A

Dead cells in the lumen of breast duct due to necrosis of inner cells caused by high grade ductal carcinoma

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12
Q

How can comedo necrosis be detected?

A

Can calcify - calcification detected on mammography

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13
Q

What is the risk of DCIS becoming invasive?

A

30% in 10 years

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14
Q

How is diagnosis of DCIS confirmed?

A

Biopsy

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15
Q

What is the second most common non-invasive breast malignancy?

A

Lobular carcinoma in situ (LCIS)

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16
Q

What is LCIS?

A

Malignancy of the secretory lobules of the breast

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17
Q

What is LCIS preceded by?

A

Atypical lobular hyperplasia

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18
Q

What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ?

A

ALH when <50% of lobule involved

LCIS when >50% involved

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19
Q

What is the risk of LCIS becoming invasive?

A

20-40% in 15 years

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20
Q

How is LCIS detected?

A

Not associated with micro calcification so usually diagnosed as incidental finding on breast biopsy rather than mammography

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21
Q

When is carcinoma classed as invasive?

A

Once malignancy has invaded the basement membrane

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22
Q

What is the most common type of invasive carcinoma of the breast?

A

Invasive ductal carcinoma (80%)

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23
Q

Which type of invasive carcinoma of the breast has a better prognosis?

A

Invasive ductal carcinoma

24
Q

Where does breast carcinoma spread by local invasion?

A

Tissue of the breast
Skin
Muscles of chest wall

25
Q

Where does breast carcinoma spread by lymphatics?

A

Regional draining lymph nodes

Sentinel nodes

26
Q

Where does breast carcinoma spread by blood?

A 
Bone
Liver
Brain
Lungs
Abdominal viscera
Female genital tract
27
Q

What factors is breast carcinoma tumour graded on?

A

Tubular differentiation
Nuclear pleomorphism
Mitotic activity

28
Q

Which are the significant hormone receptors in breast carcinoma?

A

ER - oestrogen receptor
PgR - progesterone receptor
HER2

29
Q

What is the proportion of people that are positive for each of the hormone receptors in breast carcinoma?

A

ER - 80%
PgR - 67%
HER2 - 14%

30
Q

Which prognostic scores can be used in breast carcinoma?

A

Nottinham prognostic index

NHS predict

31
Q

What is the presentation of breast carcinoma?

A 
Dimpled or depressed skin
Visible lump
Nipple change
Bloody discharge
Breast texture change
Colour change
Axillary lymphadenopathy
32
Q

What is triple assessment?

A

Clinical examination
Imaging (USS, mammogram or both)
Core biopsy

33
Q

Who are given USS over mammogram, and why?

A 
Younger people (<35)
Higher density of breast tissue makes mammogram appear white and makes it harder to interpret
34
Q

What is the staging system for breast carcinoma?

A 
T1 - <2cm
T2 - 2-5cm
T3 - 5+cm
T4a - invades chest wall
T4b - invades skin
T4c - invades chest wall and skin
T4d - inflammatory breast cancer
35
Q

When is a sentinel node biopsy done?

A

If axillary ultrasound is positive

36
Q

Who are invited for breast cancer screening?

A

General population - age 50-70

High risk - age 40+

37
Q

How often are people screened for breast cancer?

A

Every 3 years

38
Q

What is the preferred option for breast surgery?

A

Wide local excision and sentinel node biopsy

39
Q

Which circumstances can wide local excision and sentinel node biopsy be done?

A

Solitary lesion
peripheral tumour
Small lesion in large breast
DCIS <4cm

40
Q

Which circumstances can mastectomy be done?

A

Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm

41
Q

How is reconstructive surgery done?

A

Myocutaneous flap based on the latissimus dorsi or rectus abdominis muscles

42
Q

When is axillary surgery done?

A

Almost all invasive cancers

43
Q

What are the options for axillary clearance?

A

Level 2 - includes nodes lateral and deep to pec minor

Level 3 - includes apical nodes medial to pec minor

44
Q

What does axillary node sampling involve?

A

Sampling of at least 4 random nodes

Identification of the first node draining the tumour by injecting radioactive isotope and coloured dye

45
Q

What is required if there is positive node sampling or biopsy?

A

Further axillary treatment by clearance or radiotherapy

46
Q

What is the complication of axillary clearance and radiotherapy?

A

Arm lymphoedema

47
Q

When and why is radiotherapy given as adjuvant therapy for breast carcinoma?

A

To the whole breast following wide local excision

To reduce risk of recurrence

48
Q

What are the indications for adjuvant radiotherapy in breast carcinoma?

A

Following mastectomy for T3-T4 tumours

4 or more positive axillary nodes

49
Q

What is the hormonal therapy for ER or PgR positive tumours?

A

Tamoxifen or aromatase inhibitors

50
Q

Who are the different options for hormonal therapy for ER or PgR positive tumours given for?

A

Tamoxifen - for pre and peri-menopausal women

Aromatase inhibitors for postmenopausal women

51
Q

What are the options for aromatase inhibitors?

A

Letrozole
Anastrozole
Exemestane

52
Q

How long are hormonal therapies given for?

A

5 yeas after diagnosis

53
Q

What are the side effects of tamoxifen?

A

Increased risk fo endometrial cancer
Venous thromboembolism
Menopausal symptoms
Weight gain

54
Q

What biological therapy is given in HER2 positive breast carcinomas?

A

Trastuzuman (herceptin)

55
Q

When is trastuzuman (herceptin) contraindicated?

A

History of heart disorders

56
Q

When is cytotoxic chemotherapy given in breast carcinoma?

A

For patients at high risk of recurrence - positive lymph node disease

57
Q

What are the options for cytotoxic chemotherapy in breast carcinoma?

A

Doxyrubicin
Cyclophosphamide
Fluorouracil
Epirubicin

Y3 - Repro (13 decks)

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