Breast Cancer Flashcards
What are the risk factors for breast cancer?
- genetics - variants in tumour suppressor genes BCA1/2. Mutations allow cells to proliferate and grow
- age >50
- history of familial disease
- late menopause/early menarch - prolonged window of exposure to oestrogen
- obesity
- > 5U/day of alcohol
- smoking
- high socioeconomic status/urban residence
- radiation to the chest
- no previous breast feeding
How does breast anatomy relate to presentation of breast cancer?
In normal every day life, the breast does not have a function. Breast tumours can grow quite large before they cause any noticeable disruption
How does breast cancer usually present?
Usually patients have found lumps
What are the signs/symptoms of breast cancer?
Skin clumping, orange skin, inverted nipples, nipple discharge, visual lumps, breast pain, swollen lymph nodes, change in breast size/shape
How is breast cancer detected?
Mammogram, Palpation, biopsy, fine needle aspirate
What are the different T stages for breast cancer?
T0 - no palapable tumour
T1 - tumour <2cm with no fixation to underlying muscle
T2 - tumour >2cm but <5cm with no fixation to underlying muscle
T3 - tumour max diameter >5cm
T4 - tumour of any size with fixation to the chest wall or ulceration of the skin
What are the different N stages for breast cancer?
N0 - no palpable axillary nodes
N1a - palpable nodes not thought to contain tumour
N1b - palpable nodes thought to contain tumour
N2 - nodes >2cm fixed to one another and deep structure
N3 - supraclavicular or infraclavicular nodes
What are the M stages for breast cancer?
M0 - no clinically apparent distant metastases
M1 - distant metastasesnpresent
What is the UICC with relation to cancer?
% survival after 15 years
What does stage I UICC mean with relation to breast cancer?
85% survival after 15 years. T1 N0 M0
What does stage 2 UICC mean with relation to breast cancer?
55% Survival after 15 years. T1n1, M0, T2 n0-1, m0
What does stage 3 UICC mean with relation to breast cancer?
40% survival after 15 years. Any T, N2-3, m0, T3, any N, M0, T4, Any N, m0
What does stage 4 UICC mean relating to breast cancer?
Less than 5% chance of survival after 15 years. Any T, Any N, M1
What is the relationship between early diagnosis and prognosis?
Early diagnosis leads to better prognosis
What is primary breast cancer?
Localised cancer, tumour less than 2cm with possible axillary nodal involvement
What is locally advanced breast cancer?
Tumour is larger than 5cm, has not spread to other parts of the body but may involve the localised skin, muscle, lymph nodes
What is secondary (advanced) breast cancer?
Breast cancer which has metastasised to other parts of the body
What is the first line treatment for breast cancer?
Surgery. Dependant on patient/surgeon wishes, type of tumour, ratio of tumour to breast size
What is neoadjuvant treatment?
Given before surgery to reduce tumour size, to make it easier to resect
What is adjuvant treatment?
Chemo/hormonal/radiotherapy treatment used alongside surgery to improve outcomes
What are the different types of surgery for breast cancer?
- radical - removal
- modified - partial removal
- wide local - taking a slice out
- mastectomy - removal of breast
How is endocrine (hormonal) therapy used for breast cancer?
Breast carcinomas express oestrogen receptor and progesterone receptor. If you reduce oestrogen, you can reduce the tumour. Oestrogen antagonists such as tamoxifen can be used for this. Aromatase inhibitors such as anastrazole or letrozole can be used in post menopausal women.
Why are aromatase inhibitors such as letrozole used only in post menopausal women?
Because they dont stop the ovaries from producing oestrogen, they lower oestrogen levels in the body by preventing aromatase from converting hormones into oestrogen
Which drugs are used for triple-negative breast cancer?
Triple negative breast cancer doesn’t have oestrogen or progesterone receptors and also makes little or none of the HER2 protein (usual breast cancer target). Hormone therapy is not helpful, and so chemotherapy drugs are the best option Typically a taxane, platinum compound and an anthracycline
Which biological therapies are used for breast cancer and why?
Trastuzumab targets HER2 receptor which is overexpressed in tumour cells. Ligands bind to the HER2 receptor and dimerise, which amplifies the signal for oestrogen.
What caution must be taken with trastuzumab?
It has potential cardiotoxicity, especially when given with anthracyclines such as doxorubicin. Resus facilities must be available
What are common signs of metastatic spread of breast cancer?
Skeleton - patients break bones as a result of insignificant trauma
Lymph - Enlarged arms, as a result of lymphs for drainage being removed
Why is radiation therapy used with breast cancer?
As an adjuvant therapy, to eradicate any local spread following tumour exicision, such as any locally effected lymph nodes.
Pre menopausal women
What drugs are used for chemotherapy in breast cancer?
cyclophosphamide, methotrexate, epirubicin, 5 - fluorouracil, doxorubicin.
Most commonly: doxorubicin + cyclophosphamide + docetaxel
When are taxanes such as docetaxel or paclitaxel indicated in breast cancer?
Adjuvant in secondary tumours in metastatic disease, or for treatment of advanced breast cancer where initial cytotoxic chemotherapy has failed or is inappropriate
What adverse effect is typically associated with cyclophosphamide?
Haemorrhagic cystitis - cyclophosphamide is an akylating agents, which forms acrolein as an active metabolite. This active metabolite is very toxic to the urinary tract.
How do you treat haemorrhagic cystitis?
Give MESNA which binds to acrolein and prevents it from binding to proteins within the urinary tract
What are the risk factors for haemorrhagic cystitis?
Previous pelvic irradiation, high dose radiotherapy, dehydration
What are the implications of severe haemorrhagic cystitis?
It can cause implications for treatment and can be dose limiting, the highest dose must be used for the most effective period of time
What adverse effect is commonly observed with anthracyclines such as doxorubicin or epirubicin?
Cardiomyopathy, as a result anthracyclines have a lifetime ceiling dose of 450mg/m2. This can be combatted with pulse dosing, as more frequent less intense doses. Heart function should be monitored
What can happen if breast cancer is left untreated?
Tumour would self amputate, charcoal dressings can be used to absorb the smell
