Breast cancer Flashcards
What genetic mutation is associated with Breast cancer
-Tumour suppressor genes - BRCA1 & BRAC2
What are the risk factors of Breast cancer
- Age >50years
- Familial link
- Late menopause - because the time for oestrogen to cause breast cancer widens
- Early menarche
- Obesity
- Women that haven’t given birth or breast fed
- Smoking
- Alcohol >5u/day
- Increased breast density
- Lifetime oestrogen exposure (endogenous/exogenous)
- previous radiation to the chest
- Northern European/American descent
What are the signs and symptoms of breast cancer
- palpable mass ‘lumps’
- skin dimpling
- breast pain
- nipple discharge
- inverted nipple
- axillary node disease e.g node in the armpit
- visual lump
- change in breast size/shape
How does perdorange happen
-tumour grows inside and attaches itself to the normal tissues then pulls the normal tissue inwards hence inverted nipple
Why can it be hard to spot tumour growth in breast cancer
breast tissues are not used in everyday function like the kidneys so the tumour can grow undisputed until it starts causing pain etc
How is breast cancer and the lymphatic system linked?
The breast has a lot of lymphatic system around it so it can spread through there
How is breast cancer diagnosed?
- palpation - lumps attached to the breast structure are more problematic
- mammography
- ultrasomograpy
- biopsy
- CT scan
- fine needle aspiration
How is breast cancer staged?
T0 - no palpable tumour
T1 - tumour <2cm w/ no fixation to underlying muscle
T2 - tumour >2cm but <5cm w/ no fixation
T3 - tumour max diameter >5cm
T4 - tumour of any size with fixation to chest or ulceration of skin
N0 - no palpable axillary nodes
N1a - palpable node NOT though to contain tumour
N1b - palpable node thought to contain tumour
N2 - nodes >2cm fixed to one another & deep structure
N3 - spraclavicular or infraclavicular nodes
M0 - no distant metastasis
M1 - distant metastasis
What are the treatment options for breast cancer
- surgery
- radiotherapy
- chemotherapy
- hormonal treatment
- biological treatment
What is the first line treatment for breast cancer
Surgery
What does Neo-adjuvant therapy mean
treatment before operation
What does adjuvant therapy mean
given in addition to initial therapy (so after surgery)
What type of endocrine therapy are there for breast cancer
- Oestrogen receptor antagonist
- Aromatase inhibitor
- Ovarian ablation - done in pre-menopausal women
What is an example of Oestrogen receptor antagonist and how do they work
Tamoxifen - it is a SERMs (selective oestrogen receptor modulators)
MOA:
- can bind to oestrogen receptor due to its tertiary structure
- tamoxifens to be in trans form to work which is an active salt that is soluble
- it competitively binds to oestrogen receptor which leads to a reduction of oestrogen in the pathway thus decreasing tumour growth.
- overall it blocks the G1 phase of the cell cycle so proliferation cannot occur
- it is cytotoxic
- it is metabolised by the CYP 450 3A4
What is an example of Aromatase inhibitor and how do they work
Letrozole, anastrozole, exemestane
MOA:
- selectively inhibits aromatise enzyme by blocking heme group of the enzyme
- this means the aromatise enzyme cannot bind properly to other groups to make aromatic rings on them
