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YEAR 4 CANCER CARE > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

How do we name breast cancer?

A
  • Most arise from duct tissue, followed by lobular tissue- described as ductal or lobular carcinoma respectively
  • Then subdivided as to whether cancer has spread beyond local tissue ( carcinoma-in-situ) or has spread (invasive)
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2
Q

Most common types of breast cancer incl?

A
  • Invasive ductal carcinoma (this is now know as No Special Type)
  • Ivasive lobular carcinoma
  • Ducatal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS)
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3
Q

What are the ‘Special Types” of breast cancer

A
  • Lobular carcinoma
  • Medullary breast cancer
  • Mucinous (mucoid or colloid) breast cancer
  • Tubular breast cancer
  • Adenoid cystic carcinoma of the breast
  • Metaplastic breast cancer
  • Lymphoma of the breast
  • Basal type breast cancer
  • Phyllodes or cystosarcoma phyllodes
  • Papillary breast cancer
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4
Q

What is Pagets Disease of the nipple?

A
  • Eczematoid change of the nipple associated with an underlying breast malignancy
  • In half of these pts its associated with an underlying mass lesion -90% of those pts with have an invasive carcinoma
  • 30% without a mass lesion will still be found to have an underlying carcinoma
  • The remainder will have carcinoma in situ
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5
Q

What is inflammatory breast cancer?

A
  • where cancerous cells block the lymph drainage resulting in an inflamed appearance of the breast. This accounts for around 1 in 10,000 cases of breast cancer.
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6
Q

What is triple assessment?

A
  • One stop shop for 2 ww
    Involves:
  • History and examination
  • Imaging
  • Histology- core needle biopsy as fine needle is cytology only and core needle can differentiate between invasive and in situ carcinoma.
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7
Q

What is an in situ carcinoma?

A
  • Neoplastic population of cells limited to ducts and lobules by basement membrane (BM), myoepithelial cells are preserved.
  • Does NOT invade into vessels and therefore cannot metastasise or kill the patient.
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8
Q

What is the significance of peau d’orange?
What type of breast cancer is it more likely to be?

A
  • Means lymphatic drainage of the skin of breast is involved
  • More likely to be an invasive breast cancer as invades lymph nodes
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9
Q

What factors affect the prognosis of breast cancer?

5

A
  1. Whether the malignant tumour is in-situ or invasive
  2. The stage- TNM
  3. Grade of the tumour
  4. Histology of the tumour
  5. Gene expression profile
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10
Q

A patient presents with:
3cm highly mobile lesion on her breast
1) What is you top differential?
2) How do they present
3) What is the prognosis
4) When would you excise it?

A
  1. Fibroadenoma
  2. highly mobile lesions, well defined and rubbery, most are less than 5cm
  3. Low malignant potential and can be left in situ with routine follow ups over a 2 year period, up to 30% will get smaller
  4. Greater than 3cm in diameter or pt preference
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11
Q

What is invasive breast cancer?

A
  • Neoplastic population of cells NOT limited to ducts and lobules by basement membrane (BM), myoepithelial cells are preserved.
  • Can invade into vessels and therefore can metastasise / kill the patient.
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12
Q

RF for breast cancer?

A
  • BRCA1, BRCA2 genes - 40% lifetime risk of breast/ovarian cancer
  • 1st degree relative premenopausal relative with breast cancer (e.g. mother)
  • nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs)
  • early menarche, late menopause
  • combined hormone replacement therapy (relative risk increase * 1.023/year of use), combined oral contraceptive use
  • past breast cancer
  • not breastfeeding
  • ionising radiation
  • p53 gene mutations
  • obesity
  • previous surgery for benign disease (?more follow-up, scar hides lump)
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13
Q

When do you refer a pt for suspected breast cancer?

A
  • aged 30 and over and have an unexplained breast lump with or without pain or
  • aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
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14
Q

When should you consider referral of someone via 2ww for breast cancer?

A
  • with skin changes that suggest breast cancer or
  • aged 30 and over with an unexplained lump in the axilla
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15
Q

When should you consider non-urgent referral to breast clinic?

A
  • under 30 with an unexplained breast lump with or without pain
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16
Q

Outline breast screening programme?

A
  • offered to women between ages of 50-70 years
  • Mammogram every 3 years
  • After age of 70 women may still have mammograms but ‘encouraged to make their own appointments’
17
Q

Who should be offered breast screening from a younger age?

ie. referred to breast clinic for further assessment on this

A
  • one first-degree female relative diagnosed with breast cancer at younger than age 40 years, or
  • one first-degree male relative diagnosed with breast cancer at any age, or
  • one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years, or
  • two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age, or
  • one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative), or
  • three first-degree or second-degree relatives diagnosed with breast cancer at any age
18
Q

What are the treatment options for breast ca?

A
  • Masectomy
  • Wide local excision
  • Biological therapy
  • Chemotherapy
  • Radiotherapy
  • Hormonal therapy
19
Q

Prior to surgery, how does the presence/absence of axillary nodes determine management?

A
  • women with NO palpable axillary lymphadenopathy at presentaton should have PREOP axillary USS before primary surgery- if POSITIVE then have a sentinel node biopsy to assess nodal burden
  • Patients who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery
20
Q

What are the complications of axillary node clearance?

A
  • Arm lyphedema
  • Functional arm impairment
21
Q

When is mastectomy usually offered?

as opposed to wide local excision

A
  • Mutifocal tumour
  • Central tumour
  • Large lesion in small breast
  • DCIS> 4cm
22
Q

When is wide local excision offered?

As opposed to mastestomy?

A
  • Solitary lesion
  • Peripheral tumour
  • Small lesion in large breast
  • DCIS< 4cm
23
Q

When is radiotherapy offered in breast ca?

A
  • Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds.
  • Women who’ve had a mastectomy, radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes
24
Q

When do you offer adjuvant therapy is breast ca?

A
  • If tumours are positive for hormone receptors
25
Q

What hormonal therapy do you use for breast ca?
What is the regimen?

A
  • Tamoxifen for pre and peri-menopausal women
  • Aromatase inhibotrs e.g. anastrozole for post menopausal women
26
Q

Side effects of tamoxifen?

A
  • Increase risk of endometrial cancer
  • VTE
  • Menopausal symptoms
27
Q

When is biological therapy used for breast ca?
Prognosis?
Contraindications?

A
  • Trastuzumab (Herceptin)- for HER2 + tumours
  • Only useful in 20-25% of tumours that are HER2 positive
  • Cannot be used in pts with hx of heart disorders
28
Q

When is chemotherapy used in breast ca?

A
  • Neoadjuvant (prior to chemo) to downstage a primary lesion
  • Adjuvant (after surgery) depending on stage of the tumour
29
Q

Breast lumps ddx?

A
  • Fibroadenoma-common under 30, discrete, non-tender and highly mobile
  • Fibrocystic disease (fibroadenosis)- lumpy breast which may be painful, symptoms may be cyclical
  • Breast cancer- classically hard and irregular lump with skin tethering, nipple inversion
  • Mammary duct ectasia- tender lump around areola +/- green nipple discharge
  • Fat necrosis- ususally obese women with large breast, following trivial or unnoticed trauma, initally firm but may develop into hard, irregular breast lump
  • Breast abscess- more common in lactacting women, red hot tender swelling
30
Q

What is the difference between a ductal carcinoma and lobular carcinoma of the breast (both non-invasive)?

A

Ductal - limited to the ducts by the basement membrane. Lobular - limited to the lobules by the basement membrane.

31
Q

How does breast cancer present?

A
  • hard, irregular breast lump with skin tethering
  • non-flucuant
  • nipple changes/inversion
  • Pagets disease of the nipple
  • breast discharge
32
Q

Main risk of aromatase inhibitor e.g. Anastrazole?

A
  • Increases risk of osteoporosis
33
Q

Complications of breast cancer?

A
  • Pain
  • Bone mets causing hypercalcaemia, MSCC
  • Lung mets
  • Liver mets
  • Brain mets
  • Lymphedema
  • Treatment complications
    *

YEAR 4 CANCER CARE (22 decks)

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