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Breast Disease > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are the risk factors for developing breast cancer?

A

Increased oestrogen exposure
More dense breast tissue
Obesity
Age > 50
Family history of breast or ovarian cancer
BRCA 1 or BRCA 2 genes
Jewish ancestry

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2
Q

What is the lifetime risk of breast cancer in someone with BRCA1 or 2 genes ?

A

40%

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3
Q

What factors would increase oestrogen exposure?

A

Early menarche
Late menopause
Combined HRT
COCP
Nulliparity

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4
Q

Where are the BRCA1 and BRCA2 genes?

A

BRCA1 - chromosome 17
BRCA2 - chromsome 13

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5
Q

What are the types of breast cancer?

A

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

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6
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

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7
Q

What is an invasive ductal carcinoma?

A

A breast cancer that originates from cells in the breast ducts

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8
Q

What is an invasive lobular carcinoma?

A

A breast cancer that orginates from cells in the breast lobules

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9
Q

What is ductal carcinoma in situ?

A

Pre-cancerous or cancerous cells of the epithelial tissue
They are localised to a single area and have the potential to spread

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10
Q

What is lobular carcinoma in situ?

A

A pre-cancerous condition that is typically asymptomatic and seen in pre-menopausal women
Represents an increased risk of invasive breast cancer in the future

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11
Q

What is inflammatory breast cancer?

A

Where cancerous cells block the lymphatic drainage of the breast causing an inflammatory picture

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12
Q

What age women are offered breast screening?

A

50-70

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13
Q

How often are women aged 50-70 offered a breast screening appointment?

A

Every 3 years

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14
Q

Which high risk patients should be referred for assessment?

A

A first degree relative with breast cancer under 40
A first degree male relative with breast cancer
A first degree relative with bilateral breast cancer under 50
Two first degree relatives with breast cancer

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15
Q

Which patients should be referred urgently for suspected breast cancer?

A

Age 30 and over with an unexplained breast lump with or without pain
Age 50 and over with any of the following symptoms in one nipple only:
- Nipple discharge, retraction or other changes of concern

Age 30 and over with an unexpected pain in the axilla
People with skin changes that are indicative of breast cancer

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16
Q

What is the triple diagnostic assessment?

A

Triple diagnostic assessment is the initial assessment for women referred under a two week wait:
Clinical assesment
Mammogram or ultrasound
Biopsy

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17
Q

What type of imaging is used for women under 30 and why?

A

Ultrasound is typically performed in women under 30 due to more dense breast tissue

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18
Q

When would MRI be used in the diagnosis of breast cancer?

A

To screen women at high risk of breast cancer
To determine size and features of a tumour

19
Q

What type of receptors may a breast cancer have?

A

Oestrogen receptors
Progesterone receptors
HER2 (human epidermal growth factors)

20
Q

What is triple negative breast cancer?

A

Breast cancer with a worse prognosis due to having no receptors that can be targeted by medication

21
Q

Where does breast cancer typically metastasise to?

A

Lungs
Liver
Bone
Brain

22
Q

What investigations are carried out to stage breast cancer?

A

Lymph node biopsy
MRI of breast and axilla
Liver ultrasound
CT thorax, abdo, pelvis
Isotope bone scan

23
Q

What are the differential diagnoses of breast cancer?

A

Fibroadenoma
Cyst
Mastitis
Lipoma

24
Q

What are the presenting features of breast cancer?

A

Nipple discharge
Breast lump with or without pain
Skin thickening or discolouration
Nipple inversion
Axillary mass

25
Q

Where can breast cancer spread to?

A

Breast cancer can spread anywhere in the body

26
Q

What types of breast cancer surgery exist?

A

Wide local excision
Mastectomy

27
Q

When would a wide local excision be considered?

A

Solitary lesion
Peripheral tumour
Small lesion
Ductal carcinoma in situ < 4cm

28
Q

When would a mastectomy be considered?

A

Multiple lesions
Central tumours
Larger lesions
Ductal carcinoma in situ > 4cm

29
Q

What treatements other than surgery are offered to women with breast cancer?

A

Radiotherapy
Chemotherapy
Biological therapy
Hormonal therapy

30
Q

What is the main complication of axillary lymph node clearance?

A

Chronic lymphodema

31
Q

What is chronic lymphodema?

A

Impaired lymphatic drainage that leads to a build up of lymph (typically in one arm after breast surgery with lymph node removal)

32
Q

What are the side effects of radiotherapy?

A

General fatigue
Local skin irritation and swelling
Fibrosis of breast tissue
Shrinking of breast tissue
Long term skin discolouration

33
Q

What medications can be given to patients with oestrogen receptor positive breast cancer?

A

Tamoxifen for premenopausal women
Aromatase inhibitors for post-menopausal women

34
Q

What class of drug is tamoxifen?

A

Selective oestrogen receptor modulator

35
Q

What is the action of tamoxifen?

A

Blocks oestrogen receptors in breast tissue
Stimulates oestrogen receptors in bones and the uterus

36
Q

What is the action of aromatase inhibitors?

A

Aromatase blocks the creation of oestrogen in fat tissue

37
Q

What treatments are used in patients with HER2 positive breast cancer?

A

Trastuzamab
Pertuzamab

38
Q

What are the side effects of tamoxifen?

A

Menopausal symptoms
Increased risk of endometrial cancer
Increased VTE risk

39
Q

What are the options for reconstructive surgery?

A

Immediate reconstruction
Delayed reconstruction

40
Q

What type of radiotherapy is recommended after a wide local excision?

A

Whole breast radiotherapy

41
Q

What is the action of anastrazole?

A

Aromatase inhibitor - reduces the peripheral synthesis of oestrogen

42
Q

What is the action of tamoxifen?

A

SERM (selective oestrogen receptor modulator) - partial oestrogen receptor antagonist

43
Q
A

Breast Disease (8 decks)

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