Breast Cancer Flashcards
What are the risk factors for developing breast cancer?
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
What is the lifetime risk of breast cancer in someone with BRCA1 or 2 genes ?
40%
What factors would increase oestrogen exposure?
Early menarche
Late menopause
Combined HRT
COCP
Nulliparity
Where are the BRCA1 and BRCA2 genes?
BRCA1 - chromosome 17
BRCA2 - chromsome 13
What are the types of breast cancer?
Invasive ductal carcinoma
Invasive lobular carcinoma
Ductal carcinoma in situ
Lobular carcinoma in situ
What is the most common type of breast cancer?
Invasive ductal carcinoma
What is an invasive ductal carcinoma?
A breast cancer that originates from cells in the breast ducts
What is an invasive lobular carcinoma?
A breast cancer that orginates from cells in the breast lobules
What is ductal carcinoma in situ?
Pre-cancerous or cancerous cells of the epithelial tissue
They are localised to a single area and have the potential to spread
What is lobular carcinoma in situ?
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
What is inflammatory breast cancer?
Where cancerous cells block the lymphatic drainage of the breast causing an inflammatory picture
What age women are offered breast screening?
50-70
How often are women aged 50-70 offered a breast screening appointment?
Every 3 years
Which high risk patients should be referred for assessment?
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
Which patients should be referred urgently for suspected breast cancer?
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
What is the triple diagnostic assessment?
Triple diagnostic assessment is the initial assessment for women referred under a two week wait:
Clinical assesment
Mammogram or ultrasound
Biopsy
What type of imaging is used for women under 30 and why?
Ultrasound is typically performed in women under 30 due to more dense breast tissue
When would MRI be used in the diagnosis of breast cancer?
To screen women at high risk of breast cancer
To determine size and features of a tumour
What type of receptors may a breast cancer have?
Oestrogen receptors
Progesterone receptors
HER2 (human epidermal growth factors)
What is triple negative breast cancer?
Breast cancer with a worse prognosis due to having no receptors that can be targeted by medication
Where does breast cancer typically metastasise to?
Lungs
Liver
Bone
Brain
What investigations are carried out to stage breast cancer?
Lymph node biopsy
MRI of breast and axilla
Liver ultrasound
CT thorax, abdo, pelvis
Isotope bone scan
What are the differential diagnoses of breast cancer?
Fibroadenoma
Cyst
Mastitis
Lipoma
What are the presenting features of breast cancer?
Nipple discharge
Breast lump with or without pain
Skin thickening or discolouration
Nipple inversion
Axillary mass
Where can breast cancer spread to?
Breast cancer can spread anywhere in the body
What types of breast cancer surgery exist?
Wide local excision
Mastectomy
When would a wide local excision be considered?
Solitary lesion
Peripheral tumour
Small lesion
Ductal carcinoma in situ < 4cm
When would a mastectomy be considered?
Multiple lesions
Central tumours
Larger lesions
Ductal carcinoma in situ > 4cm
What treatements other than surgery are offered to women with breast cancer?
Radiotherapy
Chemotherapy
Biological therapy
Hormonal therapy
What is the main complication of axillary lymph node clearance?
Chronic lymphodema
What is chronic lymphodema?
Impaired lymphatic drainage that leads to a build up of lymph (typically in one arm after breast surgery with lymph node removal)
What are the side effects of radiotherapy?
General fatigue
Local skin irritation and swelling
Fibrosis of breast tissue
Shrinking of breast tissue
Long term skin discolouration
What medications can be given to patients with oestrogen receptor positive breast cancer?
Tamoxifen for premenopausal women
Aromatase inhibitors for post-menopausal women
What class of drug is tamoxifen?
Selective oestrogen receptor modulator
What is the action of tamoxifen?
Blocks oestrogen receptors in breast tissue
Stimulates oestrogen receptors in bones and the uterus
What is the action of aromatase inhibitors?
Aromatase blocks the creation of oestrogen in fat tissue
What treatments are used in patients with HER2 positive breast cancer?
Trastuzamab
Pertuzamab
What are the side effects of tamoxifen?
Menopausal symptoms
Increased risk of endometrial cancer
Increased VTE risk
What are the options for reconstructive surgery?
Immediate reconstruction
Delayed reconstruction
What type of radiotherapy is recommended after a wide local excision?
Whole breast radiotherapy
What is the action of anastrazole?
Aromatase inhibitor - reduces the peripheral synthesis of oestrogen
What is the action of tamoxifen?
SERM (selective oestrogen receptor modulator) - partial oestrogen receptor antagonist
