Breast cancer Flashcards
What is the incidence of breast cancer?
1 in 8 patients, around 12% will have breast cancer in their lifetime
What are the main causes of breast cancer?
- Uninterrupted oestrogen exposure
a. Nulliparity or having first child late
b. Use of HRT
c. Obesity
d. BRCA1 and BRCA2
e. P53 tumour supressor gene mutation - Lifestyle
a. over 14 units of alcohol per week
b. smoking cigarettes
c. diet
Why are BRCA1 and BRCA2 genes important to know about?
- Usually there is a history of ovarian and breast cancer at a young age in the family
- Genetic screening can be used to inform patients if they have this gene
How may breast cancer present?
- Lump/mass
- Skin tethering
- Dimpling/skin changes
- Nipple discharge
- Nipple inversion
- Erythema and swelling
What is the screening process for breast cancer?
Women ages 50 - 70 are to have a mammogram every 3 years. If high risk, they will have a yearly mammogram. The results take 14 days to come back.
What is triple assessment in breast cancer?
- Examination and history
a. How long?
b. Skin and nipple changes?
c. Menstrual cycle related?
d. Family hx?
e. Axillae lumps?
f. Past medical hx? - Imaging
a. Mammogram
b. USS
c. CT/MRI - Biopsy
a. Fine needle aspiration (FNA)
b. Core biopsy
What are the important prognostic factors in breast cancer?
Prognosis is worse if the tumour is ER negative and if it is HER-2 Positive
Prognosis is often worse if the patient is very young or very old (biologically unfavourable type of cancer)
What treatment is given for that of curative intent in breast cancer?
Surgery, adjuvant systemic tx e.g. chemotherapy. Local treatment/neo-adjuvant chemotherapy followed by surgery.
The type of surgery is dependent on the grading of the tumour. Can be a wide local excision, mastectomy or sentinel node biopsy.
What treatments given for palliative care? “Best supportive care”
Analgesia and chemotherapy to reduce the size of the disease and reduce pain to improve quality of life
Why is adjuvant chemo/radio therapy used? How does it work?
Used along side surgical intervention to eradicate any micro-metastatic disease before it becomes macroscopic metastases e.g. radiotherapy targeted at the breast tumour and adjuvant chemo for lung, bones and liver mets.
How does Tamoxifen work?
Tamoxifen blocks oestrogen from being over-expressed. It acts by fitting onto the protein surface by mimicking oestrogen.
What is the biggest side effect of tamoxifen?
Increased thrombotic risk. If a patient is very breathless, this is a red flag for pulmonary embolism and DVT.
Other than Tamoxifen, what treatments are available for oestrogen receptor associated cancer?
Oophrectomy - removal of both ovaries.
Anastrozole - blocks oestrogen production in women who has already gone through natural menopause.
What is HER-2 positive breast cancer?
A protein called human epidermal growth factor receptor 2 (HER2). This protein is overexpressed and causes growth of tumour cells.
In about 1 of every 5 breast cancers, the cancer cells have extra copies of the gene that makes the HER2 protein. HER2-positive breast cancers tend to be more aggressive than other types of breast cancer.
Which drugs are used to treat HER-2 positive cancers? Why are they used?
- Tastuzumab and Pertuzumab
- They are monoclonal antibodies against HER2 proteins
- They are a very specific treatment, not chemotherapy (Systemic)
