Breast Cancer Flashcards
Describe the aetiology of breast cancer
It’s most common in early post menopausal women
Early menarche menstruation and late menopause - due to menstruation history of hormone exposure
Nulliparity - no children so no break from menstruation
Late pregnancy - hormone surges
Breast feeding however offsets the risks of breast cancer
How do genetic effect the ricks of breast cancer ?
Family history - carriers of the BRAC1 and BRAC2
Previous breast disease - cysts and abscesses
Alcohol and high fat consumption
HRT linked to longer time with high hormone levels
80% of breastfeeding cancers occur in what region ?
Ductal region of the breast
What is a ductal carcinoma ?
This is an early form of breast cancer which can be non-invasive but affects the whole ductal region. When not treated this can lead to cancer cell division along the whole of the ducts
What hormone has the most impact on the potential of breast cancers ?
Oestrogen
Oestrogen metabolites can build up in certain circumstances and initiate cellular changes in the breast
The properties of the hormone oestrogen can initiate the proliferation of cancer
What are the two oestrogen receptors ?
ERB (Alpha)
And
ERB (Beta)
These receptors are found in a range of tissues in the breast ovaries and endothelium
What happens to cells when oestrogen enters ?
They bind with oestrogen receptors and migrates into the nucleus. This leads to transcription proteins that indicate change within the cells
Because oestrogen has proliferation properties, it can have negative effects on patients that have large quantities of these receptors intracellularly
What is hyperplasia ?
An increase in the growth of normal cells within the tissues, causing organ growth
What is dysplasia ?
The increase of abnormal cell growth in a tissue - precancerous state
What is metaplasia ?
When one mature cell type is replaces by another mature cell type that is not indigenous to that region of tissue where it is found
Is benign and noncancerous, can become dysplasic if not treated
What is neoplasia ?
Abnormal growth of cells, known to cause tumour growths, can be benign or malignant
What is Pleo-morphism ?
The ability for some microorganisms to alter their shape or size in response to environmental conditions
What is metastasis ?
When cancer cells migrate from one part of the body to another, cancer cells where the cancer metastatic cancer hasn’t originated from
What are the two main drug pharmacodynamics of breast cancer drugs ?
To reduce the uptake of oestrogen at oestrogen receptors: SERM’s + ERD’s
Or
Reduce production of circulating oestrogen: LGRH’s + Aromatase inhibitors
What is the mode of action and side effects for SERM’s
MOA - is an oestrogen antagonist (anti-oestrogen) which competes with oestrogen receptors at the binding site in target tissues
Binds to oestrogen receptors to inhibit the uptake of oestrogen in the hippocampus
Blocks intake of oestrogen, reducing proliferation effects on breast tissue and can prevent oestrogen positive tumour growth
SE - hot flushes, fatigue, joint pain
What is the mode of action and side effects of ERD’s ?
MOA - Binds to the oestrogen receptors in cancer cells to block the uptake of oestrogen and reduce the impact on breast tissue. Degrades the oestrogen receptors.
Side effects - reaction to injection site
Nausea
Vomiting
What are the mode of action and side effects of LHRH’s
MOA - binds to Gonadotrophin releasing hormone (GnRH) receptors which decreases production of Gonadotrophin in the medulla
By blocking this action, less oestrogen will be produced
Side effects - decreased appetite
Joint pain
Headache
Depression
What is the mode of action and side effects of Aromatase inhibitors
MOA - inhibits action of the enzyme Aromatase which overs androgens into oestrogen - known as ‘aromatisation’
By blocking this enzyme, less oestrogen will be produced
Side effects - joint and muscle pain
Hot flushes
What are the signs and symptoms of breast cancer ?
Feeling or seeing a lump
Discharge/blood from nipple
Swelling of the axilla
Size/shape/colour difference of breast
Triple asssesment done by clinical assessment involves what two investigations ?
Imaging
And
Needle aspiration
These are most accurate
What is palpation ?
This is when an individual or clinical specialist feels the breast and surrounding areas for any abnormalities that could be a tell for breast carcinomas
What age is a mammography likely to be done for ?
Can show cancerous changes but better results in over 50 year olds
When is an ultrasound most useful ?
When the metastatic spread to the axilla
Why are blood tests taken when screening ?
For the patients genetic profile and to see if there are BRAC1 and 11
