Breast Cancer Flashcards
What is the most common cancer in the UK?
breast cancer
What are 8 risk factors for breast cancer?
- female
- family history
- increased oestrogen exposure (early menarche and late menopause)
- Obesity
- More dense/ glandular breast tissue
- Smoking
- Combined oral contraceptive pill
- HRT
What are 4 genes associated with increase breast cancer risk?
- BRCA 1
- BRCA 2
- TP53
- PTEN
What type of genes are the BRCA genes?
tumour suppressor genes
What chromosome is BRCA 1 found on?
Chromosome 17
WHat chromosome is BRCA 2 gene found on?
13
What other cancers does a BRCA 1 mutation increase the risk of?
- Bowel
- Prostate
What age group are offered breast cancer screening?
50-70
How often are women aged 50-70 invited for NHS breast cancer screening?
every 3 years
Give 4 high risk categories of patients who may be offered mammograms more regularly than every 3 years:
- Those with a first degree relative with breast cancer under 40 years
- Those with a first degree male relative with breast cancer
- Those with a first degree relative with bilateral breast cancer, first diagnosed under 50 years
- Those with two first degree relatives with breast cancer
Give two ways in which high risk patients can be managed for breast cancer:
1) chemoprevention
2) risk-reducing bilateral mastectomy
Give two drugs used in chemoprevention for high risk breast cancer patients:
1) tamoxifen (if premenopausal)
2) anastrozole (if post-menopausal)
What is ductal carcinoma in situ?
Malignant proliferation of cells in ducts with no invasion of the basement membrane
True or false: ductal carcinoma in situ does not have the ability to become invasive
False - it can spread slowly over years
What is lobular carcinoma in situ?
Malignant proliferation of cells in lobules with no invasion of the basement membrane which is considered precancerous
How does lobular carcinoma in situ present clinically?
it is usually asymptomatic and undetectable in mammograms
How is lobular carcinoma in situ typically diagnosed?
incidentally on breast biopsy
How is lobular carcinoma in situ managed?
Monitoring
What is the most common type of breast cancer?
Invasive ductal carcinoma (80%)
What % of breast cancers are inflammatory breast cancers?
1-3%
How does inflammatory breast cancer present?
swollen, tender and warm breasts with skin changes (similar to breast abscess or mastitis)
True or false: Paget’s disease of the nipple is considered breast cancer
true (indicates underling DCIS or invasive breast cancer)
How does Paget’s disease of the nipple present?
an erythematous scaly rash on the areolar of the breast (similar to eczema)
Give 5 general clinical presentations associated with breast cancer:
1) hard, irregular, painless and fixed lump
2) skin changes and tethering
3) nipple retraction
4) skin dimpling or oedema (peau d’orange)
5) lymphadenopathy (particularly in the axilla)
Give the 4 instances where a 2 week wait referral to breast clinic is warranted:
1) unexplained breast lump in patients aged 30+
2) unilateral nipple changes in patients aged 50+
3) unexplained lump in the axilla in patients aged 30+
4) any skin changes suggestive of breast cancer
What are the three elements of triple assessment of the breast:
1) clinical assessment (history and examination)
2) imaging (ultrasound or mammography)
3) biopsy
What are the two methods used to obtain breast biopsies?
1) fine needle aspiration
2) core biopsy
In which group of patients would ultrasound imaging be preferred to mammography when investigating breast cancer?
women under 30
In addition to triple assessment of the breast, give 3 additional investigations for breast cancer:
- Lymph node assessment
- Breast cancer receptor profiling
- Gene expression profiling
How is a lymph node assessment carried out?
1) ultrasound of the axilla
2) ultrasound guided biopsy of any abnormal nodes
What procedure may be completed during breast cancer surgery where ultrasound does not show any abnormal nodes?
sentinel lymph node biopsy
Describe how sentinel lymph node biopsy is carried out:
isotope contrast and blue dye are injected into the tumour which travels into the tumour which then travels to the nearest lymph node via lymphatic drainage, meaning that the nearest node can be identified using an isotope scanner (blue) and then biopsied
Name 3 breast cancer receptors:
- Oestrogen receptor (ER)
- Progesterone receptor (PR)
- Human epidermal growth factor (HER2)
What is Human epidermal growth factor?
is a transmembrane glycoprotein that plays a key role in cell survival, proliferation and differentiation and thus is an important oncogene in breast cancer when it is overexpressed.
Why is it useful to identify the hormone receptor status of the breast cancer?
by knowing the receptor status of the cancer we can use targeted treatments that act on these receptors
What is meant by the phrase ‘triple negative breast cancer’?
where a breast cancer does not express and oestrogen, progesterone or HER2 receptors which limits treatment options and worsens prognosis
In what specific breast cancer cases is gene expression profiling particularly important?
ER positive, HER2 negative and lymph node negative breast cancers
What staging system is used for breast cancer?
TMN
What are the 4 most common sites of metastasis in breast cancer?
1) bone
2) brain
3) lung
4) liver
What are the two surgical options for breast cancer management?
1) breast conserving surgery (wide local excision)
2) total mastectomy
(often with axillary node clearance)
Axillary node clearance increases the risk of which complication?
Chronic lymphoedema
How does chronic lymphoedema present?
impaired drainage results in swelling which is prone to infection
Give 2 ways to relieve chronic lymphoedema?
1) massage techniques
2) compression bandages
What precaution should be made when preparing to take blood/insert a cannula into a post-op breast cancer patient?
avoid taking blood or putting a cannula into the arm on the side of previous breast cancer surgery due to the increased risk of infection in this arm due to impaired drainage
Radiotherapy is often used in tandem with which type of breast surgery?
breast conserving surgery
What is meant by neoadjuvant chemotherapy?
chemotherapy before surgery
What is meant by adjuvant chemotherapy?
chemotherapy after surgery
Give 3 types of aromatase inhibitors used to treat breast cancer:
1) anastrozole
2) letrozole
3) exemestane
What class of drug is tamoxifen?
selective oestrogen receptor modulator
Describe how tamoxifen helps to manage breast cancer yet increases risk of endometrial cancer:
it blocks oestrogen receptors in breast tissue but stimulates oestrogen receptors in the uterus
Describe how aromatase inhibitors help to manage breast cancer in post menopausal women?
they act on aromatase, an enzyme found in adipose tissue that converts androgens into oestrogen (after menopause, fat tissue is the primary source of oestrogen)
How long are hormone treatments like tamoxifen and anastrozole given for?
5-10 years
Name two targeted treatments that target the HER2 receptor:
1) trastuzumab (Herceptin)
2) pertuzumab (Perjeta)
Name a tyrosine kinase inhibitor that can be used to inhibit breast cancer growth:
neratinib (nerlynx)
For how many years should breast cancer patients have surveillance mammograms after treatment?
5 years
Give 4 types of reconstructive surgeries that can be used after masectomies:
1) implants
2) latissimus dorsi flap
3) transverse rectus abdominis flap
4) deep inferior epigastric perforator flap
What is a ‘pedicled’ flap in the context of breast reconstructive surgery?
the flap has the original blood suppy
What is a ‘free’ flap in the context of breast reconstructive surgery?
the flap is made from tissue that is cut away and transplanted to a new location with a new blood supply
