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Yr 3 - Breast > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the most common cancer in the UK?

A

breast cancer

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2
Q

What are 8 risk factors for breast cancer?

A
  1. female
  2. family history
  3. increased oestrogen exposure (early menarche and late menopause)
  4. Obesity
  5. More dense/ glandular breast tissue
  6. Smoking
  7. Combined oral contraceptive pill
  8. HRT
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3
Q

What are 4 genes associated with increase breast cancer risk?

A
  1. BRCA 1
  2. BRCA 2
  3. TP53
  4. PTEN
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4
Q

What type of genes are the BRCA genes?

A

tumour suppressor genes

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5
Q

What chromosome is BRCA 1 found on?

A

Chromosome 17

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6
Q

WHat chromosome is BRCA 2 gene found on?

A

13

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7
Q

What other cancers does a BRCA 1 mutation increase the risk of?

A
  1. Bowel
  2. Prostate
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8
Q

What age group are offered breast cancer screening?

A

50-70

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9
Q

How often are women aged 50-70 invited for NHS breast cancer screening?

A

every 3 years

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10
Q

Give 4 high risk categories of patients who may be offered mammograms more regularly than every 3 years:

A
  1. Those with a first degree relative with breast cancer under 40 years
  2. Those with a first degree male relative with breast cancer
  3. Those with a first degree relative with bilateral breast cancer, first diagnosed under 50 years
  4. Those with two first degree relatives with breast cancer
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11
Q

Give two ways in which high risk patients can be managed for breast cancer:

A

1) chemoprevention
2) risk-reducing bilateral mastectomy

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12
Q

Give two drugs used in chemoprevention for high risk breast cancer patients:

A

1) tamoxifen (if premenopausal)
2) anastrozole (if post-menopausal)

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13
Q

What is ductal carcinoma in situ?

A

Malignant proliferation of cells in ducts with no invasion of the basement membrane

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14
Q

True or false: ductal carcinoma in situ does not have the ability to become invasive

A

False - it can spread slowly over years

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15
Q

What is lobular carcinoma in situ?

A

Malignant proliferation of cells in lobules with no invasion of the basement membrane which is considered precancerous

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16
Q

How does lobular carcinoma in situ present clinically?

A

it is usually asymptomatic and undetectable in mammograms

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17
Q

How is lobular carcinoma in situ typically diagnosed?

A

incidentally on breast biopsy

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18
Q

How is lobular carcinoma in situ managed?

A

Monitoring

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19
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma (80%)

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20
Q

What % of breast cancers are inflammatory breast cancers?

A

1-3%

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21
Q

How does inflammatory breast cancer present?

A

swollen, tender and warm breasts with skin changes (similar to breast abscess or mastitis)

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22
Q

True or false: Paget’s disease of the nipple is considered breast cancer

A

true (indicates underling DCIS or invasive breast cancer)

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23
Q

How does Paget’s disease of the nipple present?

A

an erythematous scaly rash on the areolar of the breast (similar to eczema)

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24
Q

Give 5 general clinical presentations associated with breast cancer:

A

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)

25
Q

Give the 4 instances where a 2 week wait referral to breast clinic is warranted:

A

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

26
Q

What are the three elements of triple assessment of the breast:

A

1) clinical assessment (history and examination)
2) imaging (ultrasound or mammography)
3) biopsy

27
Q

What are the two methods used to obtain breast biopsies?

A

1) fine needle aspiration
2) core biopsy

28
Q

In which group of patients would ultrasound imaging be preferred to mammography when investigating breast cancer?

A

women under 30

29
Q

In addition to triple assessment of the breast, give 3 additional investigations for breast cancer:

A
  1. Lymph node assessment
  2. Breast cancer receptor profiling
  3. Gene expression profiling
30
Q

How is a lymph node assessment carried out?

A

1) ultrasound of the axilla
2) ultrasound guided biopsy of any abnormal nodes

31
Q

What procedure may be completed during breast cancer surgery where ultrasound does not show any abnormal nodes?

A

sentinel lymph node biopsy

32
Q

Describe how sentinel lymph node biopsy is carried out:

A

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

33
Q

Name 3 breast cancer receptors:

A
  1. Oestrogen receptor (ER)
  2. Progesterone receptor (PR)
  3. Human epidermal growth factor (HER2)
34
Q

What is Human epidermal growth factor?

A

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.

35
Q

Why is it useful to identify the hormone receptor status of the breast cancer?

A

by knowing the receptor status of the cancer we can use targeted treatments that act on these receptors

36
Q

What is meant by the phrase ‘triple negative breast cancer’?

A

where a breast cancer does not express and oestrogen, progesterone or HER2 receptors which limits treatment options and worsens prognosis

37
Q

In what specific breast cancer cases is gene expression profiling particularly important?

A

ER positive, HER2 negative and lymph node negative breast cancers

38
Q

What staging system is used for breast cancer?

A

TMN

39
Q

What are the 4 most common sites of metastasis in breast cancer?

A

1) bone
2) brain
3) lung
4) liver

40
Q

What are the two surgical options for breast cancer management?

A

1) breast conserving surgery (wide local excision)
2) total mastectomy
(often with axillary node clearance)

41
Q

Axillary node clearance increases the risk of which complication?

A

Chronic lymphoedema

42
Q

How does chronic lymphoedema present?

A

impaired drainage results in swelling which is prone to infection

43
Q

Give 2 ways to relieve chronic lymphoedema?

A

1) massage techniques
2) compression bandages

44
Q

What precaution should be made when preparing to take blood/insert a cannula into a post-op breast cancer patient?

A

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

45
Q

Radiotherapy is often used in tandem with which type of breast surgery?

A

breast conserving surgery

46
Q

What is meant by neoadjuvant chemotherapy?

A

chemotherapy before surgery

47
Q

What is meant by adjuvant chemotherapy?

A

chemotherapy after surgery

48
Q

Give 3 types of aromatase inhibitors used to treat breast cancer:

A

1) anastrozole
2) letrozole
3) exemestane

49
Q

What class of drug is tamoxifen?

A

selective oestrogen receptor modulator

50
Q

Describe how tamoxifen helps to manage breast cancer yet increases risk of endometrial cancer:

A

it blocks oestrogen receptors in breast tissue but stimulates oestrogen receptors in the uterus

51
Q

Describe how aromatase inhibitors help to manage breast cancer in post menopausal women?

A

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)

52
Q

How long are hormone treatments like tamoxifen and anastrozole given for?

A

5-10 years

53
Q

Name two targeted treatments that target the HER2 receptor:

A

1) trastuzumab (Herceptin)
2) pertuzumab (Perjeta)

54
Q

Name a tyrosine kinase inhibitor that can be used to inhibit breast cancer growth:

A

neratinib (nerlynx)

55
Q

For how many years should breast cancer patients have surveillance mammograms after treatment?

A

5 years

56
Q

Give 4 types of reconstructive surgeries that can be used after masectomies:

A

1) implants
2) latissimus dorsi flap
3) transverse rectus abdominis flap
4) deep inferior epigastric perforator flap

57
Q

What is a ‘pedicled’ flap in the context of breast reconstructive surgery?

A

the flap has the original blood suppy

58
Q

What is a ‘free’ flap in the context of breast reconstructive surgery?

A

the flap is made from tissue that is cut away and transplanted to a new location with a new blood supply

Yr 3 - Breast (4 decks)

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