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Popular SAQ topics > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is Ductal Carcinoma In situ (DCIS)? (3)

A

Describes a non-invasive ductal carcinoma of breast tissue.

Characterised by no penetration of the basement membrane and the absence of stromal invasion.

Is preceded by ductal atypia.

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1
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinomas

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2
Q

Give 1 subtype of DCIS and describe how it’s characterised

A

Comedocarcinoma

Characterised by central necrosis

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3
Q

Name 4 types of breast cancer

A

Invasive Ductal Carcinoma (most common)

Invasive lobular carcinoma

Ductal carcinoma in-situ (DCIS)

Lobular carcinoma in situ (LCIS)

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4
Q

What may be seen on mammography in DCIS?

A

Grouped microcalcifications

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5
Q

Give 4 clinical features of breast cancer

A

Lumps (Hard, irregular, painless or fixed in place)

Nipple retraction, inversion or blood tinged discharge

Skin dimpling or oedema (Peau d’orange)

Axillary Lymphadenopathy

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6
Q

Give 5 risk factors for breast cancer

A

Female

Increased oestrogen exposure

Family history (BRCA1/2 genes)

Smoking

Obesity

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7
Q

What chromosome is BRCA1 located?

A

Chromosome 17

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8
Q

What chromosome is BRCA2 located?

A

Chromosome 13

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9
Q

Between what ages is breast cancer screening (mammography) offered and repeated for women?

A

Offered between ages of 50-70. Mammography is offered every 3 years

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10
Q

What is the referral wait time and criteria for suspected breast cancer? (2)

A

2 week wait

Unexplained breast lump in patients >30

Unexplained nipple changes in patients >50 (discharge, retractions ect)

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11
Q

What criteria would make a patient high risk for breast cancer? (4)

A

1st degree relative with breast cancer <40 years old

1st degree male relative with breast cancer

1st degree relative with bilateral breast cancer, first diagnosed <50 years old

2 1st degree relatives with breast cancer

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12
Q

Give 2 medications used for breast cancer chemoprevention (in high risk patients) and state whom they are offered to.

A

Tamoxifen - Offered to premenopausal women

Anastrozole (aromatase inhibitor) - Offered to postmenopausal women

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13
Q

Give 1 contraindication for Anastrozole use as a chemopreventant.

A

Severe osteoporosis

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14
Q

What 3 factors make up the triple diagnostic assessment in breast cancer?

A

Clinical assessment (history and examination)

Imaging (ultrasound or mammography)

Biopsy (fine needle aspiration or core biopsy)

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15
Q

What 3 receptors are sampled for in all invasive breast cancers? (Found on immunohistochemistry)

A

Oestrogen receptors (ER)

Progesterone Receptors (PR)

Human Epidermal Growth Factor 2 (HER2)

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16
Q

Describe lymph node assessment in breast cancer (imagining used (2) and management offered (2)) (4)

A

Ultrasound of the axilla (looking for abnormal lymph nodes)

If abnormal lymph nodes are found, an Ultrasound guided needle biopsy is performed

If -ve then sentinel node biopsy is performed during surgery

If +ve then axillary clearance is performed during surgery

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17
Q

Give 1 common complication of axillary clearance

A

Chronic lymphoedema in affected arm

18
Q

How is chronic lymphoedema managed following axillary clearance? (3)

A

Massage techniques (manual lymphatic drainage)

Compression bandages

Weight loss (if overweight)

19
Q

Name 2 tools used to predict prognosis/survival in Breast Cancer

A

PREDICT

Nottingham Prognostic Index (NPI)

20
Q

What 10 factors does PREDICT measure (breast cancer)

A

o DCIS or LCIS
o Age at diagnosis
o Post menopausal
o ER status
o HER2/ERRB2 status
o Ki-67 status
o Invasive tumour size (mm)
o Tumour grade
o Detected by
o Positive nodes

21
Q

What 4 organs does breast cancer commonly metastasize?

A

2Ls 2Bs

Lungs
Liver
Bones
Brain

22
Q

What criteria would suggest having a mastectomy over breast conserving surgery (wide local excision) (5)

A

Multifocal tumour

Central Tumour

Large Lesion in a small breast

DCIS >4cm

Patient choice

23
Q

What criteria would suggest having Breast Conserving Surgery (wide local excision) over a mastectomy? (5)

A

Solitary lesion

Peripheral tumour

Small lesion in a large breast

DCIS <4cm

Patient choice

24
Q

In breast cancer, who may tamoxifen therapy be offered to? (2)

A

Men and post-menopausal women with ER positive invasive breast cancer

Women at low risk of disease recurrence or when aromatase inhibitors aren’t tolerated

25
Q

In breast cancer, who may aromatase inhibitors (anastrozole) be offered to?

A

Offered to women at medium-high risk of disease recurrence

26
Q

When should tamoxifen be switched to an aromatase inhibitor?

A

After 5 years of treatment

27
Q

Give 4 complications of endocrine therapy in breast cancer (tamoxifen/aromatase inhibitors) (4)

A

Endometrial cancer

Osteoporosis

Toxicity

Phlebitis (inflammaiton of a vein)

28
Q

Name 2 types of breast reconstruction

A

Latissimus dorsi myocutaneous flap

Sub perctoral implants

29
Q

What are the 1st and 2nd line investigations for breast cancer during pregnancy?

A

1st line - Ultrasound

2nd line - Mammography (if ultrasound indicates cancer)

30
Q

Why is ultrasound guided biopsy favoured over cytology in breast cancer diagnosis during pregnancy?

A

Proliferative changes during pregnancy render cytology inconclusive

31
Q

Why should breast reconstruction be delayed in pregnancy (breast cancer)

A

To avoid prolonged anaesthesia

32
Q

In breast cancer, if pre-operative axillary ultrasound is negative, what should be offered?

A

Sentinel node biopsy

33
Q

In breast cancer, if pre-operative axillary ultrasound is positive, what should be offered?

A

Axillary node clearance

34
Q

Radiotherapy is contraindicated in pregnancy (until delivery of the fetus), unless? (2)

A

Life saving

To preserve organ function (spinal cord compression)

35
Q

What 2 breast cancer medications are contraindicated in pregnancy?

A

Tamoxifen

Trastuzumab (MAB against HER2/neu receptor)

36
Q

What type of drug is Trastuzumab? (breast cancer)

A

MAB against HER2/neu

37
Q

When can women start breast feeding after tamoxifen/trastuzumab treatment?

A

14 days after stopping the drug

38
Q

What breast cancer prognostic tool is used to provide an indication of survival?

A

Nottingham Prognostic Index (NPI)

39
Q

How is the Notingham Prognostic Index (NPI) calculated?

A

Uses tumour size x 0.2 + lymph node score + grade score

40
Q

How is the lymph node score (NPI) calculated? (3)

A

Lymph nodes involved 0 = score 1 (grade 1)

Lymph nodes involved 1-3 = score 2 (grade 2)

Lymph nodes involved >3 = score 3 (grade 3)

41
Q

What is the % 5 year survival for an NPI Score 2.0-2.4? (lowest)

A

93%

42
Q

What is the % 5 year survival for an NPI Score 3.5-5.4

A

70%

43
Q

What is the % 5 year survival for an NPI Score >5.4 (highest)

A

50%

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