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Breast > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

What are some risk factors for developing breast cancer?

A
  • Increased Hormone exposure
  • Susceptibility gene mutations
  • Older age
  • Caucasian
  • Obesity
  • Alcohol and Tobacco use
  • Hx of Breast cancer
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2
Q

How does increased Hormone exposure lead to an increased risk of Breast Cancer?

A
  • Increased oestrogen exposure (earlier onset of periods and later menopause)
  • Oral contraceptive pill (Risk back to normal after 10 yrs off pill)
  • HRT (especially Combined HRT - Oestrogen + Progesterone)
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3
Q

What are the most commonly associated gene mutations in Breast Cancer?

A

BRCA mutations (BRCA1 / BRCA2)

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4
Q

Where is the BRCA1 Gene located?

A

On chromosome 17

Patients with a Faulty Gene here:
Around 70% will develop breast cancer by aged 80
Around 50% will develop ovarian cancer
Also increased risk of bowel and prostate cancer

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5
Q

Where is the BRCA2 Gene located?

A

On Chromosome 13

Patients with a Faulty gene here:
Around 60% will develop breast cancer by aged 80
Around 20% will develop ovarian cancer

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6
Q

What are some common types of Breast Cancers?

A
  • Invasive Ductal Carcinoma (IDC)
  • Invasive Lobar Carcinoma (ILC)
  • Ductal Carcinoma In Situ (DCIS)
  • Lobar Carcinoma in Situ (LCIS)
  • Inflammatory Breast Cancer (IBC)
  • Triple-Negative Breast Cancer (TNBC)
  • Pagets Disease of the Nipple
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7
Q

What is the most common type of Breast Cancer?

A

An Invasive Ductal Carcinoma (IDC)
- Accounts for 80% of all breast cancers.

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8
Q

Where does An Invasive Ductal Carcinoma start?

A

Starts in the Milk Ducts and invades through into the fatty tissue of the breast.

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9
Q

Where does an Invasive Lobular carcinoma arise from?

A

Begins in the MILK-PRODUCING Glands (LOBULES) and can spread to other parts of the body

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10
Q

What percentage of Breast cancers do Invasive Lobular Carcinomas make up?

A

around 10%

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11
Q

What is a Ductal Carcinoma In situ?

A

A non-invasive or Pre-Invasive cancer where the cells are confined to the ducts in the breast and have not spread to the surrounding Breast tissue.

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12
Q

What is a Lobular carcinoma in Situ?

A

Not a Cancer - Instead an area of abnormal cell growth that increases a person’s risk of developing invasive breast cancer later.

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13
Q

Which Cancer causes the lymph vessels in the skin of the breast to become blocked?

A

An Inflammatory Breast cancer
- Rare but aggressive type of breast cancer.

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14
Q

What is Paget’s disease of the Nipple?

A

Breast cancer involving the Neoplasm

  • Usually presents as a dry, scaly, eczematous lesion
  • Can also present as an erythematous weeping lesion on the surface of the nipple and the areola
  • There is often an underlying palpable mass or a radiological abnormality
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15
Q

What is the clinical presentation of Breast cancers?

A

Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)
Lymphadenopathy, particularly in the axilla

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16
Q

When is Breast screening done in the UK?

A

Women Between the ages of 50 and 70 every 3 years.
(women over 70 can still ask to be screened every 3)

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17
Q

Once a patient has been referred for specialist services under 2 week wait for suspected cancer, they should typically receive a triple diagnostic assessment comprising…?

A
  • Clinical assessment (history and examination)
  • Imaging (ultrasound or mammography)
  • Biopsy (fine needle aspiration or core biopsy)
18
Q

What is the preferred management of Breast Cancer?

A

Breast conserving surgery is the preferred treatment - wide local excision with or without an oncoplastic procedure to shape the breast

19
Q

What Surgical Options are there in Breast cancer?

A

Mastectomy, with sentinel node biopsies for invasive cancers. Possibly also axillary node clearance for positive nodes.
(women with mastectomy are automatically candidates for Breast Reconstruction)

20
Q

What Adjuvant Treatments are available in Breast cancer management?

A
  • Adjuvant hormonal therapy is offered if tumours are positive for oestrogen receptors. - Tamoxifen used typically in pre-menopausal patients. - Aromatase inhibitors forpost-menopausal patients
  • Immunotherapy may be used in patients whose cancersexpress specific growth factor receptors
    • Herceptin for HER-2
    • Bevacizuman for VEGF
    • Lapatibin for EGFR and HER-2

Chemotherapy (before or after surgery)

21
Q

What is A HER2-positive Breast Cancer?

A

A cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells.

Tends to be more aggressive.
May respond well to Therapies which can block HER2.

22
Q

What is A triple Negative Breast Cancer?

A

This type lacks oestrogen receptors, progesterone receptors, and does not have an excess of the HER2 protein on the cancer cell surfaces.

Tends to be Aggressive.
Not many targeted treatments available.

23
Q

How should a lady <35yrs with a breast lump be investigated?

A

With an Ultrasound rather than Mammography

24
Q

What is the main imagine modality used to investigate breast lumps?

A

Mammogram

25
Q

How should Patients <40 be investigated if they have a high risk of Breast cancer but are otherwise asymptomatic?

A

Ultrasound - Women under 40 tend to have denser breast tissue and so Mammography doesn’t work so well.

26
Q

How should a lady (36yrs) with a breast lump be investigated?

A

Mammogram.
- First line for investigating patients with Breast lumps >35yrs.

27
Q

What other Tx should a patient who has received WLE for a breast tumour get?

A

Adjuvant Radiotherapy
- Should be offered to all patients who receive WLE.

28
Q

What type of lesion should be suspected in a breast lesion that is fixed?

A

Invasive breast cancer
- May have invaded into the pectoralis major muscle.

29
Q

What Medical Tx should a patient receive if they have a breast cancer which is Oestrogen Receptor +ve? (They are 50 yrs old)

A

Tamoxifen
- Used in Pre / Peri-menopausal Women

30
Q

How does Tamoxifen slow growth of Oestrogen sensitive Breast tumours?

A

It Inhibits oestrogen receptors on the breast cancer.
- “a Selective Oestrogen receptor Modulator”

31
Q

In which patients should Tamoxifen be Avoided?

A

In Post Menopausal women
- Increases risk of Endometrial cancer

32
Q

What type of TX should be given to a Post-menopausal lady with an Oestrogen Sensitive Breast tumour?

A

Antastrozole (Aromatase Inhibitor)

33
Q

What type of drug is Antastrozole?

A

An Aromatase inhibitor which works by reducing the levels of Oestrogen in post-menopausal women.

(Aromitisation is how the majority of Post-menopausal women make their oestrogen)

34
Q

Which Breast cancer patients should be given Trastuzumab (Herceptin)?

A

HER2 +ve breast cancer patients.
- either as neoadjuvant to downstage the tumour or as part of the overall Tx regime.

35
Q

What is a Radial Scar?

A

A Benign Breast condition
- Describes Idiopathic Sclerosing hyperplasia of the Breast Ducts.

36
Q

How do Patients usually present with a Bengin Radial Scar?

A

Usually Asymptomatic

Radial Scar Breast lesions are usually caught incidentally on Screening.

37
Q

What type of Breast lesion Shows as a Star or Rosette shaped lesion with a translucent centre on Mammography?

A

Radial Scar.

38
Q

What type of breast lesion appears as Long, fine, linear branching structures on mammogram?

A

Ductal Carcinoma in Situ
- A casting-type calcification

39
Q

How does Lobar calcification in situ usually present on mammography?

A

Doesn’t display any particular abnormalities on mammogram.

Non-specific breast calcifications usually trigger biopsy which then diagnoses LCIS

40
Q

How should a lady presenting with unilateral nipple discharge at 51 yrs of age be managed?

A

NICE recommends a 2 wk wait referral for Triple Assessment for all patients >50 yrs with unilateral nipple discharge.

41
Q

What is Cyclical Mastalgia?

A

Breast pain occurring with fluctuations of hormones during the menstrual cycle.

42
Q

In which phase of the menstrual cycle does Cyclical Mastalgia usually present?

A

The Luteal Phase

Breast (2 decks)

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