Breast Cancer Flashcards
Breast cancer is the most common cancer in women. What is the aprox number of invasive breast cancers in the UK each year?
1 - 60
2 - 600
3 - 6000
4 - 60,000
4 - 60,000
Breast cancer is the most common cancer in women. What is the aprox number of non-invasive breast cancers in the UK each year?
1 - 80-90
2 - 800-900
3 - 8000-9000
4 - 80,000-90,000
3 - 8000-9000
What % of women diagnosed with breast cancer will survive beyond 10 years?
1 - 7.6%
2 - 27.6%
3 - 57.6%
4 - 76%
4 - 76%
Which of the following is NOT a risk factor for breast cancer?
1 - age (>70)
2 - oestrogen exposure (COC)
3 - obesity
4 - alcohol
5 - hypertension
6 - ethnicity (highest in black women)
7 - higher socioeconomic group
8 - previous hodgkin lymphoma
5 - hypertension
The following are risk factors for breast cancer, but which is the largest risk factor?
1 - age (>70)
2 - oestrogen exposure
3 - obesity
4 - alcohol
5 - ethnicity (highest in black women)
6 - higher socioeconomic group
7 - previous hodgkin lymphoma
1 - age (>70)
Why is it important to know when a woman has menarche (1st period)?
1 - before this women are not at risk of breast cancer
2 - oestrogen exposure is a risk factor for breast cancer
3 - women who have delayed menarche will not develop breast cancer
2 - oestrogen exposure is a risk factor for breast cancer
- late menopause is also a risk as the patient will continue to have more exposure to estrogen
Breast cancer has a genetic risk associated with it. Which group of patients are at highest risk?
1 - asians
2 - ashkenazi jews
3 - caucasians
4 - muslims
2 - ashkenazi jews
Are all neoplasias malignant?
- no
- can be benign and not invade other tissues
The range of neoplastic disease ranges from cellular atypia through carcinoma in situ to invasive disease. What is cellular atypia?
1 - cells with abnormal morphology growing rapidly
2 - normal cells growing rapidly
3 - cells growing in size and number
4 - too many cells present
1 - cells with abnormal morphology growing rapidly
What is the most common 2 week referral pathway from GPs?
1 - colon cancer
2 - breast cancer
3 - lung cancer
4 - pancreatic cancer
2 - breast cancer
Breast cancer is the most common cancer in women. What is the aprox number of invasive breast cancers in the UK each year?
1 - 60
2 - 600
3 - 6000
4 - 60,000
4 - 60,000
Breast cancer is the most common cancer in women. What is the aprox number of non-invasive breast cancers in the UK each year?
1 - 80-90
2 - 800-900
3 - 8000-9000
4 - 80,000-90,000
3 - 8000-9000
What % of women diagnosed with breast cancer will survive beyond 10 years?
1 - 7.6%
2 - 27.6%
3 - 57.6%
4 - 76%
4 - 76%
Which of the following is NOT a risk factor for breast cancer?
1 - age (>70)
2 - oestrogen exposure
3 - obesity
4 - alcohol
5 - hypertension
6 - ethnicity (highest in black women)
7 - higher socioeconomic group
8 - previous hodgkin lymphoma
5 - hypertension
The following are risk factors for breast cancer, but which is the largest risk factor?
1 - age (>70)
2 - oestrogen exposure
3 - obesity
4 - alcohol
5 - ethnicity (highest in black women)
6 - higher socioeconomic group
7 - previous hodgkin lymphoma
1 - age (>70)
Why is it important to know when a woman has menarche (1st period)?
1 - before this women are not at risk of breast cancer
2 - oestrogen exposure is a risk factor for breast cancer
3 - women who have delayed menarche will not develop breast cancer
2 - oestrogen exposure is a risk factor for breast cancer
- late menopause is also a risk as the patient will continue to have more exposure to estrogen
Breast cancer has a genetic risk associated with it. Which group of patients are at highest risk?
1 - asians
2 - ashkenazi jews
3 - caucasians
4 - muslims
2 - ashkenazi jews
Are all neoplasias malignant?
- no
- can be benign and not invade other tissues
The range of neoplastic disease ranges from cellular atypia through carcinoma in situ to invasive disease. What is cellular atypia?
1 - cells with abnormal morphology growing rapidly
2 - normal cells growing rapidly
3 - cells growing in size and number
4 - too many cells present
1 - cells with abnormal morphology growing rapidly
What is the most common 2 week referral pathway from GPs?
1 - colon cancer
2 - breast cancer
3 - lung cancer
4 - pancreatic cancer
2 - breast cancer
Patients of a certain age will require a mammogram screening every 3 years at what age?
1 - >40
2 - >50
3 - >60
4 - >70
2 - >50
- typically get invited between 50-53 years of age
- stops at age 71
Screening involves 2 X-rays of each breast
How many breast cancers are detected via the breast cancer screening pathway?
1 - 1:3
2 - 1:10
3 - 1:20
4 - 1:100
1 - 1:3
Which of the following patients would be referred on a 2-week referral for a breast cancer assessment?
1 - 21 year old with pain in breast
2 - 30 year old with discharge in both nipples
3 - 25 year old with breast lump and pain
4 - 30 years old with breast lump with or without pain
4 - 30 years old with breast lump with or without pain
Criteria:
>30 years, unexplained breast lump with/without pain
> 50 years with any of the following symptoms in one nipple:
- Discharge
- Retraction
- Other changes of concern
The criteria for a 2 week breast assessment referral is:
> 30 years, unexplained breast lump with/without pain
50 years with any of the following symptoms in one nipple:
- Discharge
- Retraction
- Other changes of concern
Is this criteria definitive?
- No
Consider referral in the following:
- skin changes that suggest breast cancer
- >30 with an unexplained lump in the axilla
- non-urgent referralin people aged < 30 years with an unexplained breast lump with or without pain
What % of breast lumps in women between 20-50 y/o are benign?
1 - 0.9%
2 - 9%
3 - 49%
4 - >90%
4 - >90%
- patients always think malignancy
- if lump is present we do triple therapy (CRP)
- C = Clinical examination and given a ’P’ or ‘E’ code (palpation/examination, respectively)
- R = Radiographic Imaging assessment and given a ‘M’ code (mammogram) and ‘U’ code (ultrasound)
- P = Pathophysiological biopsy if appropriate ‘B’ code (biopsy)
In patients with a BRCA1 or 2 mutation they will be screening annually. If they are aged >40 they will receive mammogram. if they are aged 30-49 they will receive what?
1 - ultrasound
2 - X-ray
3 - MRI
4 - PET
3 - MRI (most sensitive)
- ultrasound if MRI not possible
- mammogram not as sensitive on dense tissue (young breasts contain a lot of lobules that appear white on mammogram)
Are all suspected malignancies screened with mammogram detected?
- no
- of 10,000 screenings 500-700 women are recalled for reassessment
Why is it important to know when a woman has menarche (1st period)?
1 - before this women are not at risk of breast cancer
2 - oestrogen exposure is a risk factor for breast cancer
3 - women who have delayed menarche will not develop breast cancer
2 - oestrogen exposure is a risk factor for breast cancer
Early menarche and late menopause increases exposure to oestrogen
Also need to ask about breast feeding (reduces risk)
55 year old post-menopausal lady presents to GP with a lump in her left breast. Which of the following are important to ask about in her history?
1 - IUD (copper coil)
2 - IUS 9 progesterone only)
3 - progesterone only pill
4 - combined oral contraceptive pill
4 - combined oral contraceptive pill
Increased exposure to oestrogen increases the risk of breast cancer
Breast cancer has a genetic risk associated with it. Which group of patients are at highest risk?
1 - asians
2 - ashkenazi jews
3 - caucasians
4 - muslims
2 - ashkenazi jews
What is neoplasis?
1 - rapid increase in cell number
2 - cells grow in size but not number
3 - cells grow in number, but abnormally and die like other cells
4 - cells grow in number, but abnormally and do not die like other cells
4 - cells grow in number, but abnormally and do not die like other cells
Are all neoplasias malignant?
- no
- can be benign and not invade other tissues
The range of neoplastic disease ranges from cellular atypia through carcinoma in situ to invasive disease. What is cellular atypia?
1 - cells with abnormal morphology growing rapidly
2 - normal cells growing rapidly
3 - cells growing in size and number
4 - too many cells present
1 - cells with abnormal morphology growing rapidly
There are a number of genetic risk factors for developing breast cancer. Which of the following is NOT a genetic risk factor for breast cancer?
1 - BRCA1
2 - BRCA2
3 - TP53
4 - HER2
5 - CA19-9
5 - CA19-9
- BRCA1 and BRCA2 can also cause endometrial, ovarian and pancreatic cancer
Only 6% of breast cancer is linked to genetics
The breast cancer type 1 and 2 genes (BRCA1 and 2) are tumour suppressor genes. Mutations in these mean tumours will continue to grow unchecked. Are these autosomal dominant or recessive?
- dominant
- meaning only 1 mutated gene is required to increase risk of cancer
The breast cancer type 1 and 2 genes are tumour suppressor genes. Mutations in these mean tumours will continue to grow unchecked. Is BRCA 1 or 2 more common?
- BRCA 1
In a patient who is 35, has a breast lump and has risk factors for breast cancer, which is 1st line imaging that should be requested?
1 - Ultrasonography
2 - MRI
3 - Mammogram
4 - CT scan
1 - Ultrasonography
Mammogram best in >40
MRI best if implants are present
Breast cancer is typically divided into 2 types affecting either ductal epithelium or lobular epithelium. Which is more common?
- ductal epithelium
- accounts for 85-90%
Which of the following defines a stage 2 invasive breast cancer?
1 - poorly differentiated
2 - well differentiated
3 - moderately differentiated
3 - moderately differentiated
A 55 year old post-menopausal lady presents to GP with a lump in her left breast. She has triple assessment and receives the following score: Left P4, M5,U4
A 55 year old post-menopausal lady presents to GP with a lump in her left breast. She has triple assessment and is told she has grade III invasive ductal carcinoma. She is also told she has ER8 PR8 HER2+. Is the ER8 PR8 HER2 a good or bad thing?
- Good thing
These can all be targetted specifically in treating the cancer
ER = estrogen receptors
PR = progesterone receptors
HER2 = human epidermal growth factor receptor 2)
If a patient has
In surgery for breast cancer the aim is always to achieve local control. What surgery is generally given for ductal carcinoma in-situ (DCIS)?
1 - mastectomy, axially node biopsy and radiotherapy
2 - wide local excision
3 - wide local excision + radiotherapy
4 - wide local incision + radiotherapy and axillary node biopsy
3 - wide local excision + radiotherapy
In surgery for breast cancer the aim is always to achieve local control. What surgery is generally given for invasive disease?
1 - mastectomy, axially node biopsy and radiotherapy
2 - wide local excision
3 - wide local excision + radiotherapy
4 - wide local incision + radiotherapy and axillary node biopsy
1 - mastectomy, axially node biopsy and radiotherapy
or
4 - wide local incision + radiotherapy and axillary node biopsy
Patients with breast surgery can have adjuvant breast radiotherapy, which reduces the risk of reoccurrence following a wide local incision surgery. Is this typically given before or after chemotherapy?
- after chemotherapy
A sentinel biopsy can be performed if we are concerned a patients breast cancer has spread. What is the sentinel lymph node?
1 - closest lymph node to tumour
2 - 1st lymph node cancer spreads and has to pass to move to different area
3 - lymph node metastasis are stopped at
2 - 1st lymph node cancer spreads and has to pass to move to different area
Axillary lymph nodes drains 85% of the lymphatic drainage from all quadrants of the breast
If sentinel has metastasis then distal lymph nodes need removing
In addition to analysing if the biopsy is carcinoma in situ or invasive, we can also look at molecular markers. Which of the following is NOT a common marker looked for in breast biopsy?
1 - human epidermal growth factor receptor 2 (HER-2) receptors
2 - cancer antigen 19-9 (CA19-9) receptors
3 - estrogen receptors
4 - progesterone receptors
2 - Cancer antigen 19-9 (CA19-9) receptors
This is a marker for pancreatic cancer
- if these come back positive then this is good as we can treat with immunotherapy
- Herceptin is given for HER-2 positive cancers
Is the recurrence of breast cancer predictable?
- no
- can be long term (>5 years)
Disease severity and staging determines the 5 year prognosis of a patient with breast cancer.The 5 year survival in stage 1 breast cancer is 98%. What is the 5 year survival for metastatic disease?
1 - 0.25%
2 - 2.5%
3 - 25%
4 - 50%
3 - 25%
- patients normally treated pallatively
Which if the following is NOT commonly associated with a poor prognosis in breast cancer?
ER = estrogen receptor
PR = progesterone receptor
1 - high grade cancer/metastatic disease
2 - young age at diagnosis (normally aggressive)
3 - triple positive (HER-2, ER and PR)
4 - axillary lymph node involvement
3 - triple positive (HER-2, ER and PR)
- this is good it means we can treat
- negative would be bad
Tamoxifen is an selective adjuvant hormonal therapy (used to provide a small benefit alongside main treatment) anti-oestrogen drug that competes with oestrogen at the oestrogen receptor on the breast cancer. Which of the following women will this NOT be effective as a treatment in?
1 - 49 y/o postmenopausal woman ER+
2 - 53 y/o postmenopausal woman ER+
3 - 35 y/o pretmenopausal woman ER+
4 - 39 y/o woman ER+
4 - 39 y/o woman ER+
Typically only works in women who are pre or postmenopausal
Given for between 5-10 years
Tamoxifen is an selective adjuvant hormonal therapy (used to provide a small benefit alongside main treatment) anti-oestrogen drug that competes with oestrogen at the oestrogen receptor on the breast cancer. Which of the following is NOT a common side effect of this medication?
1 - hot flushes
2 - arthralgia
3 - weight loss
4 - mood changes
3 - weight loss
Tamoxifen is an selective adjuvant hormonal therapy (used to provide a small benefit alongside main treatment) anti-oestrogen drug that competes with oestrogen at the oestrogen receptor on the breast cancer. Tamoxifen can increase the risk of some conditions, which one of the following does NOT have an increased risk when taking Tamoxifen?
1 - vaginal discharge
2 - VTE
3 - cervical cancer
4 - endometrial cancer
3 - cervical cancer
Aromatase inhibitors are another medication that is used as an adjuvant to the main breast cancer treatment. These drugs work by blocking peripheral conversion of estrogen only. Which group of patients would benefit most from this group of drugs?
1 - pre-menopausal
2 - perimenopausal
3 - postmenopausal
4 - patient preference
3 - postmenopausal
Aromatase is an enzyme that converts androgens into estrogen. This is where the majority of oestrogen comes from in post-menopausal women
Given for 5-10 years
Aromatase inhibitors are another medication that is used as an adjuvant to the main breast cancer treatment. These drugs work by blocking peripheral conversion of estrogen from aromatase and are used in postmenopausal women as this is where oestrogen comes from. Is this more of less affective in post-menopasual women compared to tamoxifen?
- more effective
15% reduction in breast cancer mortality
Aromatase inhibitors are another medication that is used as an adjuvant to the main breast cancer treatment. These drugs work by blocking peripheral conversion of estrogen from aromatase and are used in postmenopausal women as this is where oestrogen comes from. Which of the following is NOT a common side effect of this medication?
1 - osteoporosis
2 - arthralgia
3 - weight gain
3 - weight gain
Patients should be given DEXA scans at baseline
Trastuzumab (Herceptin HER2+ patients) is a monoclonal antibody that binds to HER2 receptors and inhibit tumour growth. How is this medication given?
1 - chemotherapy
2 - oral
3 - SC
4 - IM
3 - SC
Given subcutaneously every 3 weeks for 6-12 months
Trastuzumab (Herceptin HER2+ patients) is a monoclonal antibody that binds to HER2 receptors and inhibit tumour growth. Is this given before, after or during breast cancer chemotherapy?
- during for 3-4 months
Although there are no side effects of trastuzumab (Herceptin HER2+ patients), which of the following must be monitored?
1 - renal function
2 - liver function
3 - cardiac function
4 - lung function
3 - cardiac function
Has been associated with increased risk of changes in LVEF
In addition to hormonal and immunotherapy, which 2 of the following medications are also given to patients being treated for breast cancer?
1 - zoledronic acid
2 - amilodopine
3 - levothyroxine
4 - ibandronic acid
1 - zoledronic acid
Inhibits osteoclast function and prevents bone resorption.
4 - ibandronic acid
Binds to and adsorbs onto the surface of hydroxyapatite crystals in the bone matrix, thereby preventing osteoclast resorption
In addition to hormonal and immunotherapy zoledronic and ibandronic acid are also given. Typically these are given for 3 years. Which of the following is NOT a side effect of zoledronic acid?
1 - jaw osteonecrosis
2 - renal toxicity
3 - GI toxicity
4 - all of the above
3 - GI toxicity
This is a side effect of Ibandronic acid
Renal function needs to be monitored in Zolendronic acid
In addition to hormonal and immunotherapy zoledronic and ibandronic acid are also given. Typically these are given for 3 years. Which of the following is NOT a side effect of ibandronic acid?
1 - jaw osteonecrosis
2 - renal toxicity
3 - GI toxicity
4 - all of the above
2 - renal toxicity
In addition to hormonal and immunotherapy zoledronic and ibandronic acid are also given. Typically these are given for 3 years. Which 2 of the following are given alongside these drugs?
1 - vitamin A
2 - vitamin D
3 - calcium
4 - iron
2 - vitamin D
3 - calcium
The 55 year old post-menopausal lady who had a feft breast pT1pN0M0 Grade III IDC ER8 PR8 Her2+. She is treated with wide local excision and sentinel lymph node biopsy, followed by adjuvant chemotherapy and radiotherapy. She is also given adjuvant bisphosphonatesm herceptin for 1 year and adjuvant letrozole (aromatase inhibitor) for at least 5 years and she then goes onto follow up. The women presents back to A+E 3 years later with worsening headaches, confusion, nausea and vomiting. Which of the following should be arranged as soon as possible?
1 - mammogram
2 - abdominal ultrasound
3 - head CT
4 - none of the above
3 - head CT
Headaches, confusion, nausea and vomiting can all be caused by a space occupying lesion in the brain
Image shows mass with surrounding oedema and some midline shift
What medication can be given to reduce the swelling in the brain in the case of a space occupying lesion?
1 - dexamethasone
2 - donepezil
3 - memantine
4 - any of the above
1 - dexamethasone
ALWAYS GIVE IN MORNINGS AND LUNCHTIME!
Can affect sleep
Prescribe PPI alongside
Systemic treatment for metastatic breast cancer can include hormone therapy, HER2 positive therapy or triple negative therapy. Of these which has the overall worst survival rates?
1 - hormone therapy
2 - HER2 positive therapy
3 - triple negative therapy
3 - triple negative therapy
Typical survival is 2 years
Hormone therapy = 2-8 years
HER2 positive therapy = 2.5-10 years
In systemic treatment for metastatic breast cancer, alongside hormonal and HER2 therapy, which 2 of the following should be given if bone metastasis are detected?
1 - zoledronic acid
2 - amilodopine
3 - levothyroxine
4 - denosumab
1 - zoledronic acid
4 - denosumab
Inflammatory breast cancer is rare but can occur. Does this have an insidious or rapid onset?
- rapid
Typically, weeks instead of months
Which of the following would increase your concern that a patient has Inflammatory breast cancer and not mastitis, which can present in a similar manner?
1 - breast pain
2 - rapidly growing breast lump
3 - enlarged breast or itching
4 - peau d’orange
5 - all of the above
5 - all of the above
This is normally mistaken for mastitis and antibiotics are given, but there is no response.
Which of the following is NOT a typical location for metastasis in breast cancer
1 - brain
2 - lung
3 - lymph nodes
4 - liver
5 - bone
6 - colon
6 - colon
If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count?
1 -dexamethasone
2 - granulocyte colony stimulating factors (GCSF)
3 - blood transfusion
4 - frozen WBCs
2 - granulocyte colony stimulating factors (GCSF)
