Breast cancer Flashcards
What are the breast cancer types?
Ductal carcinoma in situ
Invasive Ductal carcinoma
Lobular carcinoma in situ
Invasive lobular carcinoma
Mixed ductal/lobular
Inflammatory breast cancer
Rarer histological variants: mucinous, tubular, medullary and papillary
How is breast cancer graded?
Degree of differentiation graded according to 3 grades: well differentiated, moderately differentiated and poorly differentiated
Graded according to: nuclear pleomorphism, mitotic rate and tubule formation
Two scores are combined to give:
- Grade 1 (3-5) is low
- Grade 2 (6+7) is intermediate
- Grade 3 (8+9) is high
What breast cancer receptor status is the most responsive to treatment?
ER +ve
What is the significance of TNM staging in breast cancer?
Less pertinent in breast cancer
There are other biological variables that have greater prognostic impact
What are the general principles to breast cancer screening?
- Cheap
- Easy to perform and interpret
- Sensitive (identify those with disease)
- Specific (exclude those without)
- Conditioned screened should be important
- Test performed acceptable to population
- Recognisable latent/early symptomatic stage
- Treatment should alter the course of the disease
What imaging method is commonly used in lobular cancer?
MRI as it doesn’t always show up on mammography
What factors influence the decision of breast conserving surgery vs radical surgery?
- Tumour size- always need to consider breast size: tumor ratio
- Location
- Multifocality
- Risk of local recurrence
- Patient preference
Briefly outline sequence of events in breast cancer management of lymph nodes
US axilla- normal- SLNB
US axilla- abnormal- FNAC
FNAC- benign- SLNB
FNAC- malignant- axillary clearance
What is predict used for and what factors are taken into consideration?
A tool that helps clinicians and patients see how different treatments for early invasive breast cancer might improve survival rates after surgery
- DCIS or LCIS
- Age at diagnosis
- ER status
- HER2 status
- Post meno-pausal?
- KI-67 status
- Invasive tumor size
- Tumour grade
- Detected by
- Positive nodes
What are the side effects of SERMS (Tamoxifen, Raloxifene)
- VTE
- Endometrial cancer
- Hot flushes
- Vaginal discharge/dryness
- Weight gain
- Menstrual disturbance
What are the side effects of aromatase inhibitors? (Anastrole, letrozole, exemestane)
- Hot flushes
- Joint and muscle pain
- Osteoporosis
- Fatigue
- Vaginal dryness
Under what circumstances would you have a mastectomy?
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS > 4cm
Under what circumstance would you do a WLE?
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
What are three hormone drugs that can be given in HER2 receptor +ve breast cancer?
Trastuzumab (Herceptin) is a monoclonal antibody that targets the HER2 receptor
Pertuzumab (Perjeta) is another monoclonal antibody that targets the HER2 receptor
Neratinib (Nerlynx) is a tyrosine kinase inhibitor, reducing the growth of breast cancers
When is radiotherapy used in breast cancer?
4-8 weeks after surgery
In all patients who have had breast conserving surgery
Mastectomy with high risk of local recurrence
Radiotherapy everyday for three weeks
IF you are having chemotherapy after surgery, radiotherapy will be given after
