Breast Cancer Flashcards
What is the most common noncutaneous malignancy in the U.S.?
Breast cancer.
By what age do 1 in 8 women develop breast cancer?
By age 70.
What BMI increases the risk of breast cancer, and by how much?
A BMI of 33 or higher increases the risk by 1.3 times compared to a BMI of 21 or lower.
What term refers to a woman who has never had a child?
Nulliparous.
Name three risk factors for breast cancer related to hormone exposure.
Prolonged estrogen exposure, nulliparity, and prolonged hormone replacement therapy use.
How does early menarche affect breast cancer risk?
Early menarche increases the risk of breast cancer.
What are two types of proliferative benign breast lesions?
Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH).
How much more likely are women with dense breasts to develop breast cancer?
Women with dense breasts are 4-5 times more likely to develop breast cancer.
What percentage of breast cancers are attributed to BRCA1 and BRCA2 mutations?
BRCA1 accounts for 60%, and BRCA2 accounts for 55% of genetic breast cancers.
What anatomical area does the breast tissue span from and to?
From the 2nd to the 6th ribs and from the sternochondral junctions to the midaxillary line.
What is the function of the lactiferous ducts?
They drain each lobe of the breast and open at the nipple.
What type of breast cancer originates from the lactiferous ducts?
Infiltrating Ductal carcinoma.
Which nodes provide primary deep lymphatic drainage of the breast?
The ipsilateral axillary nodes
What is the most frequent presentation of breast cancer?
An asymptomatic, nonpalpable mass
What imaging modality is the mainstay for breast cancer screening?
Mammography.
What percentage of tumors can be missed by mammography, particularly which type?
10%-15%, particularly lobular carcinomas.
Infiltrating lobular carcinoma (ILC) account for what percent of breast cancer?
10%
Where does Infiltrating lobular carcinoma (ILC) originate?
It starts in the milk-producing glands (lobules) and will spread with the same patterns as IDC
What are two methods of biopsy for breast cancer diagnosis?
Fine needle aspiration (FNA) and core needle biopsy.
What is the difference between DCIS and LCIS?
Ductal carcinoma in situ (DCIS): non-invasive cancer, abnormal cells are found in the lining of the breast ducts, but has not spread aka “in situ.” Treatment may include lumpectomy, masectomy, or RT depending on several factors.
LCIS (lobular carcinoma in situ): not considered a true breast cancer, involves abnormal cell growth in the lobules of the breast, is a marker for increased cancer risk. Regular screening & monitoring rather than surgery.
What percentage of invasive breast cancers are invasive ductal carcinoma?
70%
What is the 5-year survival rate for Breast cancer patients with no node involvement?
96%.
What is the overall survival rate for Breast cancer?
89%
What is a sentinel node?
The primary lymph node draining a tumor.
What are the borders for whole breast irradiation using tangents?
Superior: palpable breast tissue, edge of the clavicle.
Inferior: 2cm below the inframammary fold.
Medial: midline of the patient.
Lateral: midaxillary line or 2cm beyond lateral breast tissue.
Anterior: flash 2cm-3cm to include the entire breast.
Posterior: include chest wall, often with 3cm of lung.
What percentage of breast lymphatic drainage goes to the axillary lymph nodes?
85%.
What is the preferred surgical treatment for large and multicentric breast tumors?
Mastectomy
What is the function of trastuzumab in treating HER2-amplified breast cancer?
It inhibits HER2 activity, proliferation, and induces cell death.
What is HER2?
A protein
HER2-positive, In about 20% of breast cancers, the cells make too much of a protein known as HER2. These cancers tend to be aggressive and fast-growing
What medication is commonly given to post-menopausal women with ER-positive breast cancer?
The drug _____ often is given to breast cancer patients for 5 years after surgery to block estrogen receptors.
Tamoxifen
What does radiation therapy reduce in breast cancer treatment?
Local relapse
What is the standard approach for treating inflammatory breast cancer (IBC) before surgery?
Neoadjuvant systemic therapy
What is a risk of axillary node dissection in breast cancer patients?
Increased risk of chronic lymphedema of the arm
What is the first step in using the full staging system for breast cancer?
Identify the T category. This describes the size of the primary tumor and whether it has grown into nearby areas.
What are the possible T categories for breast cancer?
T0: No evidence of primary tumor.
Tis: Carcinoma in situ (DCIS, or Paget disease of the breast with no associated tumor mass).
T1: Tumor is 2 cm (3/4 of an inch) or less across.
T2: Tumor is more than 2 cm but not more than 5 cm (2 inches) across.
T3: Tumor is more than 5 cm across.
T4: Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
What is the second step in using the full staging system for breast cancer?
Identify the N category. This indicates whether the cancer has spread to nearby lymph nodes and, if so, how many are involved.
What are the possible N categories in breast cancer?
NX: Nearby lymph nodes cannot be assessed (for example, if they were removed previously).
N0: Cancer has not spread to nearby lymph nodes.
N1: Cancer has spread to 1 to 3 axillary (underarm) lymph node(s), and/or cancer is found in internal mammary lymph nodes (those near the breast bone) on sentinel lymph node biopsy.
N2: Cancer has spread to 4 to 9 lymph nodes under the arm, or cancer has enlarged the internal mammary lymph nodes.
N3: Cancer has spread to 10 or more axillary lymph nodes, or to lymph nodes under the collarbone or above the collarbone.
What is the third step in using the full staging system?
Identify the M category. This indicates whether the cancer has spread to distant organs.
What are the possible M categories for breast cancer?
M0: No distant spread is found on imaging tests or by physical exam.
M1: Cancer has spread to distant organs (most often to the bones, lungs, brain, or liver).
In addition to the T, N, and M categories, what other factors are considered when determining the stage of breast cancer?
The other factors that are considered are:
Estrogen Receptor (ER) status: Does the cancer have the protein called an estrogen receptor?
Progesterone Receptor (PR) status: Does the cancer have the protein called a progesterone receptor?
HER2 status: Does the cancer make too much of a protein called HER2?
Grade of the cancer (G): How much do the cancer cells look like normal cells?
What is the term used to describe the process of combining all of the factors used to determine the stage of cancer?
Stage grouping
At what age should women of normal risk begin having regular annual screening
mammograms?
Starting at age 45, all women should have a mammogram done every year
Inflammatory breast cancer is always classified as which T stage?
T4d
Inflammatory carcinoma of the breast is classified as T4d.
What T stage is a breast cancer that is a 9-cm tumor with skin invasion?
T4
Skin invasion depicts a T-stage that is extensive, T4.
What T stage is a breast cancer that is a 3.5-cm tumor near the nipple?
T2
As defined by the American Joint Committee on Cancer (AJCC) Staging System for Breast Cancer, a tumor more than 2 cm but less than 5 cm is denoted as a T2.
What T stage is a breast cancer that Is a 1-cm tumor in the upper outer quadrant?
T1
As defined by the AJCC Staging System for Breast Cancer, a tumor 2 cm or less in any dimension is denoted as a T1.
What T stage is a breast cancer that is a 7-cm tumor in the upper outer quadrant with extension to the skin?
T4
As defined by the AJCC Staging System for Breast Cancer, a tumor of any size with direct
extension to the chest wall or skin is denoted as a T4.
What T stage is a breast cancer that is a 1.5-cm tumor near the nipple?
T1
As defined by the AJCC Staging System for Breast Cancer, a tumor 2 cm or less in any dimension is denoted as a T1.
What T stage is a breast cancer that is a 3-cm tumor invading the chest wall?
T4
As defined by the AJCC Staging System for Breast Cancer, a tumor of any size with direct extension to the chest wall or skin is denoted as a T4.
What ligament holds the breast in place?
Cooper
The superficial pectoral fascia encompasses the breast tissue and is attached to the deep fascia
by bands of connective tissue called Cooper suspensory ligaments, which support the breast.
What stage is a 6-cm breast cancer in the upper inner quadrant?
T3
T3 is defined by the AJCC as a tumor more than 5 cm in greatest dimension.
A woman’s risk of developing breast cancer in the United States is_________ .
1 in 8
Cancer of the breast affects one in every eight women in the United States.
Which of the following increases the risk for developing breast cancer?
- Gender: female
- Age: 65-79 highest risk
- Family history: mothers or sisters
- Hormonal: early puberty & late menopause increases risk, childbirth before 35 decreases it
- History of malignancy or benign breast disease
- Dietary & environmental factors: Europe/Canada/USA increased incidence & (heavy) alcohol consumption
- Radiation exposure
- becoming pregnant later in life, 35 and older, can increase risk
- Night shift workers
What is Lymphadenopathy?
Lymphadenopathy or lymphadenitis refers to lymph nodes which are abnormal in size, number or consistency and is often used as a synonym for swollen or enlarged lymph nodes. Common causes of lymphadenopathy are infection, autoimmune disease, or malignancy.
What are the Clinical Presentations of Breast Cancer?
- Breast mass
- Nipple discharge or retraction
- Skin changes and alterations in breast contour
- Lymphadenopathy
- Mammographic abnormality
- Distant metastasis (bone, lung, brain or liver most common)
- Erythema
- Thickening
- Peau d’orange
- ulceration
Describe Inflammatory Breast Cancer
Very aggressive form
Rapid onset
Skin erythema and indurationAsymmetric enlargement
Generally not associated with a palpable mass
IBC is automatically staged as T4d.
Paget’s disease of the breast
Starts on the nipple and extends to the areola, usually accompanied by underlying DCIS or IDC
Symptoms include flaky, scaly skin, crusty, oozing or hardened skin resembling eczema, itching, redness, tingling or burning sensation, straw-colored or bloody nipple discharge, flattened or turned-in nipple, lump in the breast, thickening skin on the breast
According to the Radiation Therapy Oncology Group bright erythema with patchy, moist desquamation is an example of skin morbidity grade__________.
2
Tender or bright erythema and patchy, moist desquamation are symptoms of skin morbidity
grade 2 according to the Radiation Therapy Oncology Group.
When is breast cancer considered hormone receptor positive?
If your breast cancer has a significant number of receptors for either estrogen or progesterone, it’s considered hormone-receptor positive.
Receptor Status types:
- HER2
Found in 15-20% of breast cancers
Adverse prognosis - ER-positive
More favorable outcomes due to endocrine therapy - PR-positive
more favorable outcomes, better overall survival - Triple-negative: poor prognosis
Triple positive
Triple positive: positive for estrogen receptors, progesterone receptors, and HER2
Triple negative
Triple negative: not positive for estrogen receptors, progesterone receptors, and HER2
Which of the following breast cancer receptor statuses has the best prognosis?
ER-positive, PR-positive, HER2-negative
The estrogen receptor-positive (ER-positive) breast cancer subtype generally has the best prognosis. This is because ER-positive cancers tend to grow more slowly and are often responsive to hormonal therapies, such as tamoxifen or aromatase inhibitors, which can effectively reduce the risk of recurrence.
The sentinel lymph node biopsy uses _____ in an effort to identify the flow of lymphatic fluid.
blue dye or radioactive material
What is the most commonly diagnosed type of breast cancer?
Infiltrating ductal carcinoma
80%
It starts in a milk duct of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast, at which point it may be able to spread via lymph and blood
What imaging modality is used for women with breast implants?
MRI is used with women who have silicone breast implants or changes in the breast subsequent to radiation.
Why dont we use CT as a screening method for Breast Cancer?
Too expensive, but used after diagnosis for evaluation
Breast Cancer distant metastases sites?
bone, lung, brain, liver, eyes, ovaries, adrenal gland, and pituitary gland
Common treatments for Breast Cancer?
- Surgical resection is the primary treatment if possible
- Chemo and radiation are most commonly done after surgery unless a tumor must first be shrunk to be resectable
- In general, radiation therapy will begin 2-4 weeks after surgery unless chemo is ordered
- Recurrence is usually treated with chemo and surgical resection if possible
Marijuana can cause…
on the list of drugs that can cause gynecomastia, which is an increase in fibroglandular breast tissue?
in the notes for the breast cancer powerpoint
