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Reproductive block - Y3 > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

Incidence of breast cancer

A

Affects 1 in 7 women
Accounts for one quarter of malignancies in women
55,000 new cases per year in the UK;
>560 new cases annually in Grampian
>9,000 diagnosed each year are <50 years old
>12 000deaths annually
Around 300 new cases per year in men

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2
Q

risk factors for breast cancer

A

Age: Increased incidence
Previous breast cancer
Genetic: BRCA1 and BRCA2 (5%)
Early menarche and late menopause
Late or no pregnancy
HRT
Alcohol (>14 units per week)
Weight
Post Radiotherapy treatment for Hodgkin’s disease

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3
Q

when is breast screening offered

A

to 50-70 y olds - 3 yearly, australia 2 yearly

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4
Q

what are typical symptoms

A

Lump
Mastalgia (persistent unilateral pain)
Nipple discharge (blood-stained)
Nipple changes (Paget’s disease, retraction)
Change in the size or shape of the breast
Lymphoedema (Swelling of the arm)
Dimpling of the breast skin

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5
Q

patient clinic criteria to cover

A

1.CLINICAL:
History and Examination
2. RADIOLOGICAL:
Bilateral mammograms / USS
3. CYTO-PATHOLOGICAL:
FNA- cells only (cytology)
Core Biopsy- tissue (histo-pathology)

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6
Q

clinical assessment what to cover

A

History
Present Complaint
Previous Breast Problems
Family History
Hormonal Status
Drug History

Examination
BOTH Breasts, Axillae, SCF

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7
Q

breast imaging offered

A

The breast can be imaged with mammography, ultrasound or MRI

Mammography is the most sensitive in older women

Sensitivity is reduced in young women due to the presence of increased glandular tissue (<35yrs)

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8
Q

cytology and histology how to obtain

A

FNA
Fine Needle Aspiration
-> Cytology

Core Biopsy
-> Histo-Pathology
Invasive versus in-situ
ER, PR, HER2 receptor status

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9
Q

what are invasive pathological types of breast cancer

A

80% Ductal Carcinoma
10% Lobular Carcinoma
10% Others

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10
Q

what are non invasive types of breast cancer

A

DCIS
LCIS

(Ductal Carcinoma In Situ
17% screening detected)
(Lobular Carcinoma In Situ)

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11
Q

what makes up the MDT for breast cancer

A

Breast Surgeon
Radiologist
Cytologist
Pathologist
Clinical Oncologist
Medical Oncologist
Nurse counselor
Psychologist
Reconstructive surgeon
Patient and partner
Palliative care

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12
Q

how is breast cancer staged

A

FBC, U&Es, LFTs, Ca2+/PO2-
Chest x ray
Others as clinically indicated
No reliable tumour markers

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13
Q

T staging

A

Tx Primary tumour cannot be assessed
T0 Primary tumour not palpable
T1 Clinically palpable tumour -size < 2 cm
T2 Tumour size 2-5 cm
T3 Tumour size > 5 cm
T4a Tumour invading skin
T4b Tumour invading chest wall
T4c Tumour invading both
T4d Inflammatory breast cancer

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14
Q

N staging

A

N0 No Regional lymph nodes palpable

N1 Regional lymph node palpable- mobile

N2 Regional lymph node palpable- fixed

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15
Q

M staging

A

Mx Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis

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16
Q

Two main types of surgical procedure for treatment of breast cancer

A

Breast conservation surgery
Mastectomy

17
Q

Patients suitable for
breast conservation surgery

A

Tumour size clinically<4cm – IN THE OLD DAYS
Breast/Tumour size ratio
Suitable for radiotherapy
Single tumours – IN THE OLD DAYS
Patient’s wish – most important!!

18
Q

Sentinel lymph node biopsy

A

first node to receive lymphatic drainage
first node the tumour spreads to
if negative, rest of nodes in lymphatic basin are negative
Only performed when preoperative axillary USS normal/benign

19
Q

treatment of the axilla

A

If SLN is negative
(= clear of tumour)
– no further treatment required

If SLN contains tumour
– either remove them all surgically (clearance= ANC) or give radiotherapy to all the axillary nodes

20
Q

Complications of axillary treatment

A

Lymphoedema (10-17%)
sensory disturbance (intercostobrachial n.)
decrease ROM of the shoulder joint
nerve damage (long thoracic, thoracodorsal, brachial plexus)
vascular damage
radiation-induced sarcoma

21
Q

Factors associated with increased risk of disease recurrence?

A

Lymph node involvement
Tumour grade
Tumour size
Steroid receptor status (negativity- ER/PR neg)
HER2 status (positivity- HER2 pos)
LVI- lymphovascular invasion

22
Q

PREVENTION/ ADJUVANT TREATMENT

A

Radiotherapy

Hormone therapy
Chemotherapy
Targeted therapies

23
Q

radiotherapy role in breast cancer treatment

A

(All) patients after WLE as adjuvant treatment
over (3 weeks)
Boosts reduce local recurrence
After Mx if there is local involv./signif LN involv.
Complications: immediate - longterm
Skin reaction- Skin telangiectasis
Radiation pneumonitis
Cutaneous Radionecrosis/ Osteonecrosis
Angiosarcoma

24
Q

hormone therapy offered to breast cancer patients

A

oestrogen receptor positive

tamoxifen
aromastase inhibitors

25
Q

Tamoxifen

A

20mg once daily over 5-10yrs
Blocks directly on ER receptor
Effective in all age groups
More effective given after chemotherapy
!Thromboembolic events

26
Q

Aromatase Inhibitors

A

Arimidex (1mg) &
Letrozole (2.5mg)
Once daily for 5 years
Inhibiting ER synthesis
Should only be used in postmenopausal women
Improve disease free survivial (switch thx)
!Osteoporosis

27
Q

chemotherapy role in breast cancer

A

Clinical Trials have shown:
Benefits greatest
in younger women (<50 years)
In patients with increasing adverse prognostic factor (grade 3, LN pos, ER neg, HER2 pos)

Traditional :
CMF Combinations (1st generation)
Anthracycline Combinations (Doxorubicin or Epirubicin- 2nd generation)
Taxane based Combinations (eg. Docetaxel- 3rd generation)

“Oncotype DX” – 21 gene assay to determine whether chemotherapy likely to be of benefit; RS= Recurrence Score

28
Q

HER2 positivity and Anti-HER2 therapy

A

Trastuzumab (Herceptin®)/Pertuzamab

Monoclonal antibody against HER-2 receptor
Given to patients with over-expression of HER2 and chemotherapy
50% decrease risk of recurrence
33% increase in survival at 3 years!

29
Q

local metastatic spread

A

Chestwall
Skin
Nipple

30
Q

distant metastatic spread

A

Contralateral Breast

Bone
Lung
Liver
Brain
Bone Marrow

Reproductive block - Y3 (46 decks)

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