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S - Ch. 8 - Breast Cancer > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q
A
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2
Q

What is the prevalence of breast cancer in women?

A

1 in 12 women

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3
Q

What is DCIS?

A
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4
Q

What % of DCIS develops into invasive ca?

A

15%

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5
Q

What is LCIS?

A
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6
Q

If a patient has the BRCA gene, how likely is it that they develop breast ca?

A

70% of those over 80 with BRCA 1/2 will develop breast cs

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7
Q

What are some genetic RFs for developing breast cancer?

A
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8
Q

List some RFs for breast cancer.

A
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9
Q

What is the most common histological subtype of breast cancer?

A

almost all adenocarcinoma

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10
Q

What are ddx for malignant breast lumps?

A
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11
Q

What is the prevalence of hormone receptor +ve breast ca.

A

70%

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12
Q

How are breast tumours graded?

A
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13
Q

DCIS

What would you see on:
mammography?

A
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14
Q

How would you manage DCIS?

A
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15
Q

How would you describe a breast ca lump? What would you ask on hx?

A

Is it painful?
has it changed in size?

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16
Q

What is peau d’ orange?

A

late sign

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17
Q

What nipple/skin changes would you expect in breast ca?

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18
Q

What are the clinical features of breast ca?

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19
Q

Where does breast ca commonly metastasise to?

A
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20
Q

What is paget’s disease of the breast?
What other Ca is it associated with

A
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21
Q

How would you Dx and Mx Paget’s disease of the breast?

A
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22
Q

Describe the position of the patient and inspection findings in a breast exam.

A
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23
Q

Describe the palpation in a breast exam and the possible findings.

A
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24
Q

A patient presents post-op mastectomy with winging of the scapula. What is the moat likely cause of the winging?
What other nerve is damaged in a mastectomy?

A
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25
Q

Describe the anatomical location of the LN in the axilla.
Go through the drainage too

A
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26
Q

Outline the clinical assessment of a breast exam.

A
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27
Q

List some ddx for breast masses.

A
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28
Q

A mammography is always taken in a craniocaudal view and lateral oblique view. What findings are suggestive of ca?

A
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29
Q

A 34 year old woman asks if she can be screened for breast cancer as she has a strong fhx. You refer her for MRI breast. Could you have done mammography?

A
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30
Q

What is an US used for in radiological assessment of breast ca?

A
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31
Q

What are the indications for MRI breast in screening? What is its purpose/ expected findings?

A
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32
Q

Outline the radiological assessment of a breast exam.

A
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33
Q

In an FNA, are the cells in the needle or the syringe?

A

NEEDLE

34
Q
A
35
Q

What is the purpose of FNA in the setting of breast disease? Why is it used in this way?

A
36
Q

What is meant by the architecture of a breast ca? Why is it important to establish?

A
37
Q

What is meant by the receptor status of a breast ca? Why is it important to establish?

A
38
Q

What is meant by the oncotype score of a breast ca? Why is it important to establish?

A

It is based on expression levels of group 21 genes.
It is used for ER/PR +ve HER2-ve disease. if her2+ –> trastuzumab
It assess the benefit of adjuvant chemo vs hormone therapy and the risk of recurrence.

39
Q

What oncotype score is an indication that chemotherapy is beneficial?

A

Over 25 in both patients < and >
50yrs.
(arnie question for long case)

40
Q

The main technique involved in pathological assessment of breast ca is a needle core biopsy which is performed under LOCAL ANAESTHESIA.
What in the purpose of this biopsy?

A
41
Q

The main technique involved in pathological assessment of breast ca is a needle core biopsy which is performed under LOCAL ANAESTHESIA.
This technique has unfortunately failed for your patient. What can you do next?
Explain the technique.

A
42
Q

Outline the pathological assessment of a breast exam.

A
43
Q

You are assessing a patient for breast ca. However, the R score and B score do not fit with the S score you determined. What is your next step?

A

repeat triple assessment

44
Q

Outline what is involved in a triple assessment.

A
45
Q

What investigations will you do to stage breast ca?

A
46
Q

Outline the T and N staging of the TNM staging of breast cancer.

A
47
Q

What are the preventative measures to decrease risk of breast ca?

A
48
Q

What neoadjuvant chemotherapies can be used to treat breast ca?

A
49
Q

When are neoadjuvant therapies indicated?

A
50
Q

How is the surgical management of breast ca determined?

A
51
Q

What is involved in breast conserving therapy for surgical tx of breast ca?

A
52
Q

What are C/I to BCT?

A
53
Q

If BCT is C/I in a breast ca patient, what is your next surgery of choice?

A
54
Q

What investigation is done to determine the LN involvement in breast ca?

A

Sentinal node biopsy

55
Q

What % of patients are node +ve on sentinal node biopsy?

What are the indications and C/I?

A

only 25%

56
Q

Explain the procedure of a sentinal node biopsy.

A
57
Q

If the sentinal node biopsy comes back +ve. How would you surgically manage this patient?

A

axillary clearance

58
Q

What are the levels of axillary clearance?

A

1 - lateral to pecs
2 - post to pecs
3 - medial to pecs

59
Q

What are some complications of surgeries/ interventions in the axilla in the setting of breast ca?

A

Intercostobrachial nerve (80%) = > axillary and inner arm paraesthesia
Thoracodorsal nerve => latissimus Dorsi
Long thoracic nerve => winging of scapula
Lymphedema (30%)

60
Q

Outline the surgical management of non-metastatic breast ca.

A

+ reconstruction

61
Q

What are the pros and cons of immediate breast reconstruction over delayed?

A
62
Q

What considerations must be taken into account before doing breast reconstruction ( or really any surgery) (RFs for poor outcome)

A
63
Q

What are the types of breast reconstructions available (what are the new breasts made from)

A
64
Q

What is the difference in the flap used in DIEP vs LD reconstruction?

A
65
Q

What is another example of a free and a pedicled flap.

A
66
Q

What exactly is used to create the breast in a DIEP reconstruction?

A
67
Q

Why would you choose DIEP over LD deconstruction?

A
68
Q

Identify the reconstruction.

A
69
Q

Identify the reconstruction.

A
70
Q

Identify the reconstruction.

A
71
Q

Identify the reconstruction.

A

Six months postoperatively: breast reconstruction with TUG flap (left breast) and ALT flap (right breast) in an anterior and lateral view. Donor site on both thighs in an anterior view (right).

72
Q

When is tamoxifen indicated in breast cancer treatment?
What is the MOA and the max length of treatment?

A
73
Q

When is anastrozole indicated in breast cancer treatment?
What is the MOA and the SEs?

A
74
Q

When is trastuzumab indicated in breast cancer treatment?
What is the MOA?

A
75
Q

When is lapitinib indicated in breast cancer treatment?
What is the MOA?

A
76
Q

What are the indications for radiotherapy in breast ca management?

A
77
Q

What is a fungating breast tumour? What is the Mx?

A

grows out of the skin (ulcerating metastatic tumour)
tx - palliate but mastectomy anyway

78
Q

What is the function of radiotherapy in palliative care of breast cancer?

A
79
Q

When is palliative care indicated for breast ca? What does it involve?

A
80
Q

Outline the FULL management of breast cancer

A
81
Q

Which architectural types/ patterns of breast cancers are a/w better prognosis

A

S - Ch. 8 - Breast Cancer (4 decks)

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