Breast Cancer Flashcards
(82 cards)
1
Q
A
2
Q
What is the prevalence of breast cancer in women?
A
1 in 12 women
3
Q
What is DCIS?
A
4
Q
What % of DCIS develops into invasive ca?
A
15%
5
Q
What is LCIS?
A
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
7
Q
What are some genetic RFs for developing breast cancer?
A
8
Q
List some RFs for breast cancer.
A
9
Q
What is the most common histological subtype of breast cancer?
A
almost all adenocarcinoma
10
Q
What are ddx for malignant breast lumps?
A
11
Q
What is the prevalence of hormone receptor +ve breast ca.
A
70%
12
Q
How are breast tumours graded?
A
13
Q
DCIS
What would you see on:
mammography?
A
14
Q
How would you manage DCIS?
A
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?
16
Q
What is peau d’ orange?
A
late sign
17
Q
What nipple/skin changes would you expect in breast ca?
A
18
Q
What are the clinical features of breast ca?
A
19
Q
Where does breast ca commonly metastasise to?
A
20
Q
What is paget’s disease of the breast?
What other Ca is it associated with
A
21
Q
How would you Dx and Mx Paget’s disease of the breast?
A
22
Q
Describe the position of the patient for inspection in a breast exam.
A
23
Q
Describe the palpation in a breast exam and the possible findings.
A
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
25
Describe the anatomical location of the LN in the axilla.
Go through the drainage too
26
Outline the clinical assessment of a breast exam.
27
List some ddx for breast masses.
28
A mammography is always taken in a craniocaudal view and lateral oblique view. What findings are suggestive of ca?
29
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?
30
What is an US used for in radiological assessment of breast ca?
31
What are the indications for using MRI breast in the workup of a breast lump? What is its purpose/ expected findings?
32
Outline the radiological assessment of a breast exam.
33
In an FNA, are the cells in the needle or the syringe?
NEEDLE
34
35
What is the purpose of FNA in the setting of breast disease? Why is it used in this way?
36
What is meant by the architecture of a breast ca? Why is it important to establish?
37
What is meant by the receptor status of a breast ca? Why is it important to establish?
38
What is meant by the oncotype score of a breast ca? Why is it important to establish?
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
What oncotype score is an indication that chemotherapy is beneficial?
Over 25 in both patients < and >
50yrs.
(arnie question for long case)
40
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?
41
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.
42
Outline the pathological assessment of a breast exam.
43
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?
repeat triple assessment
44
Outline what is involved in a triple assessment.
45
What investigations will you do to stage breast ca?
46
Outline the T and N staging of the TNM staging of breast cancer.
47
What are the preventative measures to decrease risk of breast ca?
48
What neoadjuvant chemotherapies can be used to treat breast ca?
49
When are neoadjuvant therapies indicated?
50
How is the surgical management of breast ca determined?
51
What is involved in breast conserving therapy for surgical tx of breast ca?
52
What are C/I to BCT?
53
If BCT is C/I in a breast ca patient, what is your next surgery of choice?
54
What investigation is done to determine the LN involvement in breast ca?
Sentinal node biopsy
55
What % of patients are node +ve on sentinal node biopsy?
What are the indications and C/I?
only 25%
56
Explain the procedure of a sentinal node biopsy.
57
If the sentinal node biopsy comes back +ve. How would you surgically manage this patient?
axillary clearance
58
What are the levels of axillary clearance?
1 - lateral to pecs
2 - post to pecs
3 - medial to pecs
59
What are some complications of surgeries/ interventions in the axilla in the setting of breast ca?
Intercostobrachial nerve (80%) = > axillary and inner arm paraesthesia
Thoracodorsal nerve => latissimus Dorsi
Long thoracic nerve => winging of scapula
Lymphedema (30%)
60
Outline the surgical management of non-metastatic breast ca.
+ reconstruction
61
What are the pros and cons of immediate breast reconstruction over delayed?
62
What considerations must be taken into account before doing breast reconstruction ( or really any surgery) (RFs for poor outcome)
63
What are the types of breast reconstructions available (what are the new breasts made from)
64
What is the difference in the flap used in DIEP vs LD reconstruction?
65
What is another example of a free and a pedicled flap.
66
What exactly is used to create the breast in a DIEP reconstruction?
67
Why would you choose DIEP over LD deconstruction?
68
Identify the reconstruction.
69
Identify the reconstruction.
70
Identify the reconstruction.
71
Identify the reconstruction.
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
When is tamoxifen indicated in breast cancer treatment?
What is the MOA and the max length of treatment?
73
When is anastrozole indicated in breast cancer treatment?
What is the MOA and the SEs?
74
When is trastuzumab indicated in breast cancer treatment?
What is the MOA?
75
When is lapitinib indicated in breast cancer treatment?
What is the MOA?
76
What are the indications for radiotherapy in breast ca management?
77
What is a fungating breast tumour? What is the Mx?
grows out of the skin (ulcerating metastatic tumour)
tx - palliate but mastectomy anyway
78
What is the function of radiotherapy in palliative care of breast cancer?
79
When is palliative care indicated for breast ca? What does it involve?
80
Outline the FULL management of breast cancer
81
Which architectural types/ patterns of breast cancers are a/w better prognosis
82
BRCA 1 vs BRCA 2
Higher breast cancer risk in women?
More likely to be triple negative?
Higher ovarian cancer risk?
Higher risk of male breast cancer?
Higher risk of prostate cancer?
Higher risk of pancreatic cancer?
Associated with colon cancer?
Associated with melanoma and cholangiocarcinoma?
Higher breast cancer risk in women? - 1 (55-70% vs 45-70%)
More likely to be triple negative? - 1
Higher ovarian cancer risk? - 1
Higher risk of male breast cancer? - 2
Higher risk of prostate cancer? - 2
Higher risk of pancreatic cancer? - 2
Associated with colon cancer? - 1
Associated with melanoma and cholangiocarcinoma? - 2
