Breast Cancer Flashcards
What part of the anatomy contains the cells where more breast cancer arrives?
Lobules and Ducts
What supports the breast tissue?
Cooper’s Ligaments
What is the primary site of lymphatic drainage? In relation to cancer metastasis, why is this site important?
Axilla; First site for breast cancer to spread.
What muscle separates the three levels of axillary nodes?
Pectoralis Minor
What is the lifetime risk of breast cancer?
1/8
If you have ductal tumor that starts out as ductal cancer in situ (DCIS) and can turn into…
Invasive ductal; This is a cancer
If you have lobular tumor that starts out as ductal cancer in situ (LCIS) and can turn into…
Invasive lobular; This is not a Cancer
This is a type of breast cancer that is a vascular malignancy and caused by radiation.
Angiosarcoma
This is a type of breast cancer that is composed of mixed connective tissue and epithelium. It metastasizes hematogenously.
Phyllodes
What is the appropriate screening for breast cancer?
- 40+ yo in good health = yearly mammograms
- Clinical breast exam about every 3 years for women in their 20s and 30s
- If family history is positive, then 10 years earlier than the age of the youngest affected.
How do you dx breast cancer?
- H&P
- Imaging
- Biopsy
Sign/Symptoms of Breast Cancer
- Asymptomatic
- Mass
- Pain
- Discharge
- Dimple
- Rash
- Edema
- Duration, Change, Relationship with Cycle, Trauma
What are high risk factors for Breast Cancer? (PACAN)
P- Pregnancy first >30 years A- Age at Menarche C- Cancer breast (self or family) A- Age at Menopause N- Nulliparity
What are other risk factors for breast cancer?
- OCP Use
- Hormone Therapy in postmenopausal women
- Genetics (BRCA 1 = Ovarian; BRCA 2 = Male)
- Prior Brest Biopsies (Adenosis, Cysts, Ectasia, Apocrine metaplasia, Atypical ductal or lobular hyperplasia, LCIS)
When inspecting the breast, what are we looking for?
- Asymmetry
- Deformity
- Skin Changes
- Edema
When finding/examining a mass, what are we looking for?
- Size
- Shape
- Texture
- Tenderness
- Location
- Fixation
When finding/examining a discharge, what are we looking for?
- Color
- Quality
- Pressure
When finding/examining a nodes, what are we looking for?
- Axillary
2. Supraclavicular
What imaging techniques are used for breast cancer visualization?
- Mammogram
- US and Bx
- MRI
What is the BIRADS?
Breast Imaging Reporting and Data System. Rates on a scale from 0 to 5 – incomplete assessment to high suggestion of malignancy.
What is the GOLD standard for initially assessing image detectable lesions in the breast?
Needle Biopsy
T/F: Most biopsies of the breast require open surgical biopsy
False! Only 5-10% should require it.
When you have an abnormal biopsy result, what should you do next?
Excisional Biopsy – Needle localized breast bx. It goes all the way through to the musculature in the back and then comes back
What is the TNM staging?
T- Tumor Size
N- Lymph Node
M- Metastasis
Staging of Tumor Size
1- 5 cm
4- Extends to skin or chest wall
Staging of Lymph Nodes
0- No lymph node metastases
1- Metastasis to ipsilateral, movable, axillary lymph nodes
2- Metastasis to ipsilateral fixed axillary or IM lymph nodes
3- Metastasis to infraclavicular lymph node or to axillary and IM lymph nodes
Staging of Metastasis
0- No distant metastasis
1- Distant Metastasis
Common metastases sites for breast cancer
- Lymph Nodes
- Lung
- Liver
- Bone
- Brain
What are the biomarkers for breast cancer
- Hormone Receptors (ER/PR = Good)
2. Her2/neu (ERB2) – Epidermal growth factor family = Bad
Treatment options for Breast Cancer
- Surgery
- Chemo
- Radiation
What is the primary treatment for early stage breast cancer?
Surgery – Lumpectomy or partial mastectomy, mastectomy, or modified radical mastectomy
What are the contraindications for Breast Conservation Therapy?
- First and second trimester preggo
- Multicentricity
- Diffuse suspicious microcalcifications
- Prior therapeutic RT to breast
- Persistent positive margins
- Connective Tissue Issues (except RA)
- Large Tumor in Small Breast
Tell me about Skin, Nipple, Areolar Sparing Mastectomy
- Ideal for early stage breast cancer and/or preventative operations
- Saving skin facilitates reconstruction
- Nipple and Areola can be reconstructed in staged procedures.
What is the first lymph node of drainage from the breast?
Sentinel Lymph Node; Found with radioactive tracer and/or blue dye.
*Allows for histological examination of single node.
Challenges with Whole Breast Radiation Therapy
- Geographic Miss
- Collateral Damage
- Cosmesis
- Delay in starting one or other modality
Examples of Collateral Damage from Whole Breast Radiation Therapy
- Cardiac Ischemia
- Lung Cancer
- Esophageal Cancer
- Contralateral breast cancer
- Radiation induced sarcoma
Chemotherapeutic Hormone Receptor Modulators
- Tamoxifen (needs to have a positive receptor)
2. Raloxifen
Chemotherapeutic Alternates
- Steroids
- Aromatase Inhibitors (anastrozole) (only Postmenopausal women)
- Bilateral oophorectomy
Follow up after Breast Cancer Treatment
- H&P Q 3-6 months for first 5 years, then yearly
- Mammogram Q 12 months
- Bone density scan if on aromatase inhibitors
- Annual GYN exam if on Tamoxifen and uterus present
