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Clinical Radiation Oncology II > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What muscle do breasts lie over?

A

Pectoralis major

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2
Q

What percentage of breast tissue is adipose and connective tissue; what percentage is glandular?

A

80%;20%

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3
Q

Which part of the breast contains more glandular tissue than the rest of the breast?

A

Upper half (esp. upper outer section)

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4
Q

How many lobes are contained in each breast?

A

15 to 20

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5
Q

Name the 4 quadrants of the breast and what percentage of breast cancer accounts for each.

A
  1. Upper Outer (50%)
  2. Upper Inner (15%)
  3. Lower Outer (11%)
  4. Lower Inner (6%)
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6
Q

Name the 3 channels of breast lymphatic drainage

A
  1. Axillary lymph nodes
  2. Internal Mammary lymph nodes
  3. Supraclavicular lymph nodes
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7
Q

What are the 3 major sections of the Axillary lymph nodes?

A
  1. Level I
  2. Level II
  3. Level III
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8
Q

What percentage of tumours drain to the axillary nodes?

A

70%

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9
Q

What is multifocal tumours?

A

When the tumours are contained near a primary tumour in the same quadrant

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10
Q

What is multicentric tumours?

A

Tumours that are not confined to one quadrant

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11
Q

Which has a better prognosis? Multifocal or Multicentric?

A

Multifocal

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12
Q

Name some of the risk factors for breast cancer

A
  1. Lifestyle risks (alcohol, tobacco, obesity, lack of exercise)
  2. Early menstruation (before age 12)
  3. Late menopause (after age 55)
  4. Nulliparity (having no children)
  5. Having children late (after age 35)
  6. Hormone replacement therapy
  7. No history of breastfeeding children
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13
Q

What two chromosomes are related to increased risk for breast cancer?

A
  1. BRCA 1 (Chromosome 17)
  2. BRCA 2 (Chromosome 13)
    NB: They are tumour suppressor genes that control cell growth and death
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14
Q

What happens when BRCA1 and BRCA2 genes get mutated?

A

Damaged DNA does not get repaired, which brings about an increased risk for breast cancer

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15
Q

What percentage of breast cancers are inherited?

A

5 - 10%

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16
Q

What cancers are associated with BRCA1 mutations in women?

Sex organs related

A

Ovarian
Cervical
Uterine
Pancreatic
colon

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17
Q

What cancers are associated with BRCA1 mutations in men?

A

Breast
Testicular
Pancreatic
Prostate

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18
Q

What cancers are associated with BRCA2 mutations in women?

GI related

A

Ovarian
Pancreatic
Stomach
Gall bladder
Bile duct
Melanoma

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19
Q

What cancers are associated with BRCA2 mutations in men?

A

Breast
Pancreatic
Prostate

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20
Q

List the types of Ductal Carcinoma from best to worst prognosis

DADDI

A
  1. Ductal hyperplasia
  2. Atypical ductal hyperplasia
  3. Ductal carcinoma in situ
  4. DCIS-MI (DCIS with microinvasion)
  5. Invasive ductal cancer
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21
Q

What is the most common type of breast cancer (70%)

A

Infiltrating Ductal Carcinoma

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22
Q

What percentage of breast tumours is Invasive Lobular Carcinoma?

A

5-10%

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23
Q

Inflammatory Breast Cancer is the rare and aggressive kind of breast cancer. True or false

A

True

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24
Q

What type of breast cancer is characterized by skin changes known as “peau d órange”?

A

Inflammatory Breast Cancer (IBC)

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25
Q

What stage is Inflammatory Breast Cancer given?

A

T4d

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26
Q

What type of breast cancer affects the nipple and areola?

A

Paget’s Disease

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27
Q

Paget’s Disease accounts for what percentage of breast cancers?

A

5%

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28
Q

List the means of detection and diagnosis of breast cancer

BUMMBI Detects

A
  1. Breast Self Exam (BSE)
  2. Mammography
  3. Ultrasound
  4. MRI (esp. abbreviated MRI: takes less time)
  5. Biopsy
  6. Incision and Excision
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29
Q

What are the two types of mammograms for breast cancer?

A
  1. Screening (asymptomatic women)
  2. Diagnostic (specific indication)
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30
Q

What are the two types of biopsy used in breast cancer diagnosis?

A
  1. Fine needle biopsy
  2. Stereotactic needle biopsy
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31
Q

What does BI RADS stand for?

A

Breast Imaging Reporting And Data System

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32
Q

What is positive margins?

A

When cancer cells are found at the EDGE of removed tissue after surgery

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33
Q

What is negative margins?

A

When no cancer cells are found at the edge of removed tissue after surgery

34
Q

Name the metastatic sites of breast cancer

A

Bone (bone scan)
Brain (MRI)
Lung (CT, MRI, Chest X-ray)
Liver (CT, MRI, Ultrasound)

35
Q

What are the two methods of breast cancer staging?

A
  1. Clinical (cTNM)
  2. Pathological (pTNM)
36
Q

Grade I staging=

A

Well differentiated cells

Good prognosis

37
Q

Grade III staging=

A

Poorly differentiated cells (poor prognosis)

38
Q

What is the most important prognostic factor for breast cancer?

A

Lymph node status

39
Q

Name 5 prognostic factors for breast cancer

LTHIE

A
  1. Lymph node status
  2. Tumour size
  3. Histology
  4. Inflammatory or not
  5. ER/PR status
40
Q

What percentage of tumours are ER/PR positive?

A

70%

41
Q

HER2+ breast cancers tend to be more aggressive than HER2-. True or false?

A

True

42
Q

What is the prognostic outlook for a Triple Negative diagnosis (ER-, PR-, and HER2-)

A

Very poor prognosis

43
Q

Name the 5 types of mastectomies

RMTPN

A
  1. Radical mastectomy
  2. Modified radical mastectomy
  3. Total mastectomy
  4. Partial mastectomy
  5. Nipple-sparing mastectomy
44
Q

What is the main difference between a radical mastectomy and a modified radical mastectomy?

A

With radical, there is extensive removal of lymph nodes but with modified radical, level III lymph nodes are spared.

45
Q

Tamoxifen is for both pre- and post-menopausal women with breast cancer. True or false?

A

True

46
Q

Letrozole is only for post-menopausal women. True or false?

A

True

47
Q

Which drug works by blocking estrogen receptors to prevent growth of cancer cells?

Block the taXI

A

Tamoxifen

48
Q

What drug works by lowering the overall amount of estrogen in the body?

LL: LET’s lower

A

Letrozole

49
Q

Why is Letrozole not used for premenopausal women?

A

Estrogen levels in premenopausal women is too high to make a difference

50
Q

What drug is used to treat breast cancer for HER2+ patients?

A

Trastuzumab (Herceptin)

51
Q

What group of drugs is used to treat ER+ and HER2- METASTATIC breast cancer?

A

CDK4/6 inhibitors

52
Q

What is Oncotype Testing?

NB: It’s done after surgery

A

It’s used to predict how likely a breast cancer is to come back after surgery and the likely benefit of having chemotherapy

53
Q

How many genes in a tissue sample are analyzed during oncotype testing?

A

21

54
Q

List the 3 criteria for when we do oncotype testing?

A
  1. No spread to lymph node under the arm
  2. ER+
  3. HER2-
55
Q

What score should one have to be a candidate for chemo after oncotype testing?

A

26 or greater (out of 100)

56
Q

True or False. MULTIAGENT chemotherapy plays a primary role in the treatment of locally advanced breast tumours.

A

True

57
Q

List the common side effects of chemotherapy

A
  1. Hair loss
  2. Fatigue
  3. Nausea and vomiting
  4. Mouth sores
  5. Diarrhea
  6. Neutropenia (Reduced WBC count)
  7. Increased infections
  8. Taste changes
  9. Neuropathy (numbness in hands and feet)
58
Q

Important Table: Treatment volumes

A
59
Q

Name the types of RT treatment techniques for breast cancer.

A
  1. Partial Breast Irradiation (PBI)
  2. Whole Breast Irradiation
  3. Whole Breast Irradiation and Involved Lymphatics
  4. Wide Tangent Fields
  5. Chest Wall (CW) Irradiation
  6. Deep Inspiration Breath Hold (DIBH)- For left-sided disease
  7. Bilateral Breast Treatment
  8. Inoperable Breast Irradiation
60
Q

What is the main advantage of using DIBH?

A

Much less dose to the heart and left lung. More consistent dose coverage

61
Q

Name the 4 criteria that would make someone a good candidate for DIBH

A
  1. Able to follow hold instructions
  2. Able to achieve a 20 second breath hold without difficulty
  3. Display adequate DIBH chest breathing reproducibility
  4. Display no factors that would compromise DIBH set-up reproducibility
62
Q

True or False. Bolus of 0.5 or 1cm is normally used in Chest Wall Irradiation

A

True

63
Q

What is the conventional dose/fractionation for Whole Breast RT?

5 letters in the word “whole”. ie 5000cGy

A

4500-5000cGy/25fx

64
Q

What is the conventional dose/fractionation for Post Mastectomy, Whole Breast RT?

4 PM (post mastectomy)

A

4256/16

65
Q

What is the D/F for electron or photon boost for positive margins?

A

1000/4

66
Q

What is the D/F for PBI?

P+B+I = 27

A

2700/5

67
Q

What is the D/F for hypofractionated tangent fields?

HTF 265

A

2600/5

68
Q

True of False. The supraclavicular (with or without an axillary field) will always have its own prescription.

A

TRUE!!

69
Q

What is the D/F for the separate supraclavicular and/or axillary node treatment?

Supraclav 4525

A

4500/25

70
Q

True or False. Hypofractionation in EARLY BREAST CANCER is as good as conventional fractionation, if not better.

A

True

71
Q

When are radioactive implants appropriate for breast boost?

A
  1. Gross residual tumour post-surgery
  2. Deep seeded in large breast
72
Q

What percentage of metastasis occur within 5 years of diagnosis?

A

75%

73
Q

What tumour marker is increased due to metastatic disease?

A

Carcinoembryonic antigen (CEA)

74
Q

What is the main met site for breast cancer?

A

Bone

75
Q

In what situation would the RO prefer a 3-field technique (tangents + Sc) over a 4-field (tangents + Sc + Ax)

A

To spare the brachial plexus

76
Q

What is brachial plexopathy?

A

The damage or dysfunction of the brachial plexus

77
Q

What are the symptoms of brachial plexopathy?

A
  1. Tingling
  2. Weakness
  3. Numbness or pain in the shoulder, arm, hand or wrist
78
Q

Example of Breast treatment directive

A
79
Q

True or False. Silk and Sparkle Body Lotion is not recommended for use on compromised, radiated skin

A

True

80
Q

What is the treatment volume (fields) for Stage I breast cancer?

A

Tangential fields

81
Q

What is the treatment volume for Stage III breast cancer?

A

Tangential fields + Supraclavicular and/or Axillary fields

Clinical Radiation Oncology II (10 decks)

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