Breast Cancer Flashcards
What is the genetic risk?
Tumour suppression gene mutations = BRCA1 + BRCA2
What are the risk factors?
> 50
Familial disease
Northern/European/American descent
Early menopause
Early puberty
Obesity
Alcohol >5units/day
Breast density = younger girls have more denser breasts
High economic status
No previous breast feeding
Lifetime oestrogen exposure
Urban residence
Smoking
Previous history of breast cancer
What is the anatomy of the breast?
Dense = can’t always fell
Many ducts + lobes = some women have lumps to begin with
Potential to catch cancer too late due to anatomy
Would spread to bone + lymphatic system
Describe the lymphatics around the breast
Extensive around breast area + armpit
= if you surgically change = change lymphatic system
What is the presentation?
Have found lumps during breast exam or washing
Other signs = skin dimpling (“orange skin”), inverted nipples, discharge, visual lumps, breast pain, axillary lymphadenopathy + change in breast size/shape
How do you diagnose?
Palpation = characteristics of lump = size, texture + whether it moves easily
If it moves more likely a cyst
Mammography
Ultrasound
Biopsy
CT scan
What is the staging?
Tumour, Node, Metastasis (TNM)
What is the tumour status?
TNM
T0 = no palpable tumour
T1 = <2cm with no fixation to muscle
T2 = > 2 BUT <5cm no fixation
T3 = >5
T4 = any size with fixation
What is the status of the lymph nodes?
TNM
N0 = no nodes
N1a = palpable nodes BUT don’t contain tumour
N1b = palpable nodes contain tumour
N2 = nodes >2cm fixed to deep structure
N3 = supraclavicular or infraclavicular nodes
What is the distant metastasis?
TNM
M0 = none
M1 = present
What is UICC classification?
I = 85% chance survival in 15 years
II = 55%
III = 40%
IV = <5% = M1
What is primary breast cancer?
Localised cancer <2cm possible axillary node involvement
What is locally advanced breast cancer?
> 5cm has NOT spread BUT may involve localised skin, muscle + lymph nodes
What is secondary advanced breast cancer?
Has metastasised to other parts of the body
What is 1st line treatment?
Treatment is dependent on stages above
Surgery
Used with neoadjuvant + adjuvant therapy
What different types of surgery?
Mastectomy = full removal
Wide local excision = cut area around tumour
Why do hormonal therapy?
Many breast carcinomas express oestrogen receptor or progesterone receptor
Stimulate growth of tumour
= reduce oestrogen will reduce tumour
What is an example of oestrogen receptor antagonist?
Pre-menopausal
Tamoxifen - very important
Pre-menopausal
What is an example of aromatase inhibitors?
Post-menopausal
Anastrozole
Describe Tamoxifen
Started after chemo at dose of 10mg BD or 20mg OD for 5 years
After 5 years risk outweighs benefits
STOP it for surgery then restart again if haven’t been on for 5 year
What is the MoA of Tamoxifen?
Selective oestrogen receptor modulator
Competively binds to oestrogen receptors on tumours + blocks growth of tumour
AND binds to DNA + initiates carcinogenesis
Cytostatic rather than cidal
What is Trastuzumab?
Biological therapy = monoclonal Ab type treatment
Targets Her-2
Licensed in metastatic breast cancer
What is the Moa of Trastuzumab?
Binds to HER-2 receptors + blocks growth signals
= stops uncontrolled cell division
= helps immune cells recognise cancer + kill it
What is the dosing for Trastuzumab?
Available as IVI loading dose at 4mg/kg + starting one week later at 2mg/kg
Implicated in cardiotoxicity
What is radiotherapy?
Adjuvant
Treat locally affected lymph nodes
What are taxanes used for?
Available for treatment of advanced breast cancer where initial cytotoxic chemo has failed or inappropriate
Describe cyclophosphamide
Alkylating agent for solid tumours
Pro-drug activated by liver metabolism
Acrolein is urinary metabolite = very toxic to urinary tract = painful + blood loss
Complication of this is haemorrhagic cystitis
What is used to combat haemorrhagic cystitis?
Mensa given to patients on high IV dose
Reacts with acrolein in urinary tract to prevent toxicity
How can cardiomyopathy occur?
Doxorubicin treatment = reduced ejection fraction
Caused by cumalative doses of drug = relapse
Limit of 450mg/m2
