Breast Cancer (28) Flashcards
What can be recognized in mammogram?
Speculated mass + microcalcifications
What is the triple assessment for breast cancer?
- History & examination
- Imaging (Mammography or ultrasound)
- Biopsy (core is best as provides histology as well)
What other tests can be done?
Tissue biopsy ( Core biopsy, TRU-cut, FNAC) - core biopsy provides full histology unlike
MRI imaging is not routinely used in triple assessment, but can be useful in assesssment of lobular breast cancers & neoadjuvant therapy respnse)
(Ultrasound more useful in women <35 and men, due to density of breast tissue)
What is the most common site of breast cancer?
The upper outer quadrant, as it has more glandular tissue
What does a C4 lesion in the FNAC test mean?
- C1 – inadequate sample
- C2 – benign
- C3 – equivocal
- C4 – suspicious
- C5 – malignant
What information should be reported/looked for in an excision pathology report?
- Type of cancer
- Number of positive lymph nodes
- Margins status
- HER2 receptors status – poor prognosis
- ER/PR receptor status – good prognosis
- Ki 67 proliferation index – indicates how progressive the cancer is; the higher the percentage, the higher the progression of the cancer
What is the most common type of breast cancer?
Invasive duct carcinoma
What is HER2-positive breast cancer?
- HER2-positive breast cancer is a type of breast cancer that tests positive for the HER2 protein, which promotes the growth of cancer cells.
- HER2-positive breast cancers tend to grow faster and are more likely to spread and come back.
- Treatments that specifically target HER2 are very effective, such as Lapatinib, Neratinib, Pertuzumab, and Trastuzumab.
- Knowing if a breast cancer is HER2-positive or negative is important for treatment choice and prognosis.
What is HER2?
- HER2 is an oncogene, biomarker, transmembrane Human Epidermal growth factor Receptor 2 that is overexpressed in 15% of breast cancer cases and associated with bad prognosis.
- Tests used to determine HER2 status include IHC and FISH.
- IHC measures the amount of HER2 protein in the cancer cells.
- FISH looks at the number of copies of the HER2 gene in the cancer cells.
What microbiological tests are used for a patient going for an implant and flap and for a patient who has breast erythema and discharge from the nipple?
- A MRSA screen is used for a patient going for an implant and flap.
- If the MRSA screen is positive, the patient is a carrier and will require decolonization.
- Nose: Mupirocin 2% (Bactroban Nasal®) nasal ointment TDS for 5 days
- Skin: Once daily wash with Chlorhexidine 4% (Hibiscrub®) for 5 days
- Hair: Wash with Chlorhexidine 4% (Hibiscrub®) on day 1 and day 5
- Cultures and sensitivity tests are used for a patient who has breast erythema and discharge from the nipple.
- The causative organism for breast erythema and discharge from the nipple is Staph. aureus.
- Broad-spectrum antibiotics such as Flucloxacillin are likely to be prescribed for treatment, after discussion with a microbiologist and according to trust policy.
How does Herceptin (trastuzumab) work?
- Herceptin is a monoclonal antibody that interferes with the HER2/neu receptor, which are embedded in the cell membrane and communicate molecular signals from outside the cell to inside the cell, and turn genes on and off.
- The HER protein binds to human EGF and stimulates cell proliferation, leading to inhibition of MAPK and PI3K-Akt.
- Herceptin causes antibody-mediated destruction of cells overproducing HER2 and is taken three times weekly for 12 months.
What are the management options for breast cancer?
- Radiotherapy, chemotherapy, and hormonal therapy are used in breast cancer management.
- Premenopausal patients may take Tamoxifen (20mg/d) for 5 years to block estrogen receptor, while postmenopausal patients may take aromatase inhibitors (anastrozole) to prevent peripheral conversion to estrogen.
- A multidisciplinary team including a radiologist, surgeon, oncologist, and pathologist should be involved in the care of a breast cancer patient.
What causes Paget disease and how is it treated?
- Paget disease is caused by the extension of DCIS (ductal carcinoma in situ) up the lactiferous ducts and into the contiguous skin of the nipple, producing a unilateral crusting exudate over the nipple and areolar skin.
- Unlike Paget disease of the vulva, Paget disease of the nipple stems from in situ extension of an underlying carcinoma.
- Treatment options include surgery, radiation therapy, and chemotherapy.
