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Neoplasia > breast cancer > Flashcards

breast cancer Flashcards

1
Q

Thelarche is

A

Sustained period of mammary gland growth in adolescence

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2
Q

Breast parenchyma is composed of

A

Ducts and lobules

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3
Q

Breast lymphatic drainage to

A

Axillary
internal mammary lymph nodes
supraclavicular

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4
Q

2 types of breast stroma

A

1 - intralobular - supports lobules

2 - Fibroadipose - interlobular

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5
Q

In young woman breast tissue is

A

very fibrous - more radiolucent with age - more adiopse

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6
Q

Breast examination between what structures

A

clavicle
sternum
inframammary ridge
axilla

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7
Q

Paget’s disease

A

In situ Brca

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8
Q

Non -cancerous Breast lumps can be

A

fibroadenomas

fibrocytic chances in prolfierative disease

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9
Q

triple test for breast cancer diag

A

1- breast exam
2- imaging
3- biopsy

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10
Q

Fat and dairy have
red meat
vitamin D

A

no significant impact on brca
slight impact of red meat and alcohol
vitamin D reduces risk, soy not recommended

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11
Q

Linear relationship between

A

Alcohol and breast cancer
3-5 drinks a day - 1.5x increased risk
advise 1 drink a day
folate reduces risk

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12
Q

Can dietary changes reduce risk for Brca?

A

NO evidence - except for slight benefit of VitD

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13
Q

Available agents to reduce risk

A

Tamoxifen -reduce opposite breast risk after brca in one breast
Raloxifene - for post menopausal

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14
Q

Tamoxifen given as a chemopreventative can

A

Increase risk of endometrial hyperplasia after 5 years

better for women under 50

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15
Q

Now 2011 guidelines recommend

A

against mammography and CBE (40-49)

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16
Q

How are most brca detected in women <45

A

Most often self-detected - encourage opportunistic breast examinations

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17
Q

In 50-69 age group
in 40s age group
In 70s

A

there is 20-35% reduction in mortality
15% reduction in mortality
55% reduction

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18
Q

For 50-74 yr old women recommend mammography

A

Every 2 years - not 3

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19
Q

NEJM article states that

A

30% overdiagnosis of brca

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20
Q

recommendations of NEJM articles

A

Most people recommend routine mammography -

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21
Q

Screening recommendations of the canadian task force are for
for clinicians

A

Average risk women with NO breast symptoms

discuss screening for all above 40

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22
Q

50 yr old woman - screening recommendations

A

mammogram q2 years, annual if high risk
consider OBSP
discuss BA
Opportunistic BE

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23
Q

40 yr old woman

A

consider mammogram q1-2 yrs depending on patient risk and preference
discuss bA
OBE

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24
Q

70 yr old woman

A

mammography until life expectancy <10 years

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25
Q

Younger women present with what type of tumor

Cysts common

A

Fibroadenoma - not always - wider than it is taller

pre and peri-menopausal women

26
Q

Mediolateral view of the breast is

A

Most important - covers most tissue

27
Q

Biopsy should be consideredin BI-RADS when

A

4

0- means needs more info

28
Q

What 4 things do you look for on screening

A

1- asymmetries
2- distortion
3- masses
4- calcifications

29
Q

Breast cancer attributable to inheritance of a known mutated gene constitutes

A

<10% of total cases

BRCA1/2 - 50-80% lifetime risk

30
Q

If you have pre-invasive disease -

A

at 10x increased risk for Brca (dcis, lcis)

31
Q

atypical hyperplasia

A

proiferative disease with nuclear atypia

32
Q

what percent of women will have fibrocystic breast changes

A

33%

thought to be estrogen driven

33
Q

Proliferative breast changes without atypia include

A 
florid ductal hyperplasia
sclerosing adenosis
papillomas
preserved basal cell layer!!
1.5-2x increased risk
34
Q

Proliferative breast changes WITH atypia include

A

ductal or lobular hyperplasias resemble cancer
preserved basal cell layer!
5x risk! for both breasts!!

35
Q

DCIS

A

no invasion
intact myoepithelial layer
can get skin/nipple changes (paget’s disease)

36
Q

paget’s disease

A

extenstion of an insitu process

37
Q

No special type invasive ductal carcinoma

A

NO myoep cel layer

38
Q

Lobular carcinoma

A

lost E cadherin

indivdual cells

39
Q

Amplification of her2/neu seen

A

10-30% of breast and ova cancer and poorer prognosis

40
Q

Stage 3 and 4 tumors 5-yr survival

A

72% and 22%

41
Q

which type of brca do you do a full work up - metastatic work up on

A

Invasive ductal carcinoma

12% will have distant mets

42
Q

lumpectomy - must get

A

radiation - 3-5 weeks - decrease local recurrence
40% recurrence just with lumpectomy
5% with radiation

43
Q

lumpectomy with radiation compared with mastectomy

A

same overall survival

44
Q

with an axillary dissection you remove

A

10 lymph nodes - 15% lymphedema

45
Q

sentinal node biopsy

A

2-3 nodes

46
Q

whether you have sentinal node positive and complete dissection

A

same recurrence!

47
Q

30% of people with stage 1 disease develop
50% with stage 2
70% with 3 or higher

A

mets

48
Q

what % of patients with her2+

A

20% of patients

49
Q

hormones and traztuzumab have

chemotherapy

A

50% efficacy

15-40%

50
Q

luminal A tumors have

A

good prognosis c/w luminal b

high ER low prolif

51
Q

in positive and negative node early brca - with oncotype Dx

A

High risk groups benefit greatly from adding chemo+hormone therapy

52
Q

Chemo 1st gen, 2nd gen, 3rd gen

A

CMF<taxanes

3rd gen: use anthrax+taxane

53
Q

Tamoxifen is used

A

eR antagonist - used in any age group

54
Q

aromatase inhibitors work

A

In the periphery, prevent androgen to estrogen conversion

55
Q

In post-menopausal women what is the standard of care

A

aromatase inhibitors

56
Q

aromatase inhibitors vs tamoxifen

A

no signficaint survival benefits!!

57
Q

Tamoxifen and AI both

A

reduce contralateral breast cancer risk

58
Q

Special Sideeffects of tamoxifen

A

increased risk of thromboembolic events

stroke and endometrial cancers

59
Q

Side effects of AIs

A

increases osteoporosis risk and CVD

60
Q

10 and 15 years after diagnosis there is a reduced risk

A

with taking tamoxifen continuation to 10 years

Neoplasia (1 decks)

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