Breast Cancer Flashcards
Tamoxifen-
blocks the actions of estrogen-taken every day for up to five years
Tamoxifen S/E
Side effects: hot flashes, vaginal dryness, mood swings, thinning hair
Herceptin
can be given before and after surgery
Herceptin S/E
Flu like symptoms in the beginning -nausea and vomiting, chills Cardiotoxic -heart failure
What is HER2?
The HER2 gene makes HER2 proteins. HER2 proteins are receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself.
What can happen to HER2
in about 25% of breast cancers, the HER2 gene doesn’t work correctly and makes too many copies of itself (known as HER2 gene amplification). All these extra HER2 genes tell breast cells to make too many HER2 receptors (HER2 protein over-expression). This makes breast cells grow and divide in an uncontrolled way.
Aromatase inhibitors- When S/E
Aromatase inhibitors- post menopausal- Side effects-bone pain, osteoporosis, arthralgia
Cancers can form where?
In the ducts, or Lobules(Glands that produce milk) and lymph nodes
Benign Breast lumps
Very common, Known as Fibroadenomas.
Fibroadenomas occur in women ages?
30-35 but can be found in younger women
Fibroadenomas are?
Solid firm tumors that are usually painless or slightly tender. they sometimes can grow quickly in teens and during pregnancy due to horomones
What is a Breast Cyst
they are small fluid filled sacs within breast tissue that are benign in nature, they are common over 35 and may be tender and increase in size during menses
What are Fibro cystic Changes?
Fibrocystic changes are characterized by breasts that are lumpy with many irregularities in the breast that almost feels grainy on palpation. they are common from fluctuation of hormones and can be painful
Benign tumors are
Caused by cysts or Fibrosis, they can cause changes in breast swelling and pain.
What is the most common cause of breast mass in female patients younger that 25?
Fibroadenoma, and may appear as multiple masses
Phyllodes tumors or giant Fibroadenoma’s
are generally begnin, common in age 40-50 are large size(5cm{lime}) solitary firm breast nodule
Papillary Adenoma of nipples
Highest over40, commonly presents with unilateral Serous or bloody nipple discharge that increases before menses. THIS IS BAD, YOU SHOULD NEVER HAVE DISCHARGE FROM NIPPLES UNLESS BREAST FEEDING
Breast abcesses
Can be caused by infections of Staph or Strep.
Mastitis
Fungal inflammation of the breast tissue when breast feeding
Treatment of Mastitis
Warm compresses frequent pumping and feeding of breasts
Treatment of breast abscess
Antibiotics, warm compresses, ultrasounds, needle aspiration and incense and drain as needed.
What are some Modifiable Risk factors for breast Cancers
Diet, Weight, Smoking Avoid Pre-menopausal weight gain
What are some Non Modifiable Risk factors for breast Cancers
Gender, Age, genetic Risk factors, family history, race, dense breasts, menstrual periods, breast radiation early in life
Factors that can contribute to breast cancer
Genetics, Menstrual history(early or late) Heredity BRCA1, BRCA2
BRAC 1 is associated with increased risk of?
breast cancer, ovarian cancer and prostate cancers
BRAC2 is associated with increased risk of?
Associated with Breast cancer, ovarian cancer, PANCREATIC, prostate, MELANOMA
Additional Factors that can contribute to breast cancer
Mal-parity (not having children), certain birth controls, hormone replacement therapies after menopause, not breast feeding, alcohol use, being overweight, smoking
What are some myths that spread related to links to breast cancers
Antiperspirant, Bras or Bra Types, Induced abortions, and Breast Implants have no effect on risks to breast cancer.
What are some prevention techniques to utilize in breast cancer
Reduce Alcohol consumption, increase exercise, eat appropriate diet, avoid post menopausal hormone therapies, keep body weight WNL, regular breast cancer screenings and ensure to breast feed children.
When should a women preform SBE( Self Breast Exams)
Every month 5-7 days after start of menstrual period
What are some S/S of Breast Cancer
Nipple changes-Rash, Nipple discharge, shape changes, skin peeling or flaking, lumps in the breast or arm pit, pain in armpits not related to menses cycle. (THERE SHOULD NEVER BE DISCHARGE OR RASH ON THE NIPPLES)
Other changes in breast appearance that can be cause for concern
Dimpling, Inverted Nipples, Nipple inversion with Erythema (redness), Peu D’orange(orange peel appearance)
Ways of Diagnosing Breast cancer
SBE, Mammograms, breast ultra sound, breast MRI, Biopsy ( only truly definiative diagnosis
What is Pagets Disease
Rare Type of cancer involving the skin of the nipple and or areola
- May be one or more tumors in the same breast
- sypmtoms are often mistaken for dermititis or excema, but these should never be present on the breast.
- other mistaken symptoms are:
- Itching tingleing or redness of the nipple
- flaking crusty or thickend skin on or around the nipple
- Flattened Nipple or discharge from the nipple that may be yellowish or bloody.
Breast cancer commonly presents when, is screened for how and why
Breast cancer is usually screened with a BSE from 20-40yoa, however if lump is found or increased familal history is present may be given a Mamogram sooner. Generally after 40 pts recieve a mamogram yearly
types of Breast biopsy
- Fine Needle-
- extraction of fluid from the lump
- Core-
- removal of more tissue for better results
- Surgical-
- Removal of lump
- Lymph Node Biopsy
- Checking for spread to lymphatic tissue
What is a Sentinel lymph node and why is it biopsyede
The sentinal Lymph node is the first closest lymph node to a cancerous area or tumor. It is the first to recieve fluid from the tumor resulting in a need for biopsy to check for metastasis of cancer cells
What does SITU mean
Cancer remains where it is and has not transfered to any where in the duct
Breast cancer staging Stage 1
Stage 1A= a tumor 2cm or less and cancer has not spread outside the breast
Stage 1B= Small clusters of breast cancer cells larger than 0.2cm-2cm and are found in the lymph nodes and either there is no tumor found in the breast or the tumor is smaller than 2cm
Breast cancer Staging Stage 2
Stage 2A= No tumor is found in the breast or the tumor is 2cm or smaller larger that 2mm is found in the1-3 axilliary lymph nodes
Stage 2B= tumor, larger than 2 cm but not greater than 5cm. Small clusters of breast cancer cells larger than .2mm but not larger than 2mm in the lymph nodes, or larger thatn 2 cm but not larger than five cm and has spread to the lymphnodes, or larger than 5 cm but has not spread to lymph nodes
Breast Cancer Staging Stage 3
Stage 3 A= No tumor found in the breast or a tumor may be any size, cancer is found in 4-9 axiliary lymph nodes near the breast bone or the tumor is larger than 5 cm.
Stage 3 B A tumor may be any size and cancer has spread to the chest wall or skin of the breast and caused swelling or ulceration. also cancer may have spread to up to 9 lymph nodes and the nodes near the mediasinum(chest wall)
What is a sentinel node biopsy
It is the process where radioctive die is placed in tumor and followed to the affected lymph nodes to determine first and worst affected
Modified Masectomy
If done early reduces need for total and can reduce amount to be taken. for example in a modified as much is saved as possible
Radical or Total mastectomy
total removal of breasts and lymphnodes. many complications can be involved
Complications after Mastectomy
- Risk of local recurance 5-10%
- Wound infection
- seroma(accumulation of fluid aroud sight
- mastectomy skin flap necrosis
- hematoma
- chronic pain
- incisional dog ears
-
Lymhadema- largest complicaton drainage is impeded to lymph causing increased accumulation of fluid in the arms
- fibrosis
*
- fibrosis
After surgery what is the baseline for follow up mamograms
Every 6 montsh with assesment by md every 4
What are the types of breast cancer 3?
Hormone receptor positive BC
HER2 positive
Triple negative
What is Hormone receptor BC?
protiens from endocrine system attach to hormones such as estrogen or progesterone and fuel BC growth
ER- Estrogene
PR- Progesterone
Therapies used
Tamoxifen- Taken for up to five years after initial tx , helps prevent reoccurance by blocking estrogen receptors on BC cells
Aromatase inhibitors Stop estrogen production in post menopausl women
HER2- Human epidermal growth factor 2 is?
- A protein that causes its cancers to tend to grow faster than other BC
- present in 1 of every 5 BC
- Herceptin is given along with standard treatment
- after surgery and chemo
Triple negative BC
Results from Lack of Estrogen and Progesteron receptors and does not express HER2 protien (BRCA1)
use of standard chemo
overall poorest diagnosis over other BC’s
Non invasive Cancers
- Non invasive
- Ductoal cancerous cells confined to duct tissue
tx- breast conservation : Lumpectomy, with Radiation
- lumpectomy 25% reoccurence and significant of them are invasive
- with radiation reoccurance down to 8%
- Modified radical risk down to 1%
*
- Modified radical risk down to 1%
Lobular Carcinoma
More common to find incidentally
Is a marker for indicatoin of cancer in the other breast
if mastectomy is needed Bilateral should be considered
If Infiltration in ductal carcinoma
CA with have Spread to basement membrane of cells
MOST COMMON BC
TX- Sugery, and Sent NODE Biopsy
Chemo if spread to nodes or elsewhere
Hormone therapy(tamoxifen, Raloxifene
