Breast Cancer Flashcards
Epidemiology of Breast ca
Most common cancer in women
1 in 8 women
Secondary Risk factors for breast ca
Early menarche Late menopause HRT Pregnancy hx Benign breast disease
What are BRCA1 and BRCA2 Mutations?
Breast and ovarian gene
Increases risk to 85%
Primary Risk factors for breast ca
Female >50 Personal hx 1st degree relative hx BRCA1 or BRCA2 mutation North America & Northern Europe
ACS Screening Guidelines
Monthly self exam
CBE (q 6mo if high risk)
Annual mammo at age 40
-10yrs earlier than relative diagnosed/fam hx of BRCA mutation
BI-RADS
0-1: annual mammogram 2-3: return in 6mo 4: f/u imaging or biopsy 5: biopsy 6: malignancy already present
What is a suspicious lump?
Stoney-hard Fixed Skin changes Bloody nipple discharge Complex/solid on US
How is diagnosis of Breast Ca made?
*Core needle bx is standard w/ lymph node bx
Incisional bx: takes part of mass
Excisional bx: takes all (like lumpectomy)
Histopathology of breast ca
Adenocarcinoma
Usually in UOQ
More common on left side r/t increased circulation
What are the types of breast cancer?
Carcinoma In Situ (CIS)
Infiltrating ductal (IDC) (75%)
Infiltrating lobular (ILC) (5-50%)
Inflammatory
Describe CIS
No invasion/spread
Confined to ducts or lobules
Subtypes of CIS
DCIS -common, non-malignant -calcification on mammo -Tx: lumpectomy, tamoxifen -GOOD PROGNOSIS LCIS -more of a tumor marker -not seen on mammo -usually seen w/ another invasive cancer
Describe IDC
MOST COMMON starts in duct Not always palpable Mets thru lymph system May or may not have calcifications
Describe ILC
2nd most common Starts in milk glands Palpable Usually w/ contralateral findings (bilateral) May not appear on mammo Node mets common
Characteristics of Inflammatory Breast Ca
Sudden onset; Emergent
quick spread of ca cells into lymph of skin
Dermal invasion
Poor prognosis
*Peau d’ orange, ulceration, erythema, heat, edema, skin nodules
What is a lumpectomy?
Removes cancer and tissue 1-2mm around
Local control of breast ca w/ XRT
Lumpectomy+XRT= mastectomy
Types of Mastectomies
Simple: takes breast tissue (also prophy for BRCA)
Skin-sparing: leaves skin and nipple; empties breast
Modified: most common, removes breast tissue,skin, nipple
Radical: takes muscles and ribs out
W/ or w/o reconstruction
Sentinel lymph node hypothesis
If SLN in regional basin is negative; all others are too
-node mapping
Lymph Nodes
Primary prognostic factor
1st site of spread
# of lymph nodes + shows risk of mets
Hormone receptors (Estrogen)
Estrogen receptor/Progesterone receptor (0-100%)
-the more + cells is= better response to hormone tx
When receptors are blocked= no response
-blocking/decreasing estrogen=decrease ER+ tumor cells
What is HER2+ Breast Ca ?
Human epidurmal receptor growth factor 2
Too much HER2
-more relapses and chemo-refractory (aggressive)
Adjuvant Therapy for Breast ca
Tx after surgery for stage I, II, III Prevents regional/distant spread -chemo (Adria and Cyclophosphamide + taxane) -XRT -endocrine therapy
Treatment for HER2 Neu +
Tx’d with Herceptin (for 12mo) standard of care
Pertuzumab: 1st Neoadjuvant approved drug
Iapatinib: metastatic breast ca; crosses bob
What does tamoxifen do?
Inhibits reuptake of estrogen in cells
Used in ER+ breast ca
Only used premenopausal
