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Pathobiology of Neoplasia > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Epidemiology of Breast ca

A

Most common cancer in women

1 in 8 women

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2
Q

Secondary Risk factors for breast ca

A 
Early menarche
Late menopause
HRT
Pregnancy hx 
Benign breast disease
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3
Q

What are BRCA1 and BRCA2 Mutations?

A

Breast and ovarian gene

Increases risk to 85%

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4
Q

Primary Risk factors for breast ca

A 
Female
>50
Personal hx 
1st degree relative hx 
BRCA1 or BRCA2 mutation
North America & Northern Europe
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5
Q

ACS Screening Guidelines

A

Monthly self exam
CBE (q 6mo if high risk)
Annual mammo at age 40
-10yrs earlier than relative diagnosed/fam hx of BRCA mutation

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6
Q

BI-RADS

A 
0-1: annual mammogram 
2-3: return in 6mo 
4: f/u imaging or biopsy
5: biopsy
6: malignancy already present
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7
Q

What is a suspicious lump?

A 
Stoney-hard
Fixed
Skin changes
Bloody nipple discharge 
Complex/solid on US
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8
Q

How is diagnosis of Breast Ca made?

A

*Core needle bx is standard w/ lymph node bx

Incisional bx: takes part of mass
Excisional bx: takes all (like lumpectomy)

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9
Q

Histopathology of breast ca

A

Adenocarcinoma
Usually in UOQ
More common on left side r/t increased circulation

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10
Q

What are the types of breast cancer?

A

Carcinoma In Situ (CIS)
Infiltrating ductal (IDC) (75%)
Infiltrating lobular (ILC) (5-50%)
Inflammatory

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11
Q

Describe CIS

A

No invasion/spread

Confined to ducts or lobules

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12
Q

Subtypes of CIS

A 
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
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13
Q

Describe IDC

A 
MOST COMMON
starts in duct
Not always palpable
Mets thru lymph system
May or may not have calcifications
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14
Q

Describe ILC

A 
2nd most common
Starts in milk glands
Palpable 
Usually w/ contralateral findings (bilateral)
May not appear on mammo 
Node mets common
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15
Q

Characteristics of Inflammatory Breast Ca

A

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

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16
Q

What is a lumpectomy?

A

Removes cancer and tissue 1-2mm around
Local control of breast ca w/ XRT
Lumpectomy+XRT= mastectomy

17
Q

Types of Mastectomies

A

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

18
Q

Sentinel lymph node hypothesis

A

If SLN in regional basin is negative; all others are too

-node mapping

19
Q

Lymph Nodes

A

Primary prognostic factor
1st site of spread
# of lymph nodes + shows risk of mets

20
Q

Hormone receptors (Estrogen)

A

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

21
Q

What is HER2+ Breast Ca ?

A

Human epidurmal receptor growth factor 2

Too much HER2
-more relapses and chemo-refractory (aggressive)

22
Q

Adjuvant Therapy for Breast ca

A 
Tx after surgery for stage I, II, III 
Prevents regional/distant spread
-chemo (Adria and Cyclophosphamide + taxane)
-XRT
-endocrine therapy
23
Q

Treatment for HER2 Neu +

A

Tx’d with Herceptin (for 12mo) standard of care

Pertuzumab: 1st Neoadjuvant approved drug

Iapatinib: metastatic breast ca; crosses bob

24
Q

What does tamoxifen do?

A

Inhibits reuptake of estrogen in cells

Used in ER+ breast ca

Only used premenopausal

25
Q

Side effects of tamoxifen

A

Blood clots
Endometrial ca
Bone pain
Hot flashes

26
Q

Things to do with hot flashes

A

Avoid CYP2D6 antidepressants

-Prozac, Paxil, Wellbutrin, cymbalta

27
Q

What are aromatase inhibitors?

A

Used post-menopausal

Block androgens to stop estrogen production

Anastrazole (Arimidex)
Femara

Causes osteoporosis

28
Q

Oncologic emergencies r/t breast ca

A

Hypercalcemia (bone mets common)

Spinal cord compression (spine mets common)

SVC syndrome (mediastinal node mets)

29
Q

What is lymph edema and tx ?

A

Swelling of hand and arm r/t increased lymph fluid after node removal

*exercise prevents

Pathobiology of Neoplasia (7 decks)

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