Breast cancer Flashcards
Lifetime risk for UK women
1/8
Main types of breast cancer (2)
Ductal epithelium
Lobular epithelium
Infiltrating carcinoma of the nipple epithelium
Paget’s disease of breast
Specific risk factors for breast cancer (e.g. other than age, previous history) (5)
Family Hx (e.g. BRCA) Ovulating a lot (nulliparity, early menarche and late menopause) HRT radiation to chest alcohol intake
Most common presentation of breast cancer
Painless lump
Proportion of patients presenting with a breast lump, which is painful
20%
Other signs of breast cancer (3)
Nipple change (e.g. inversion) Nipple discharge Lymphoedema of the arm
Imaging modalities available for investigating a breast lump (3)
Mammography
US
Ultrasound
In what situation might mammography be less useful? What might be used instead?
Younger patients with denser breast tissue. US/MRI
Biopsy method of choice in breast lump
Core needle biopsy
Monoclonal antibody techniques are used to determine what? (3)
ER, PR and HER2 status
What is CA 15-3?
A tumour marker which may be useful for prognosis
When might bone scan be indicated? (3)
Bone pain
Fractures
Distant/lymph node mets
What is stage 0 carcinoma?
Carcinoma in situ
Sites of metastases of breast cancer a) local and b) distant
a) chest wall, skin, nipple
b) contralateral breast, lung, liver, bone, brain
Surgical options for treatment (2)
Wide local excision
Mastectomy
When is mastectomy preferred over WLE? (2)
When tumour is >4cm, or is multifocal
Indication for prophylactic bilateral mastectomy
BRCA1/BRCA2 carriers
When is radiotherapy offered as treatment? (2)
After conservative surgery (WLE); after mastectomy if axillary nodes +ve
Complications of radiotherapy (3)
Radiation pneumonitis
Skin telangiectasis
Osteonecrosis
Hormonal therapy for ER+ breast cancers (2)
Tamoxifen (pre-menopausal) Aromatase inhibitors (post-menopausal)
Mechanism of aromatase inhibitors
Inhibit aromatization of androgens to oestrogens in adipose tissue
When is tamoxifen less effective?
HER2 amplified cancers
in which groups of patient is adjuvant chemotherapy useful?
Younger women
In patients with adverse prognostic indicators e.g. HER2+, ER-,
Chemotherapeutic agents used in breast ca. (3)
CMF (cyclophosphamide, methotrexate, 5-FU)
Taxane
Anthracyclines
Side effects of anti oestrogens (4)
Reduced libido
Hot flushes
Weight gain
Lethargy
Targeted treatment for HER2 amplified cancers
Trastuzumab (herceptin)
