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Miscellaneous > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What type of cancer is breast cancer most commonly?

A

Adenocarcinoma

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2
Q

Is breast cancer common?

A

Yes! Very common

32 women diagnosed every day

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3
Q

What are the risk factors of breast cancer?

A

Age: increased prevalence with age

Lifestyle:

  • overweight
  • alcohol
  • physical inactivity

Occupational, chemicals, night shift

Increased oestrogen exposure

Family history

Genetics: BRCA1 + 2

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4
Q

Why does overweight + obesity increase the risk of breast cancer?

A

Fat cells produce oestrogen
The more fat cells you have the more oestrogen you have

Oestrogen increases the risk of breast cancer

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5
Q

Why does doing lots of night shifts increase the risk of breast cancer?

A

Night shifts reduce levels of melatonin in the blood

Melatonin is a hormone associated with darkness and going to sleep

It also prevents tumour formation

So the less melatonin you have the more risk of tumour formation

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6
Q

What things can cause increased oestrogen exposure?

A

HRT
OCP
Obesity

Breastfeeding and parity reduce exposure

Time between menarche and menopause

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7
Q

What genetic mutations are associated with breast cancer?

A

BRCA 1 and 2

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8
Q

What is the link between oestrogen and breast cancer?

A

Sometimes, oestrogen can stimulate breast cells to grow in an uncontrollable way

These become oestrogen positive tumours

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9
Q

The family history risk of breast cancer is significant only if it involves … relatives.

A

First degree

Sister, mother, daughter

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10
Q

What cancers does BRCA1 increase the risk of?

A

Breast
Bowel
Ovarian
Prostatic (men)

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11
Q

What cancers does BRCA 2 increase the risk of?

A

Breast

Ovarian

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12
Q

Why does mutation of BRCA1 and 2 cause an increased risk of breast cancer?

A

Because BRCA 1 and 2 are tumour suppressor genes

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13
Q

HER 2 gene mutation is inherited.

True or false?

A

False!

HER2 is a mutation that occurs in some cancer cells

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14
Q

What happens to the HER2 gene when it mutates?

A

Overexpression of HER2 gene meaning overexpression of HER2 protein

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15
Q

What type of gene is HER2?

A

A proto-oncogene
It usually regulates cell growth
When out of control it leads to uncontrolled growth

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16
Q

What is an adenocarcinoma?

A

Cancer of epithelial cells of glands or ducts

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17
Q

What is a non-invasive carcinoma?

A

When the tumour is confined to the ducts, lobules or acini

No infiltration of the basement membrane

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18
Q

Why do we need to worry about non-invasive carcinomas?

A

Because they have the potential to become invasive

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19
Q

Desrcibe the anatomy of the breast?

A

Acini: small glands

Clusters of these acini are called a lobule

These drain into ducts which drain into bigger ducts and connect to the nipple

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20
Q

Which is the most common type of breast cancer?

A

Invasive ductal carcinoma

21
Q

Describe what a breast lump caused by cancer might be like?

A 
Painless
Firm and irregular
Asymmetric
Lump not present on other side
Fixed to muscle
Causing tethering of skin
22
Q

Besides a lump, how does breast cancer present?

A

Nipple changes
Blood or watery discharge
Peau d’orange
Erythema

Signs of metastatic disease

23
Q

Investigation of breast cancer?

A

Triple assessment

  1. clinical assessment
  2. imaging
  3. histology (biopsy)
24
Q

What imaging should you do when assessing breast cancer?

A

USS

Mammogram if you are strongly suspicious of breast cancer

MRI can be helpful

25
Q

What types of biopsy are there to investigate breast cancer with?

A

Biopsy of deep breast tissue using US guidance

Punch biopsy: take some epidermis and dermis
Useful in breast cancer that is obvious on skin

Lymph node biopsy: to check for metastasis to there

26
Q

How do we stage breast cancer?

A

Stage 1-4

TNM

27
Q

When does a cancer become invasive?

A

When it ruptures the bassment membrane

28
Q

What options are there in terms of breast cancer surgery?

A

Wide local excision (WLE)

Breast conservation surgery

Mastectomy

Breast reconstruction

29
Q

When is radiotherapy indicated in breast cancer?

A

After a WLE or breast conservation surgery

As a neo-adjuvant therapy to shrink a tumour making it operable

30
Q

What is the difference between adjuvant and neo-adjuvant therapy?

A

Neo-adjuvant: before surgery

Adjuvant: after surgery

31
Q

What is the point in neo-adjuvant therapy?

A

To shrink a tumour and make it operable or easier to operate

32
Q

What is the point of adjuvant therapy?

A

Often there are micro-metastases that have spread even before the cancer was detectable

Adjuvant therapy clears these

33
Q

What are micro-metastases?

A

Metastasis of small clusters of cancer cells, occurs very early on in cancer

They can lie dormant for years and be activated causing a recurrence of cancer

34
Q

All breast cancers are sensitive to chemotherapy.

True or false?

A

False

Some are completely insensitive

Some are sensitive initially but adapt and become resistant

35
Q

When is chemotherapy indicated?

A

Herceptin positive

Oestrogen receptor positive (sometimes)

As a neo-adjuvant or adjuvant therapy

36
Q

What is the best treatment for oestrogen receptor positive chemotherapy?

A

Endocrine

Oestrogen receptor blockers or aromatase inhibitors

These tumours are stimulated to grow by oestrogen, so if no oestrogen no growth

37
Q

Name the endocrine agents used in oestrogen receptor

positive breast cancer?

A

Tamoxifen: an oestrogen receptor blocker

Aromatase inhibitors: inhibit the conversion of androgen into oestrogen

38
Q

What are some common sites of metastasis in breast cancer?

A 
Lymph nodes
Liver
Lung
Brain
Bone
39
Q

How does breast cancer metastasis damage bone?

A

Tumours in the bone stimulate osteoclast activity

They make holes in the bone

40
Q

When are women invited to screening for breast cancer?

A

Between ages 47 to 73 (approximately)

41
Q

What types of drugs are used in HER2 breast cancers?

A

Biologics, such as trastuzumab

42
Q

What is meant by triple negative breast cancer?

A

Cancer that is not linked with oestrogen, progesterone or HER2

43
Q

Which hormones are associated with breast cancer?

A

Oestrogen

Progesterone

44
Q

What is lymphoedema?

A

Fluid retention resulting from problems with the lymph drainage system

Often because lymph nodes have been removed because breast cancer has spread to them

45
Q

What is the normal function of the lymphatic system?

A

Returns interstitial fluid to the thoracic lymph duct and then the bloodstream

46
Q

Why should you be careful before removing lymph nodes?

A

Only remove them if necessary, because the more you remove the higher the risk of lymphoedema

47
Q

What are the signs of lymphoedema?

A

Swelling, heaviness of arm

48
Q

How can you prevent lymphoedema?

A

Minimise trauma to arm, i.e. don’t put a canulla in that arm

Wear a tight support on the arm

Miscellaneous (9 decks)

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