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Breast > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

Incidence of breast cancer

A

1 in 9 women will develop breast cancer during their lifetime

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2
Q

Risk factors for breast cancer x10

A 
Gender
Increasing age
Nulliparity- late age at first baby
Early menarche, late menopause
Oral contraception/HRT
Greater height/weight (obesity)
Ionising radiation 
Carcinogen exposure
Family hx 
Alcohol
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3
Q

Peak age for male breast cancer

A

71 years

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4
Q

Relationship of male breast cancer and gynaecomastia

A

No increased risk of MBC with gynaecomastia once treated by radiotherapy

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5
Q

Relationship of breast cancer risk to steroid hormones

A

Longer the duration that the breast epithelium is exposed to steroid hormones - especially in cyclical form - greater risk of malignancy

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6
Q

Risk factors for male breast cancer x4

A

Work in hot environment (testicular failure)
Males taking oestrogens (transsexuals and prostate carcinoma)
Undescended testis
Mumps >20 years

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7
Q

Genetics and male breast cancer

A

Almost all male breast cancer of genetic origin is due to BRCA2 mutations

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8
Q

Association of Klinefelters syndrome and breast cancer

A

Risk of breast cancer is similar to that in females

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9
Q

What is a new risk factor for breast cancer

A

Higher levels of serum gamma-glutamyl transferase (GGT) in premenopausal women
Serum GGT may be a marker of prior exposure to carcinogens

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10
Q

Protective factors against breast cancer x5

A

Pregnancy
Oophorectomy (before age of 50)
Lactation
Late menarche and early menopause

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11
Q

Relationship of oral contraception and breast cancer risk

A

Risk is increased when on oral contraception but decreases when you stop it

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12
Q

Relationship of smoking and breast cancer risk

A

Smoking has anti-oestrogenic effects therefore induction of earlier menopause, but does not protect against breast cancer - could be because of increase in more aggressive ER- lesions

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13
Q

Role of alcohol and breast cancer

A

Alcohol increases oestrogens

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14
Q

Relationship of diet and breast cancer

A

Significant relationship between national mortality rates from breast cancer and fat consumption

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15
Q

Risk of breast cancer and ovarian cancer with BRCA2

A

50-85% breast cancer

10-30% ovarian cancer

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16
Q

Where are breast cancers derived from?

A

The epithelial cells that are found within the terminal duct lobular unit - TDLU

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17
Q

Difference between non-invasive (DCIS) and invasive

A

non-invasive are within the basement membrane of the duct unit whereas invasive has dissemination of cancer cells outside of the basement membrane into adjacent normal tissue

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18
Q

What is the grade of a breast cancer?

A

It is a characteristic of the tumour which does not change with time - eg. a low grade well-differentiated DCIS evolves slowly into a well-differentiated grade 1 invasive cancer
High grade into high grade

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19
Q

What is the stage of a breast cancer?

A

Duration of breast cancer and may reflect delay

eg. DCIS stage can develop into a cancer

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20
Q

What do the majority of ER- positive cancers express?

A

Progesterone receptors therefore also have greatest probability of responding to hormone therapy

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21
Q

Other gene which is associated with increased risk of breast cancer

A

TP53 gene - also assocaited with other malignancies and Li Fraumeni syndrome (soft tissue/osteosarcoma - early onset breast cancer, glioma and childhood adrenal cancer)

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22
Q

Investigation of breast cancer

A

2 view mammography, whole breast ultrasound, image-guided core biopsy and if invasive cancer then axillary ultrasound with FNA or core biopsy of suspicious lymph nodes - sentinel node biopsy

23
Q

What contributes to the grading of a cancer?

A

Degrees of glandular formation, nuclear pleomorphism and frequency of mitoses - Nottingham modification

24
Q

What % of breast cancers express significant amounts of oestrogen receptor

A

75%

25
Q

What % of breast cancers are HER2 (human epidermal growth factor receptors) positive

A

15-20%

26
Q

Relationship of ER and HER2 positive cancers

A

Most ER positive cancers are HER2 negative

27
Q

What are triple negative breast cancers

A

HER2, ER and PR negative - more common in BRCA1 carriers

1/2 respond well to chemotherapy, but some are chemo resistant

28
Q

How can breast cancer present? x10

A 
Breast lump 
Nipple discharge
Inversion of the nipple
Skin dimpling/deformity 
Mammographic abnormality 
Lump in axilla (secondary spread)
Lymphoedema (secondary spread) 
Bone pain, weight loss (secondary spread)
Paraneoplastic syndromes (secondary spread)
29
Q

Grading of cancer diagnostically

A 
1 - normal 
2 - benign 
3 - interderminate, probably benign 
4 - suspicious of malignancy 
5 - malignant
30
Q

Extra classification of grading diagnostically

A

B5a - DCIS

B5b - Invasive

31
Q

Features of pathological nipple discharge x4

A

Spontaneous
Unilateral
Blood stained
Single duct

32
Q

Which breast cancers are treated with intention to cure?

A

All stages apart from stage 4 (distant mets)

33
Q

Stage 1 breast cancer?

A

Small - T1 = less than 2cm

34
Q

Treatment strategy for loco-regional invasive breast cancer

A

Surgery - breast conserving/wide excision + radiotherapy or mastectomy

35
Q

Stage 3 breast cancer?

A

Locally advanced, T3 = larger than 5cm

36
Q

Stage 4 breast cancer?

A

Distant mets - t4 any involvement of chest wall or skin

37
Q

What are 2 relative contraindications to breast conserving surgery

A

Multifocal disease

Large operable cancer

38
Q

When is breast reconstruction best?

A

Immediate - one procedure, better planning of incisions, can be modified and better cosmetic outcomes, also if delayed then post-radiotherapy chest wall makes surgery more difficult and probably causes more complications

39
Q

Options for breast reconstruction x3

A

Implants (expandable = saline+silicone or solid = silicone)
Using own tissue, SC fat and muscle (lattismus dorsi and transvers rectus abdominus muscle)
Or combination of own tissue and implants

40
Q

Treatment strategy for systemic invasive breast cancer

A

Chemotherapy
Endocrine treatment
Or targeted treatment

41
Q

What are 2 absolute contraindications to breast conserving surgery

A

Diffuse disease or multicentric disease

42
Q

What is Sentinel node biopsy?

A

First port of call for lymph from breast - can be identified with dye or isotope (technetium colloid)
In theory if sentinel is okay then axilla will be negative

43
Q

Use of chemotherapy in breast cancer

A

Can be given as primary systemic therapy prior to surgery to downstage tumour - neoadjuvant chemotherapy - can enable breast conservation
Also adjuvant therapy following surgery

44
Q

What are the benefits of axillary clearance?

A

Gives very important prognostic information - can also have a therapeutic effect as inadequate axillary treatment can lead to increased loco-regional relapse and increased breast cancer mortality

45
Q

What is now routine chemotherapy?

A

Athracycline (…rubicin) containing regimes
FAC (5-fluorouracil , doxorubicin, cyclophosphamide)
FEC (5-fluorouracil, epirubicin and cyclophosphamide)

46
Q

Options other than axillary clearance x3

A

Doing nothing
Axillary sampling (hit and miss)
Axillary irradiation - more morbidity and lack of prognostic information

47
Q

Adjuvant treatment for HER2 positive cancers

A

Herceptin/Trastuzumab - monoclonal antibody that intereferes with the HER2 receptor

48
Q

What is the standard chemotherapy for breast cancer?

A

CMF - 6 cycles

Cyclophosphamide, methotrexate and 5-fluorouracil

49
Q

What is tamoxifen

A

Selective oestrogen receptor modulator

50
Q

Another possible drug for ER- positive breast cancers?

A

Aromatase inhibitors - block synthesis of oestrogen - only if post-menopausal eg. anastrozole, letrozole

51
Q

Signs of breast cancer on mammography

A

Branching or lineal microcalcifications (calcifications very indicative of malignant disease)
Spiculated lesions

52
Q

Bloods in breast cancer suspicion

A

FBC, U&E, Ca2+ (can get hypercalcaemia), bone profile, LFTs, tumour marker (CA-15-3)

53
Q

Node staging of breast cancer

A

N1 - mobile ipsilateral axillary node
N2 - fixed ipsilateral axillary node
N3 - ipsilateral internal mammary node

54
Q

Other hormonal therapy for BC

A

Ovarian ablation with LNRH-analogues eg. goserelin

Selective oestrogen down-regulators eg. fulvestrant and progestins

Breast (3 decks)

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