Breast Cancer Flashcards
(121 cards)
1
Q
Breast cancer is the number ___ malignancy in American women and the number ___ cause of death to women by cancer
A
1:2
2
Q
What is the likely reason why people who are over weight are at a higher risk of developing breast cancer
A
Fat cells generate higher levels of estrogen
3
Q
BRCA-1 and BRCA-2 are
A
Oncogenes: tumor suppressor genes: DNA mutation
4
Q
Most of the breast tissues over lies the
A
Pectoralis major
5
Q
Ductal carcinoma occurs in the
A
Lactiferous ducts
6
Q
Lobular carcinoma occurs in the
A
Lobules
7
Q
What nodal group is not part of the nodal staging for breast cancer
A
Intramammary
8
Q
Medial and lateral breast tangents are typically how far apart
A
180 degrees apart (Coplanar)
9
Q
The typical treatment for ductal carcinoma is
A
It is the patients preference
10
Q
What is the most common acute side effect of breast radiation
A
Erythema
11
Q
Which is a disease of the lymphatics and not characterized by a local lesion
A
Inflammatory carcinoma
12
Q
Whole breast radiation is typically given to a total dose of
A
45-50 Gy
13
Q
Which is cardiotoxic
A
Herceptin, doxorubicin
14
Q
Why did the incidence of BC increased in the 1980
A
Due to the use of hormonal replacement drugs
15
Q
Average age for BC
A
55
16
Q
Most important risk factor is
A
Gender
100 women to 1 men will develop BC
17
Q
T/F
Alcohol, tobacco and night work increases the risk for BC
A
True
18
Q
BC is more common in ____ women
A
White women BUT black women present with more advanced disease
19
Q
Women with mothers or sisters who have/had BC are more _____ times more likely
A
2-3 times
20
Q
What are BRCA1/BRCA2
A
These are tumor suppressor scenes that fight off tumors. When these are mutated, risk for BC increases greatly
21
Q
Which tumor suppressor gene (BRCA1/BRCA2) is more common
A
BRCA1 is more common (50-55%0 BRCA 2 (45%)
22
Q
T/F
First child after 35 is just as likely of developing BC as a nulliparous woman
A
True
23
Q
T/F
History of BC, either invasive or ductal carcinoma in situ (DCIS) increase risk for other breast
A
True
24
Q
T/F
BC is curative at young age
A
True
25
Examples of benign disease
```
Atypical hyperplasia (over production of abnormal cells)
Lobular carcinoma in situ (together with fam hx, risk increases 11 times)
```
26
The breast is composed of
Subcutaneous fat
Glandular tissue
Fibrous stroma (hold everything together)
27
Location of the breast
Located between ribs 2-6
28
The breast attaches at
Sternocostal junction to mid axillary line (tissue is often beyond these borders)
29
Breast tissue consist of how many lobes
Each breast has 15-20 lobes
30
Each lobe is drained by a system ducts that opens at the
Nipple
| Tumors in these are known as lobular carcinoma
31
Each lobes has numerous lobules that contains
Alveoli that produces milk
32
Ductal carcinoma originates in the
Lactiferous ducts
33
What are the 2 sets of lymphatic chain associated with the breast
Superficial
| Deep
34
The superficial lymphatics drains
The skin
35
The deep lymphatic drains
Internal tissue
36
70% of drainage is to the
Axillary
37
30% of drainage is to the
Intermammary nodes
38
Primary deep drainage occurs to the
Ipsilateral axillary
39
IM nodes are located
Near the edge of the sternum
40
IM nodes are embedded in the fat in the
Intercostal spaces (most are in the 1st, 2nd, 3rd)
41
Major prognostic indicators includes
Lymph nodes status
Tumor event
Histology grade
ER/PR and HER2/neu status
42
Which lymph involvement is the most important prognostic indicator
The number of axillary lymph involvement
43
Increased risk of recurrence is associated with
Higher number of node involvement
44
Low risk is how many node
3 or less
45
High risk is associate with how many nodes
4 or more
46
What lymph nodes status would indicate poor prognosis
IM and S'clav involvement is poor prognosis
| 10 or less nodes involvement is an extremely poor prognosis
47
T/F
| Location does not seem to matter except in instances of attachment of tumor to chest wall
True
48
Most common BC histology
Infiltrating ductal carcinoma (70-80%)
49
Second most common BC histology
Infiltrating lobular carcinoma
50
If the tumor is fueled by estrogens and progesterone then positive estrogen and progesterone tumors may respond well to
Hormone therapy
51
Overall 5 year survival rate is
89%
Decreases to 83% if regional spread
Decrease to 20% if distant mets presents at diagnosis
52
T/F
| Because of the systemic nature of BC, patients may relapse up to 20 yrs after treatment
True
53
```
T/F
Multi focal (tumors appears in same area) are the most common and has the best prognosis
```
True
| Compared to multi centric- tumors appears in several areas
54
Upper outer lesions usually metastasize to
Axillary nodes
55
Medial lesions tends to metastasize to
IM nodes
56
Local reocurrence can be treated with
Surgery
57
Regional reoccurrence is usually treated with
Chemotherapy and/or surgery
58
How does BC spread
Via blood vessels
59
Common places for mets
Bone
Lung
Liver
Brain
60
Age recommended for mammo
40
61
T/F
| If detected early, BC is one of the most curable cancers
True
62
Most common presentation is
Painless lump
63
What kind of masses are more suspicious
Post menopausal masses
64
What is the second most common symptom/presentation
Nipple discharge or retraction and also Paget's disease
65
Other BC presentation includes
Lymphadenopathy of axillary
| Arm edema
66
What imaging modality is recommended for high risk women
MRI
67
Most common form of biopsy
Excisional biopsy (lumpectomy)
68
What is fine needle biopsy
Small needle
Least painful
Difficult to know what you're looking at
69
What is core needle biopsy
Larger needle to remove core of mass
| More painful but gets a better cross section of the tumor
70
What is incisional biopsy
Partial removal of mass for examination
| Done is mass is too large
71
What are the odds of American women developing breast cancer
1:8
72
Breast cancer is ____ times more likely to occur in women than men
100 times
73
Breast cancer occurs slightly more in ___ women but is more advanced in ____ women
More in white women
| Advance in black women
74
What is likely the reason why people who are overweight at a higher risk of developing BC
Fats cells generate higher levels of estrogen
75
Who is LEAST likely to develop BC
A women who has 3 children between the ages of 20-30
76
T/F
| Breast pathology in one breast increases the risk of a second pathology in the contra lateral breast
True
77
A women with a first degree relative that has or had BC has a ____ risk of developing BC
2fold
78
T/F
| Men are not susceptible to BRAC2 mutations
False
79
What factors increases the risk of women developing BC
Alcohol
Tobacco
Obesity
Night shift work
80
Most of the breast tissues overlies the
Pectoralis major
81
Breast parenchyma consist of how many lobes
15-20 lobes
82
Ductal carcinoma originate in the
Lactiferous ducts
83
Which nodal groups are part of the nodal staging
Axillary
Internal mammary
Supra clavicle
84
Medial and lateral breast tangents fields are typically how far apart
Greater than 180 degrees apart
85
The typical treatment regime for ductal carcinoma.
Lumpectomy followed by XRT
86
What is this advantage of prone breast treatment
Reduced dose to the heart and lungs
87
T/F
| The central axis of tangent fields are typically not Coplanar
True
88
What is the most common side effect of breast radiation
Erythema
89
Whole breast radiation is typically given a dose of
45-50Gy
90
Compared to whole breast radiation, hypo fractionated partial breast radiation (PBI) delivers:
A lower number of fractions, higher daily dose and lower total dose
91
Herceptin and doxorubicin is
Cardiotoxic
92
T/F
| DCIS (ductal carcinoma in situ) increase the risk for BC
False.
| LCIS (lobular carcinoma in situ) increase the risk for BC
93
What is multi centric
Different area of the breast
94
What is multifocal
Different lesions within the same region
95
IDC tends to spread to
Axillary nodes
96
Some researchers believe that BC is a systematic disease due to:
Little change in survival since radical mastectomy
| Late distant mets continue even as advanced detection and treatment occurs
97
Most common lymphatic involvement
Axillary nodes
98
Level I nodes included
Axillary and is more lateral
99
Level II nodes include:
In the middle and deeper
100
Level III nodes includes :
Supraclavicluar region
101
Internal mammary nodal involvement is more commonly seen in what age group
Younger age are higher IM positive nodes
102
IM nodes are ____ positive
20% positive
103
IM and S'clav nodal involvement will have _____ prognosis
Poor prognosis
104
T/F
All 3 modalities, meaning chemo, surgery and XRT is used for BC since it is very complex
**however, decision about treatment are patient and tumor specific**
True
Chemo for microscopic disease and more aggressive tumors
Surgery to remove the tumor
XRT post op (usually)
105
The modified radical mastectomy includes what nodal levels?
Level I and Level II lymphatics
106
Total mastectomy is done for
High risk patients, BRAC1 and BRAC2 mutations. This removes entire breast and has a 90% survival
107
this type of biopsy is Used for staging when axillary are negative
Sentinel node biopsy
108
Adjuvant mean
After surgery
109
Neo-adjuvant means
Before surgery
110
Most common route for chemo
IV
111
Used to deliver deprive cancer cells of hormone that promote growth. Most common agents tamoxifen and aromitase inhibitors
Endocrine therapy
112
Inoperable tumors can receive
Nemo-adjuvant chemo and XRT (before surgery)
113
NCCN guidelines for BC with negative nodal involvement
XRT to whole breast with or without boost or PBI
114
NCCN guidelines for BC with 1 and more nodal involvement
XRT to whole breast with or without boost, S'clav , infra clave and IM strongly consider
115
Boost breast dose
Boost to 60-66Gy
| Regular dose is 45-50Gy
116
Lung limitations
1cm-3.4cm
117
Lateral field border
2cm of flash/beyond tissue
118
Inferior field border
1.5cm below breast tissue/inframammary fold
119
Superior field border
First intercostal space or as superior as possible
120
Medial field border
Midline
121
Pins and shift system is also known as
Landmark and coordinate system
