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CAN > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Incidence

A

Most common cancer in the U.K.
50000 women 400 men
1 in 8 women will be diagnosed with BC in her lifetime
12000 women 80 men will die from breast cancer each year

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2
Q

Incidence inc of dec

Why

A

Inc
Women living longer age risk factor
Life styles

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3
Q

Mortality associated with BC

A

Low in comparison to diagnoses

More women diagnosed less are dying

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4
Q

Worldwide incidence

A

Geographical location matters
More likely in Europe than USA
Lifestyle and genetic factors

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5
Q

Migration studies

A

Chinese women same risk once emigrated

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6
Q

Survival by stage

A

Smaller the tumour better the chances of survival
Stage 1 - survive 10 years
Stage 4- mets unlikely to survive 10 years

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7
Q

Risk factors

A 
Age
Geographical location 
Oestrogen exposure 
Family history- BRCA1 
Prev BC
Exogenous hormone 
BMI high 
Ionising radiation
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8
Q

Nhs breast screening programme

A

47-73 every 3 years invitation

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9
Q

Socioeconomic factors and BC

A

High sat fats obesity
Age at first pregnancy lower less risk
Number of children

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10
Q

Reproductive factors

A 
Early onset menarche 
Late menopause 
Older age at first pregnancy 
Nulliparity 
Longer duration breast feeding 
- reduces risk of BC
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11
Q

Lifestyle factors- obesity

A

Activation of IGF1 and insulin signalling pathways
Activation of PI3K Akt mTOR signalling pathways
Inc production of oestrogen
Inc production of adipokines

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12
Q

Lifestyle- alcohol

A 
Effect of acetaldehyde 
Epigenetic changes (DNA methylation)
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13
Q

BRCA genes

A

Rare
Testing is expensive so only offered to certain groups
Younger women
Rare in women with BC
More common in BC onset before 40
Most of BRCA1 breast cancers are basal like subtypes
BRCA2 is the major high penetrance predisposition gene for luminal ER pos Bc
If BRCA pos very likely will get Bc by 70
Give a prophylactic/ risk reducing mastectomy
Prevent still 5% chance of getting cancer

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14
Q

Most common type of BC

A

Duct cancer

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15
Q

2nd common type of Bc

A

Lobule type

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16
Q

In situ bc can occur at multiple sites in one breast

A

DCIS

LCIS

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17
Q

DCIS

A

Incidence inc

30-50% chance of progressing to invasive cancer

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18
Q

LCIS - lobule carcinoma in situ

A

Marker of increased risk (8-10fold) for ILC rather than a true precursor

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19
Q

If find DCIS on biopsy

A

Treat more aggressive likely to result in cancer

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20
Q

If find LCIS on biopsy

A

Don’t necessarily have to treat as it is less aggressive/ likely to result in cancer

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21
Q

How many subtypes of invasive cancer

A

At least 17

22
Q

DCIS likely or unlikely to metastasise

A

Unlikely

Basement membrane is still intact

23
Q

If basement membrane breached

A

Metastasis of cancer can occur

Cancer can spread to blood vessels/ lymph nodes

24
Q

Molecular subtypes of BC

A

Basal like (BRCA1/ triple negative 10-20%
Luminal A (ER+, HER2-) 50-60%
Luminal B ER+ and HER +
HER2 10-15%
Claudin low 12-14% Claudins are a family of proteins that are the most important components of tint junctions
Normal like 5-10%

25
Q

3 markers for treatment planning

A

HER2 pos - herceptin
ER pos
Progesterone Pos

26
Q

Management diagnosis, surgery, adjuvant therapy

A

Not just surgery need to prevent cancer fro returning

Involves MDT

27
Q

Diagnostic team includes

A

Breast clinician
Radiologist and radiographer
40+ mammogram and Ultrasoind possibly MRI
Under 40 breast tissue v glandular and dense therefore mammogram is not informative
Mammogram more radiation
Under 40s x ray
Breast cancer nurse

28
Q

Cancer treatment team includes

A

Clinical oncologist
Medical oncologist
Breast surgeon

29
Q

Diagnosis triple assessment

A

Clinical
Radiological
Pathological

30
Q

Clinical

A

Inspection and palpation if breasts - changes nipple, skin, visible lumps
Check lymph nodes in axilla and neck

31
Q

Radiological

A 
Mammogram  USS
Find lumps via imaging 
White - glandular tissue 
Black fatty tissue 
Older more white breasts look 
Cancer breast look more black 
Abnormal imaging - biopsy 
Image armpits too
32
Q

Pathological

A

Biopsy with ultrasound guidance
Biopsy FNA or core biopsy
Biopsy lymph glands - localisation or spread

33
Q

Mel adjuvant therapy

A 
Before surgery - shrink lump as much as you can - conserve as much breast as you can 
Endocrine 
Chemo
Radio
Herceptin
34
Q

Surgery

A

Before or with new- adjuvant surgery
2
1) wide local excision breast conserving
Remove cancer and a good margin of tissue around it -> if pathologist says the margin is clear - ok
2) mastectomy
Simple or skin sparing
Large tumour and small breast cannot shrink tumour with chemo recommend mastectomy
2 cancers in one breast mastectomy
BRCA gene carriers recommend as massive risk they will develop cancer during their lifetime

35
Q

Auxiliary lymph node surgery

A

Always sample these
Check lymph nodes to see if pos or neg
If pos further treatment as cancer is spreading
Neg no further treatment needed
Sentinel lymph node - 1st node or group of nodes draining a cancer. In the case of established cancer met -> it is believed that the sentinel lymph nodes are the target organs first reached by metastasising cancer cells from the tumour
If Sentinel lymph node clear no cancer spread to it
Identify sentinel by using 2 dyes
1 radioactive the other blue if the blue met

36
Q

Adjuvant therapies

A

Additional cancer treatment to lower risk cancer will come back

37
Q

Which population most important to do this in

A 
Young 
More metabolic activity 
Better blood supply 
More likely cancer cells to spread chemo shrink tumour 
Chemo through entire body 
Kills any cancer cells present
38
Q

Types of adjuvant

A

Endocrine
Chemotherapy- iv injection sig SE
Radio therapy
Biological agents

39
Q

Endocrine therapy

A

Tamoxifen - competitive inhibit E2
AI - lower E2 contents
Ovarian suppressors - GnRH agonist suppress ovarian function.

40
Q

Radiotherapy when given

A

Following wide local excision
Still have breast tissue have not removed the breast
If don’t give radio more likely to get cancer again

Post mastectomy
Reduce recurrence by 70%

41
Q

Chemotherapy when

A

Mel adjuvant or adjuvant

42
Q

Adjuvant

A

Size grade lymph node status, receptor status

Cycles of chemo

43
Q

Chemo SE

A

Bad

Suppresses normal cell numbers in blood counts, vomiting, hair loss

44
Q

Who benefits most fro chemo

A

Young
Need to assay the cancer estimate how much a patient will benefit from chemotherapy
Done because chemo expensive
Can also make you feel more sick

45
Q

Biological therapies

A

Herceptin/ trastuzumab

Pertuzumab

46
Q

What do mab do

A

Attack her 2 Ag destroy cancer cells

47
Q

Se mab

A

Cardiotoxic cannot use if ha heart problems

48
Q

Intracellular RTK inhib

A

Laparinib

Expensive lots of se

49
Q

Future - vaccines

A

Tumour Ag MUC1 HER2

50
Q

Oncolytic viral therapy

A

Infects and kills cancer cells

CAN (21 decks)

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