Breast Cancer Flashcards
What is the incidence of breast cancer?
Most common F cancer
19% of all new cases
1:12 women
What are risk factors for breast cancer?
Increasing age Nulliparity Early menarche Late menopause Obesity Late childbearing Ionising radiation FHx Inherited mutation: BRCA1&2
Where are sites of oestrogen synthesis?
Premeno: Produced by ovaries
Postmeno: Extra ovarian tissue (breast, excess fat)
What is the histology of breast cancers?
70% of cancers express a protein in the nucleus making them sensitive to oestrogen
What are the types of breast cancer?
Most common- Invasive/infiltrating ductal carcinoma (adenocarcinoma) Lobular carcinoma Medullary Colloid Comedo Papillary
How do breast cancers present?
Mass
Nipple discharge
Regional lymphadenopathy
Symptoms of mets
What investigations are done?
Bilateral mammography
FNAC/needle biopsy/incisional/excisional biopsy for diagnosis
Disseminated disease: isotopic bone scan, liver w/USS/CT
What does a ‘cancer’ lump usually feel like?
Hard
Doesn’t move
Skin changes/puckering
How is surgery used for breast cancer treatment?
Tx of choice for localised disease
Mastectomy (radical/simple), Conservative (WLE)
with post-op RT
How is treatment option decided?
Depends on: Size Location Breast size Appearance on mammogram Extent of in-situ changes Patient preference
How is RT used to treat breast cancer?
Following conservative surgery ALL patients May be indicated in mastectomy for high risk of recurrence Multiple axillary nodes involved Widespread lymphovascular tumour
What factors constitute high risk of local recurrence?
- Deep resection margin involvement
- Large primary >4cm
- Lymph nodes involved
- Widespread lymphovascular tumour permeation
When should RT not be given?
Full axillary dissection
Can RT be used in palliative breast cancer?
Yes
Control symptoms- pain due to bony mets
Locally recurrent disease
What factors need to be considered in a patient wanting systemic therapy with endocrine/chemo treatment?
Hormone receptor status (ER+/-) HER2 receptor status Menopausal status Performance status Response to prev Tx Disease-free interval Site of recurrence
When should systemic therapy with endocrine/chemo treatment be considered?
Micro-metastatic disease in adjuvant setting
Recurrent/metastatic disease
When is Tamoxifen used?
Adjuvant-20mg/day reduces risk of recurrence
Reduced incidence of contralateral breast Ca
How does tamoxifen work?
Competitive inhibitor does not stop the production of oestrogen
Who should be given Tamoxifen?
Primary ER +ve tumours
What are the SE of tamoxifen?
Inc risk of endometrial carcinoma Inc thrombotic complications Vaginal changes Loss of libido Vasomotor No clinical benefit after 2-5years (switch to aromatase inhibitors)
What are the SE of aromatase inhibitors?
Osteoporosis
Arthralgia & myalgia
Vaginal dryness
Hot flushes
Give examples of aromatase inhibitors
Anastrazole
Letrozole
When should chemo be given in breast cancer?
ADJUVANT: better effect in <50years
PALLIATIVE: Metastatic disease, improve QoL
What is the 5 year prognosis for stages 1 & 4
1: 84%
4: 18%
What is prognosis dependant on?
Histological grade Nuclear grade HER2/ER receptor status Peri-tumoral lymphatic invasion Tumour microvessel density Proliferative capacity
In what cancers is sentinel node biopsy carried out?
Breast
Penile
Melanoma
What are the adjuvant treatment types for different cancers?
Adj RT: Local recurrence (B, L, Oe, Endo)
Adj Chemo: Met recurrence (B, L, L.GI)
Adj Bio: Met recurrence (HER2 B)
Adj Hormone: Local & met recurrence (B)
Adj Bisphos: Bone mets (B)
