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CCC > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the incidence of breast cancer?

A

Most common F cancer
19% of all new cases
1:12 women

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2
Q

What are risk factors for breast cancer?

A 
Increasing age
Nulliparity
Early menarche
Late menopause
Obesity
Late childbearing
Ionising radiation
FHx
Inherited mutation: BRCA1&2
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3
Q

Where are sites of oestrogen synthesis?

A

Premeno: Produced by ovaries
Postmeno: Extra ovarian tissue (breast, excess fat)

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4
Q

What is the histology of breast cancers?

A

70% of cancers express a protein in the nucleus making them sensitive to oestrogen

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5
Q

What are the types of breast cancer?

A 
Most common- Invasive/infiltrating ductal carcinoma (adenocarcinoma)
Lobular carcinoma
Medullary
Colloid
Comedo
Papillary
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6
Q

How do breast cancers present?

A

Mass
Nipple discharge
Regional lymphadenopathy
Symptoms of mets

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7
Q

What investigations are done?

A

Bilateral mammography
FNAC/needle biopsy/incisional/excisional biopsy for diagnosis
Disseminated disease: isotopic bone scan, liver w/USS/CT

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8
Q

What does a ‘cancer’ lump usually feel like?

A

Hard
Doesn’t move
Skin changes/puckering

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9
Q

How is surgery used for breast cancer treatment?

A

Tx of choice for localised disease
Mastectomy (radical/simple), Conservative (WLE)
with post-op RT

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10
Q

How is treatment option decided?

A 
Depends on:
Size
Location
Breast size
Appearance on mammogram
Extent of in-situ changes
Patient preference
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11
Q

How is RT used to treat breast cancer?

A 
Following conservative surgery
ALL patients
May be indicated in mastectomy for high risk of recurrence
Multiple axillary nodes involved
Widespread lymphovascular tumour
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12
Q

What factors constitute high risk of local recurrence?

A
  • Deep resection margin involvement
  • Large primary >4cm
  • Lymph nodes involved
  • Widespread lymphovascular tumour permeation
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13
Q

When should RT not be given?

A

Full axillary dissection

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14
Q

Can RT be used in palliative breast cancer?

A

Yes
Control symptoms- pain due to bony mets
Locally recurrent disease

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15
Q

What factors need to be considered in a patient wanting systemic therapy with endocrine/chemo treatment?

A 
Hormone receptor status (ER+/-)
HER2 receptor status
Menopausal status
Performance status
Response to prev Tx
Disease-free interval
Site of recurrence
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16
Q

When should systemic therapy with endocrine/chemo treatment be considered?

A

Micro-metastatic disease in adjuvant setting

Recurrent/metastatic disease

17
Q

When is Tamoxifen used?

A

Adjuvant-20mg/day reduces risk of recurrence

Reduced incidence of contralateral breast Ca

18
Q

How does tamoxifen work?

A

Competitive inhibitor does not stop the production of oestrogen

19
Q

Who should be given Tamoxifen?

A

Primary ER +ve tumours

20
Q

What are the SE of tamoxifen?

A 
Inc risk of endometrial carcinoma
Inc thrombotic complications
Vaginal changes
Loss of libido
Vasomotor
No clinical benefit after 2-5years (switch to aromatase inhibitors)
21
Q

What are the SE of aromatase inhibitors?

A

Osteoporosis
Arthralgia & myalgia
Vaginal dryness
Hot flushes

22
Q

Give examples of aromatase inhibitors

A

Anastrazole

Letrozole

23
Q

When should chemo be given in breast cancer?

A

ADJUVANT: better effect in <50years
PALLIATIVE: Metastatic disease, improve QoL

24
Q

What is the 5 year prognosis for stages 1 & 4

A

1: 84%
4: 18%

25
Q

What is prognosis dependant on?

A 
Histological grade
Nuclear grade
HER2/ER receptor status
Peri-tumoral lymphatic invasion
Tumour microvessel density
Proliferative capacity
26
Q

In what cancers is sentinel node biopsy carried out?

A

Breast
Penile
Melanoma

27
Q

What are the adjuvant treatment types for different cancers?

A

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)

CCC (21 decks)

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