Breast Cancer

Question 1

Breast cancer facts

Answer 1

1 in 8 women will get it

3rd highest cause of cancer death in UK

Question 2

What are the risk factors associated w breast cancer?

Answer 2

1. Age (greatest factor),
2. Oestrogen exposure incl exogenous hormones
3. Famility history + previous BC
4. Ionising radiation e.g. X-ray therapy, radiotherapy
5. Geographical location (higher in developed countries)
6. OBESITY!

Question 3

What can cause hgh oestrogen exposure?

Answer 3

Early menarche (before 12), late menopause (after 45)
Nulliparity/late first pregnancy (increases ovulatory cycles)
Not breast feeding
Oral contraceptives, HRT (but risk reduced on cessation)

Question 4

Why is breast feeding encouraged?

Answer 4

Reduced oestrogen exposure

Reduces breast epithelial proliferation

Question 5

BRCA mutations + types of breast cancer

Answer 5

BRCA1 –> basal-like BC

BRCA2 –> luminal ER posiive BC

Question 6

Why does obesity increase risk of breast cancer?

Answer 6

Adipose tissue activates pro-survival + pro-proliferative pathways

• IGF1 + insulin signalling pathways
• activation of PI3K pathway
• increases oestrogen
• increases leptin - pro-invasive factor

Question 7

How does alcohol increase risk of breast cancer?

Answer 7

Raised levels of acetaldehyde –> epigenetic changes & increases cellular oxidative stress

Question 8

Types of BC based of histology (3 types)

Answer 8

1. In-situ (ductal + lobular), pre-malignant

2. Invasive (ductal, lobular, tubular, papilary)

Question 9

DCIS vs LCIS

Answer 9

DCIS can progress to invasive type but LCIS can’t. LCIS DOES increase risk of invasive

Question 10

BC molecular subtypes

Answer 10

Luminal A (ER+, HER2-) - best survival
Luminal B (ER+, HER2-)
Basal - BRCA1 mutation, lowest survival 
HER2+
claudin-low

Question 11

3 stages of BC treatment + management?

Answer 11

1. Diagnosis
2. Surgery
3. Adjuvent therapy

Question 12

How is BC diagnosed?

Answer 12

Triple asessment

• Clinical: inspection + palpation, lymph nodes
• Radiological: mammogram/USS for younger
• Pathological: biopsy/fine needle aspiration

Question 13

What are the 3 treatment options for BC?

Answer 13

1. Neo-adjuvant
2. Surgery
3. Adjuvant

Question 14

Types of neo adjuvant therapy for BC? Why is it done?

Answer 14

1. Endocrine e.g. aromatase inhibitors
2. Chemo
3. Biological e.g. herceptin
   Done to shink tumour before surgical excision to reduce risk

Question 15

Types of surgery for BC?

Answer 15

Wide local excision (breast conserving)
Mastectomy
Axillary sentinal node biopsy (then clearance if positive)

Question 16

What are sentinal nodes?

Answer 16

The first lymph nodes cancer may spread to - there are located by injecting blue dye near tumour + looking at which node it goes to first

Question 17

Types of adjuvant therapy for BC?

Answer 17

1. Endocrine - AI, tamoxifen, GnRH antagonists
2. Radio
3. Chemo (usually after radio)
4. Biological e.g. herceptin, TKIs e.g lapatinib

Question 18

Future treatment for BC?

Answer 18

Possible tumour vaccines but need antigens it can target
Possible: HER2, MUC1
Oncolytic viral therapies, gene therapies