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Womens Health > breast cancer > Flashcards

breast cancer Flashcards

1
Q

PP of breast cancer

A

malignancy primarily of the milk ducts or lobules, which produces the milk

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2
Q

what is significant about BC?

A

Most common non-skin malignancy in women → 2nd most common cause of cancer death after lung → 1 in 8 lifetime incidence

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3
Q

RF for BrCA?

A

75% have no RF

BRCA1 & BRCA2
age >65 yo (50%)

hormonal (increased number of menstrual cycles)

increased estrogen: postmenopausal HRT, obesity, etoh

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4
Q

hormonal RF for BrCA?

A

Nulliparity, 1st full term pregnancy >35 yrs, early onset menarche (<12yrs), late menopause, prolonged unopposed estrogen, never having breast fed

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5
Q

types of BrCA?

A

ductal carcinoma
lobular carcinoma

Medullary, Mucoid, Tubular, Papillary, Metastatic, Mammary Paget’s Disease of the Breast

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6
Q

what is the MC form of BrCa?

A

Infiltrative ductal carcinoma

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7
Q

what is infiltrative ductal carcinoma associated with?

A

Mets- axillary

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8
Q

what is the other type of ductal carcinoma?

A

Ductal carcinoma in situ: doesn’t penetrate the basement membrane

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9
Q

types of lobular carcinoma?

A

infiltrative and lobular carcinoma in situ (May not progress but associated with ↑risk of invasive breast cancer in either breast)

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10
Q

s/sx of br ca

A

Breast Mass → Usually painless, hard, fixed (non-mobile) lump → May be mobile early on

+/- axillary lymphadenopathy

Unilateral nipple discharge → +bloody, purulent or green

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11
Q

what breast quad is mass mc found?

A

Upper Outer Quadrant (65%), areola (18%)

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12
Q

common areas of br ca mets?

A

lungs, liver, bone, brain

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13
Q

PE findings of breast ca

A

skin changes

Pagets dz of nipple
inflammatory breast ca

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14
Q

describe skin changes associated with br ca

A

Asymmetric redness, discoloration, ulceration, skin retraction (dimpling if Cooper’s ligament involvement), changes in breast size & contour, nipple inversion, skin thickening

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15
Q

what is paget’s dz of nipple?

A

Chronic eczematous itchy, scaling rash on nipples & areola (may ooze) →

Lump is often present

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16
Q

describe inflammatory br ca

A

Red, swollen, warm, itchy breast → Often with nipple retraction, peau d’orange → Usually NOT associated with a lump

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17
Q

what is peau d/orange

A

Skin changes that look like the peel of an orange due to lymphatic obstruction → Associated with poor prognosis

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18
Q

dx of br ca

A

mammogram, US, bx

19
Q

what may be seen on mammogram of breast ca?

A

Microcalcifications & spiculated masses highly suspicious for malignancy

20
Q

what is the recommended initial modality to evaluate breast masses in women< 40 yo

A

US

21
Q

types of biopsies used to evaluate breast mass

A

Fine needle with biopsy, large needle core biopsy, open/excisional biopsy

22
Q

br ca staging:

A

Based on T (size), N (nodes → axillary lymph nodes), M (metastasis)

23
Q

stage 0

A

Precancerous, DCIS or LCIS

24
Q

stage 1-111

A

Within breast/regional lymph nodes

25
Q

stage Iv

A

Metastatic Breast Cancer

26
Q

tx of br ca initially

A

lumpectomy followed by radiation

mastectomy

removal of regional lymph nodes (check for mets)

27
Q

indications for mastectomy

A

Diffuse, large tumor, prior XRT to breast etc

28
Q

adjunctive tx of br ca?

A

radiation
chemo
neoadjuvant endocrine ths

29
Q

describe radiation therapy in br ca

A

done ofater lumpectomy and +/- post mastectomy to destroy residual microscopic tumor cells

external beam or barchytherapy (internal)

30
Q

chemo tx description/indications

A

Used in breasts stage II-IV & inoperable disease → Especially Estrogen Receptor (ER) negative disease

Ex → Doxorubicin, Cyclophosphamide, Fluorouracil, Docetaxel

31
Q

what are ex of neoadjuvant endocrine tx

A

Hormone Therapy → Breast cancer tumors may be Estrogen Receptor (ER) positive, Progesterone Receptor as well as HER2 positive

32
Q

anti-estrogen tx

A

Tamoxifen → Useful in tumors that are ER positive → Dependent on estrogen for growth
MOA: Binds & blocks estrogen receptor in breast tissu

33
Q

aromatase inhibitors indications and MOA

A

Letrozole, Anastrozole → Useful in post-menopausal ER-positive patients with breast cancer

MOA: Reduces the production of estrogen

34
Q

monocolonal ab tx indications and MOA

A

Trastuzumab/Herceptin → Useful in patients with HER2 positivity (Human Epidermal Growth Factor Receptor) →

HER2 receptors stimulate cancer growth and are associated with more aggressive tumors

35
Q

important side effects of monoclonal ab tx?

A

cardiotoxicity

36
Q

breast cancer screening

A

mammogram!!!

Detects breast cancer as early as two years before a mass can be palpated clinically

37
Q

what are the ACS screening guidlines for breasts?

A

Annually age 45-54 yrs & q 2 yrs age > 55 yrs

38
Q

what are th USPSTF guidelines

A

Baseline mammogram every 2 yrs 50-74 yrs or every 2 yrs at age 40yrs if increased risk factors or 10 years prior to the age the 1st degree relative diagnosed

39
Q

when should clinical breast exams been done?

A

At least every 3 years in women 20-39 yrs & annually after age 40 yrs

40
Q

recommendations for self breast exam?

A

Monthly > 20 yrs of age immediately after menstruation or on days 5-7 of menstrual cycle - less fluid retention & hormonal influence on breast days 5-7

41
Q

breast ca prevention in high risk pt?

A

SERM → Tamoxifen or Raloxifene can be used in post-menopausal or women >35 yrs w/ high risk

42
Q

how long can tamoxifen be used for br ca prevention?

A

5 yrs

43
Q

what are adr of tamoxifien/ black box warning?

A

increased risk of DVT & endometrial cancer compared to Raloxifen

Womens Health (24 decks)

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