breast cancer Flashcards
PP of breast cancer
malignancy primarily of the milk ducts or lobules, which produces the milk
what is significant about BC?
Most common non-skin malignancy in women → 2nd most common cause of cancer death after lung → 1 in 8 lifetime incidence
RF for BrCA?
75% have no RF
BRCA1 & BRCA2
age >65 yo (50%)
hormonal (increased number of menstrual cycles)
increased estrogen: postmenopausal HRT, obesity, etoh
hormonal RF for BrCA?
Nulliparity, 1st full term pregnancy >35 yrs, early onset menarche (<12yrs), late menopause, prolonged unopposed estrogen, never having breast fed
types of BrCA?
ductal carcinoma
lobular carcinoma
Medullary, Mucoid, Tubular, Papillary, Metastatic, Mammary Paget’s Disease of the Breast
what is the MC form of BrCa?
Infiltrative ductal carcinoma
what is infiltrative ductal carcinoma associated with?
Mets- axillary
what is the other type of ductal carcinoma?
Ductal carcinoma in situ: doesn’t penetrate the basement membrane
types of lobular carcinoma?
infiltrative and lobular carcinoma in situ (May not progress but associated with ↑risk of invasive breast cancer in either breast)
s/sx of br ca
Breast Mass → Usually painless, hard, fixed (non-mobile) lump → May be mobile early on
+/- axillary lymphadenopathy
Unilateral nipple discharge → +bloody, purulent or green
what breast quad is mass mc found?
Upper Outer Quadrant (65%), areola (18%)
common areas of br ca mets?
lungs, liver, bone, brain
PE findings of breast ca
skin changes
Pagets dz of nipple
inflammatory breast ca
describe skin changes associated with br ca
Asymmetric redness, discoloration, ulceration, skin retraction (dimpling if Cooper’s ligament involvement), changes in breast size & contour, nipple inversion, skin thickening
what is paget’s dz of nipple?
Chronic eczematous itchy, scaling rash on nipples & areola (may ooze) →
Lump is often present
describe inflammatory br ca
Red, swollen, warm, itchy breast → Often with nipple retraction, peau d’orange → Usually NOT associated with a lump
what is peau d/orange
Skin changes that look like the peel of an orange due to lymphatic obstruction → Associated with poor prognosis
dx of br ca
mammogram, US, bx
what may be seen on mammogram of breast ca?
Microcalcifications & spiculated masses highly suspicious for malignancy
what is the recommended initial modality to evaluate breast masses in women< 40 yo
US
types of biopsies used to evaluate breast mass
Fine needle with biopsy, large needle core biopsy, open/excisional biopsy
br ca staging:
Based on T (size), N (nodes → axillary lymph nodes), M (metastasis)
stage 0
Precancerous, DCIS or LCIS
stage 1-111
Within breast/regional lymph nodes
stage Iv
Metastatic Breast Cancer
tx of br ca initially
lumpectomy followed by radiation
mastectomy
removal of regional lymph nodes (check for mets)
indications for mastectomy
Diffuse, large tumor, prior XRT to breast etc
adjunctive tx of br ca?
radiation
chemo
neoadjuvant endocrine ths
describe radiation therapy in br ca
done ofater lumpectomy and +/- post mastectomy to destroy residual microscopic tumor cells
external beam or barchytherapy (internal)
chemo tx description/indications
Used in breasts stage II-IV & inoperable disease → Especially Estrogen Receptor (ER) negative disease
Ex → Doxorubicin, Cyclophosphamide, Fluorouracil, Docetaxel
what are ex of neoadjuvant endocrine tx
Hormone Therapy → Breast cancer tumors may be Estrogen Receptor (ER) positive, Progesterone Receptor as well as HER2 positive
anti-estrogen tx
Tamoxifen → Useful in tumors that are ER positive → Dependent on estrogen for growth
MOA: Binds & blocks estrogen receptor in breast tissu
aromatase inhibitors indications and MOA
Letrozole, Anastrozole → Useful in post-menopausal ER-positive patients with breast cancer
MOA: Reduces the production of estrogen
monocolonal ab tx indications and MOA
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
important side effects of monoclonal ab tx?
cardiotoxicity
breast cancer screening
mammogram!!!
Detects breast cancer as early as two years before a mass can be palpated clinically
what are the ACS screening guidlines for breasts?
Annually age 45-54 yrs & q 2 yrs age > 55 yrs
what are th USPSTF guidelines
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
when should clinical breast exams been done?
At least every 3 years in women 20-39 yrs & annually after age 40 yrs
recommendations for self breast exam?
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
breast ca prevention in high risk pt?
SERM → Tamoxifen or Raloxifene can be used in post-menopausal or women >35 yrs w/ high risk
how long can tamoxifen be used for br ca prevention?
5 yrs
what are adr of tamoxifien/ black box warning?
increased risk of DVT & endometrial cancer compared to Raloxifen
