breast cancer Flashcards

1
Q

peak age for incidence of breast cancer?

A

women aged 60-70

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2
Q

where do most breast cancers arise from ?

A

duct tissue followed by lobular tissue

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3
Q

4 common breast cancers?

A

invasive ductal carcinoma
invasive lobular carcinoma
ductal carinoma in situ
lobular carinoma in situ

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4
Q

what is pages disease of the nipple?

A

an eczematoid change of the nipple associated with an underlying breast malignancy and it is present in 1-2% of patients with breast cancer.

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5
Q

what percentage of patients with breast cancer have pages disease of the nipple?

A

1-2%

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6
Q

when should a patient with one first-degree or second-degree relative diagnosed with breast cancer be referred?

A

age of diagnosis < 40 years
bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in a relative younger than age 45 years
glioma or childhood adrenal cortical carcinomas
complicated patterns of multiple cancers at a young age
paternal history of breast cancer (two or more relatives on the father’s side of the family)

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7
Q

most common type of cancer in the breast ?

A

carcinoma

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8
Q

what are the two most common precursors to carcinoma ?

A

DCIS 70%

LCIS 10%

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9
Q

how are breast cancers staged?

A

carrying out
bloods (FBC, U and E, LFT, bone)
axillary ultrasound
CXR / CTCAP / bone scan

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10
Q

how are breast cancers staged?

A

TNM

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11
Q

what are the two positive and one negative receptors for effect on prognosis ?

A
Oestrogen
Positive
Progesterone. 
Positive
HER 2
Negative.
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12
Q

the best combination of receptor expression ?

A

ER positive
PR positive
HER 2 negative

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13
Q

worst prognosis combination of receptor expression ?

A

all negative

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14
Q

poor prognostic indicator for breast cancer?

A

less than 35
her 2 positive
oestrogen receptor negative
lymph node positive

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15
Q

risk factors for breast cancer?

A
over 55
early menarche 
late menopause 
nullparity 
late age of first born (>35) 
no breast feeding of infants 
History of breast cancer
history of radiotherapy 
current or previous use of HRT 
long term use of COCP 
obesity 
smoking 
alcohol 
breast cancer 
ovarian cancer
BRCA 1/2 and p53 mutations
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16
Q

DCIS usually develops in women

A

over 50

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17
Q

what percentage diagnosis does it represent?

A

25%

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18
Q

how does DCIS present?

A

breast lump
nipple discharge
pages disease of nipple (eczema of the nipple that doesn’t respond to steroids)

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19
Q

can DCIS be asymptomatic ?

A

yes can be detected by screening

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20
Q

what found on MXR is pathognomonic of DCIS?

A

microcalcifications

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21
Q

diagnosis of DCIS?

A

diagnostic investigation: core biopsy

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22
Q

management of DCIS?

A

WLE and radiotherapy

radical mastectomy

23
Q

LCIS - what age group of women ?

A

younger (usually in 40s)

24
Q

prognosis?

A

increased risk of invasive carcinoma but not to same event as DCIS

25
management of LCIS?
excision biopsy at time of triple assessment
26
invasive carcinoma - what kind of lump?
irregular, tethered and non fluctuating.
27
nipple signs in invasive carcinoma ?
Unilateral blood stained nipple discharge, retraction, pagets.
28
general management of invasive carcinoma ?
• Surgery +/- axillary clearance, radiotherapy, chemotherapy, endocrine or immunotherapy and reconstruction.
29
two surgical options available ?
o reast conserving: WLE + radiotherapy. | Non breast conserving: radical mastectomy +/- radiotherapy
30
what surgical option in generally preferred ?
WLE
31
general rule - WLE can only be carried out if less than ?
2cm in size
32
tumours can be shrunk with ? in order to achieve WLE
adjuvant chemo
33
when is axillary clearance carried out ?
only when clinically indicated
34
when can reconstruction be carried out?
at time of surgery or later date
35
reconstruction options ?
o Implants. o Tissue flaps. o +/- nipple reconstruction and future fat remodeling to achieve best cosmetic outcome.
36
implants - where are they fitted?
underneath the pec major muscle.
37
implants associated with more/less problems than tissue flaps?
more
38
common problems ?
o rippling, migration and capsular contraction of the implant.
39
what are the three tissue flaps used?
``` latissimus dorsi o TRAM / DIEP (tissue from abdomen) o IGAP (skin and fat flap from buttocks) ```
40
what is the artery used in lat dorsi reconstruction
thoracodsorsal
41
why is the procedure known as a pedicle?
artery is not dissected out, it is kept intact
42
tram / diep - both involve tissue from the ?
abdomen
43
what is IGAP?
skin and fat flap from the buttocks
44
what can be used as adjuvant to reduce the rate of local recurrence?
radiotherapy
45
whats the typical regimen of radiotherapy?
o 45 – 50 Gy for 3 or 5 weeks, starting within a month from surgery.
46
who give chemo to?
• Adjuvant in women with poor prognostic indicators: o <35. o ER negative, HER2 positive. o >4 lymph nodes involved.
47
what sort of chemtherapy agents would be used
♣ Cyclophosphamide, methotrexate, 5FU.
48
what is tamoxifen?
partial oestrogen agonist
49
who is tamoxifen used in ?
pre and post menopausal women
50
what is letrozole?
aromatase inhibitor
51
who is letrozole used in ?
post menopausal women
52
endocrine therapy includes tamoxifen and letrozole. what sort of tumours can these be used in ?
oestrogen receptor positive tumours
53
when is immunotherapy used? (trustuzimab)
post operatively in HER2 positive tumours
54
what can be used to prolong life in metastatic disease
radiotherapy, chemotherapy and hormonal therapy