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General Surgery > breast cancer > Flashcards

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
Q

management of LCIS?

A

excision biopsy at time of triple assessment

26
Q

invasive carcinoma - what kind of lump?

A

irregular, tethered and non fluctuating.

27
Q

nipple signs in invasive carcinoma ?

A

Unilateral blood stained nipple discharge, retraction, pagets.

28
Q

general management of invasive carcinoma ?

A

• Surgery +/- axillary clearance, radiotherapy, chemotherapy, endocrine or immunotherapy and reconstruction.

29
Q

two surgical options available ?

A

o reast conserving: WLE + radiotherapy.

Non breast conserving: radical mastectomy +/- radiotherapy

30
Q

what surgical option in generally preferred ?

A

WLE

31
Q

general rule - WLE can only be carried out if less than ?

A

2cm in size

32
Q

tumours can be shrunk with ? in order to achieve WLE

A

adjuvant chemo

33
Q

when is axillary clearance carried out ?

A

only when clinically indicated

34
Q

when can reconstruction be carried out?

A

at time of surgery or later date

35
Q

reconstruction options ?

A

o Implants.
o Tissue flaps.
o +/- nipple reconstruction and future fat remodeling to achieve best cosmetic outcome.

36
Q

implants - where are they fitted?

A

underneath the pec major muscle.

37
Q

implants associated with more/less problems than tissue flaps?

A

more

38
Q

common problems ?

A

o rippling, migration and capsular contraction of the implant.

39
Q

what are the three tissue flaps used?

A 
latissimus dorsi 
o	TRAM / DIEP (tissue from abdomen)
o	IGAP (skin and fat flap from buttocks)
40
Q

what is the artery used in lat dorsi reconstruction

A

thoracodsorsal

41
Q

why is the procedure known as a pedicle?

A

artery is not dissected out, it is kept intact

42
Q

tram / diep - both involve tissue from the ?

A

abdomen

43
Q

what is IGAP?

A

skin and fat flap from the buttocks

44
Q

what can be used as adjuvant to reduce the rate of local recurrence?

A

radiotherapy

45
Q

whats the typical regimen of radiotherapy?

A

o 45 – 50 Gy for 3 or 5 weeks, starting within a month from surgery.

46
Q

who give chemo to?

A

• Adjuvant in women with poor prognostic indicators:
o <35.
o ER negative, HER2 positive.
o >4 lymph nodes involved.

47
Q

what sort of chemtherapy agents would be used

A

♣ Cyclophosphamide, methotrexate, 5FU.

48
Q

what is tamoxifen?

A

partial oestrogen agonist

49
Q

who is tamoxifen used in ?

A

pre and post menopausal women

50
Q

what is letrozole?

A

aromatase inhibitor

51
Q

who is letrozole used in ?

A

post menopausal women

52
Q

endocrine therapy includes tamoxifen and letrozole. what sort of tumours can these be used in ?

A

oestrogen receptor positive tumours

53
Q

when is immunotherapy used? (trustuzimab)

A

post operatively in HER2 positive tumours

54
Q

what can be used to prolong life in metastatic disease

A

radiotherapy, chemotherapy and hormonal therapy

General Surgery (26 decks)

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