Breast Cancer Flashcards
1
Q
What proportion of women are affected by breast cancer?
A
1/10
2
Q
How many cases of breast cancer are there a year in the UK?
A
20,000
3
Q
How does the mortality of breast cancer compare to other cancers?
A
It is the most common cause of cancer death in females 15-54, and the second most common cause of cancer deaths overall
4
Q
What % of breast cancer cancers are familail?
A
10%
5
Q
By how much does having a first degree relative with breast cancer increase the risk?
A
2x
6
Q
What % of cases of breast cancers are associated with BRCA mutations?
A
5%
7
Q
What are the risk factors for breast cancer?
A
Family history Oestrogen exposure Proliferative breast disease with atypia Previous breast cancer Older age
8
Q
What factor is protective against breast cancer?
A
Breast feeding
9
Q
What factors can increase a persons oestrogen exposure?
A
Early menarche, late menopause
HRT and OCP
First child >35 years
Obesity
10
Q
What is DCIS/LCIS?
A
A non-invasive pre-malignant condition
11
Q
How is DCIS/LCIS discovered?
A
Microcalcification on mammography
12
Q
How much does DCIS/LCIS increase the risk of invasive breast cancer?
A
10x
13
Q
What are the subtypes of breast cancer?
A
Invasive ductal carcinoma Invasive lobular Medullary Colloid/mucinous Inflammatory Papillary Phyllodes tumour
14
Q
What is the most common subtype of breast cancer?
A
Invasive ductal carcinoma
15
Q
What % of breast cancers are invasive ductal carcinoma?
A
70%
16
Q
How does a invasive ductal carcinoma feel on palpation?
A
Hard (scirrhous)
17
Q
What % of breast cancers are invasive lobular?
A
20%
18
Q
Who do medullary breast cancers affect?
A
Younger patient
19
Q
How do medullary breast cancers feel on palpation?
A
Soft
20
Q
Who do colloid/mucinous breast cancers affect?
A
Elderly
21
Q
What are the features of inflammatory breast cancers?
A
Pain
Erythema
Swelling
Peau d’orange
22
Q
What is a Phyllodes tumour?
A
Stromal tumour
23
Q
How does a Phyllodes tumour present?
A
Large, non-tender, mobile lump
24
Q
How can breast cancer spreadd?
A
Direct extension
Lymph
Blood
25
Where might breast cancer spread by direct extension?
Muscle and/or skin
26
What are the signs of lymphatic involvement in breast cancer?
P'eau d'orange
| Arm oedema
27
Where does breast cancer commonly spread to in the blood?
Bones
Lungs
Liver
Brain
28
How does breast cancer that has spread to bones present?
Bone pain
Increased calcium
Fractures
29
How does breast cancer that has spread to lungs present?
Dyspnoea
| Pleural effusion
30
How does breast cancer that has spread to brain present?
Headache
| Seizures
31
How does breast cancer that has spread to the liver present?
Abdominal pain
| Hepatic impairment
32
How often is breast cancer screening done?
Every 3 years from 50-70
33
What views are taken in breast cancer screening?
Craniocaudal and oblique views
34
By how much does breast cancer screening reduce breast cancer death?
25%
35
What is the false negative rate of breast cancer screening?
10%
36
How might breast cancer present?
Lump
Skin changes
Nipple problems
Symptoms of mets
Presentation through screenin
37
What is the most common presentation of breast cancer?
Lump
38
Is the lump in breast cancer painful or painless?
Painless
39
Should elliot buy mollie a present for making all the brainscape cards?
Yes
40
What % of breast cancer lumps occur in the upper outer quadrant?
50%
41
What skin changes might be seen in breast cancer?
Paget's
| Peau d'orange
42
What is Paget's skin change in breast cancer?
Persistent eczema
43
What nipple problems might breast cancer present with?
Discharge
| Inversion
44
What symptoms of mets might breast cancer present with?
Pathological fractures
Abdominal pain
SOB
Seizures
45
What are the differential diagnoses of breast cancer?
Cysts
Fibroadenomas
DCIS
Duct ectasia
46
When is a triple assessment required?
For any breast lump
47
What is involved in the triple assessment of breast lumps?
Hx and clinical examination
Radiology
Pathology
48
What radiology technique is used in the triple assessment of a breast lump?
If <35 years, ultrasound. If >35 years, ultrasound and mammography
49
How is a biopsy carried out in the triple assessment if it is a solid lump?
Tru-cut core biopsy
50
How is a biopsy carried out in the triple assesment if it a cystic lump?
FNAC with 18G needle
51
What should be done if clear fluid is extracted from cystic lump in FNAC?
Reassure
52
What should be done if bloody fluid is extracted from cystic lump in FNAC?
Send cytology
53
When should a core biopsy be done in a cystic lump?
If there is a residual mass
| If +ve cytology
54
What other investigations might be done in suspected breast cancer?
Bloods
Imaging
Wire-guided excision biopsy
55
What bloods should be done in breast cancer?
FBC
LFTs
ESR
Bone profile
56
What constitutes clinical stage 1 breast cancer?
Confined to breast, mobile, to LNs
57
What constitutes clinical stage 2 breast cancer?
Stage 1 + nodes in ipsilateral axilla
58
What constitutes clinical stage 3 breast cancer?
Stage 2 + fixation to muscle (not chest wall)
LNs matted and fixed
Large skin involvement
59
What constitutes clinical stage 4 breast cancer?
Complete fixation to chest wall
| Mets
60
What constitutes Tis in breast cancer?
CIS
61
What constitutes T1 in breast cancer?
<2cm
| No skin fixation
62
What constitutes T2 in breast cancer?
2-5cm
| Skin fixation
63
What constitutes T3 in breast cancer?
5-10cm
| Ulceration and pectoral fixation
64
What constitutes T4 in breast cancer?
>10cm
Chest wall extension
Skin involvement
65
What constitutes N1 in breast cancer?
Mobile nodes
66
What constitutes N2 in breast cancer?
Fixed nodes
67
Who should be involved in the MDT management of breast cancer?
```
Oncologist
Breast surgeon
Breastcare nurse
Radiologist
Histopathologist
```
68
What factors should be considered when determining treatment for breast cancer?
Age
Fitness
Wishes
Clinical stage
69
What is the aim of surgery in breast cancer?
Gain local control
70
What are the options for surgery in breast cancer?
Wide local excision and radiotherapy
| Mastectomy
71
What % of surgical breast cancer patients are treated with wide local excision and radiotherapy?
80%
72
When is mastectomy used in breast cancer treatment?
Large tumours >4cm
Multifocal or central tumours
Nipple involvement
Patient choice
73
What is the difference in effectiveness between wide local excision and mastectomy?
No difference in survival, but WLE has increased recurrence rates
74
What is the sentinel node?
The first node that a section of breast drains into
75
What is the significance of a clear sentinel node?
If the sentinel node is clear, there is no need for further axillary dissection
76
How is a sentinel node biopsy carried out?
Blue dye/radiocolloid is injected into the tumour. In surgery, a visual inspection/gamma probe is used to identify the sentinel node, which is removed and sent for frozen section
77
What is done if the sentinel node is clear?
Axillary clearance or radiotherapy
78
How does sentinel node biopsy compare to axillary clearance?
There is no difference overall, or in disease free survival, but sentinel node biopsy has reduced mortality in terms of lympoedema, pain, and numbness
79
What are the surgical complications of axillary node clearance?
```
Haematoma
Seroma
Frozen shoulder
Long-thoracic nerve palsy
Lymphoedema
```
80
What is the purpose of the Nottingham Prognostic Index in breast cancer?
It predicts survival and risk of relapse
81
What does the Nottingham Prognostic Index guide in breast cancer?
Appropriate adjuvant systemic therapy
82
How is the Nottingham Prognostic Index calculated?
(0.2 x tumour size) + histological grade + nodal status
83
What is used to determine the histological grade in breast cancer?
The Bloom-Richardson system
84
What are the options for the management of breast cancer?
Radiotherapy
Chemotherapy
Endocrine therapy
Supportive
85
What is the purpose of radiotherapy post-wide local excision?
Reduce the chance of local recurrence
86
When is radiotherapy used post-mastectomy?
When there is a high risk of local recurrence, e.g. when large, poorly differentiated, node +ve cancer
87
When is axillary radiotherapy used in breast cancer?
Node +ve disease
88
When can axillary radiotherapy be used palliatively?
For bone pain
89
When is chemotherapy used in breast cancer?
In pre-menopausal, node +ve, high grade or recurrent tumours
90
What is the advantage of neo-adjuvant chemotherapy in large tumours?
Improves survival
91
What chemotherapy regime is used in breast cancer?
6x FEC (5-FU, epirubicin, cyclophosphamide)
92
What is trastuzumab?
Anti-Her 2 antibody
93
When is trastuzumab used in breast cancer?
If the cancer is Her2 +ve
94
What is the side effect of trastuzumab?
Cardiac toxicity
95
When is endocrine therapy used in breast cancer?
In ER or PR +ve disease
96
What is the purpose of endocrine therapy in breast cancer?
Improves survival
97
How long is endocrine therapy given in breast cancer?
5 years of adjuvant therapy
98
What are the options for adjuvant endocrine therapy in breast cancer?
Tamoxifen
| Anastrazole
99
What is the mechanism of action of tamoxifen?
It is a selective oestrogen reuptake modulator, which is antagonistic in the breast and an agonist in the uterus
100
What are the potential adverse effects of tamoxifen?
Menopausal symptoms
| Endometrial cancer
101
What is the mechanism of action of anastrazole?
It is an aromatase inhibitor, and so decreases oestrogen
102
When is anastrazole better than tamoxifen?
If she is post-menopausal
103
What can be considered if a patient is pre-menopausal and ER +ve?
Ovarian ablation or GnRH analogues e.g. goserelin
104
How is advanced breast cancer managed?
Tamoxifen if ER +ve
| Chemotherapy
105
What is involved in the supportive management of bone pain?
DXT
Bisphosphonates
Analgesia
106
What is involved in the support management of brain mets?
Occasionally surgery can be performed
107
What is involved in the supportive management of lymphoedema?
Decongestion
| Compression
108
When can reconstruction be offered in breast cancer?
Either at original surgery, or as delayed procedure
109
What are the options for reconstruction in breast cancer?
Implants
Latissimus dorsi myocutaneous flap
Transverse rectus abdominis myocutaneous flap
Nipple tattoo
110
What implants can be used in reconstruction in breast cancer?
Silastic or saline inflatable
111
What is the flap made of in a latissimus dorsi myocutaneous flap?
A pedicled flap, made up of the skin, fat, muscle, and blood supply
112
What artery supplies the latissimus dorsi myocutaneous flap?
The thoracodorsal, via the subscapular artery
113
What is the gold standard reconstruction option in breast cancer?
Transverse rectus abdominis myocutaneous flap
114
Is the flap in a transverse rectus abdominis myocutaneous flap pedicled or free?
It can be pedicled, supplied by the inferior epigastric artery, or free, supplied by the internal thoracic artery
115
What is the advantage of a transverse rectus abdominis myocutaneous flap?
No implant necessary
| Combined tummy tuck
116
When is a transverse rectus abdominis myocutaneous flap contraindicated?
Smokers
Obese
PVD
DM
117
What is there a risk of in transverse rectus abdominis myocutaneous flap?
Abdominal hernia
