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Reproductive > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Brief epidemiology of breast cancer.

A
  • Affects 1 in 8 women
  • 46,000 new cases per year in the UK; >440 annually in Grampian
  • Accounts for 1/4 malignancies for women
  • 18% deaths due to cancer
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2
Q

How does risk increase/decrease with age?

A

Risk increases with age

  • 30-40, 1:252
  • 40-50, 1:68
  • 50-60, 1:35
  • 60-70, 1:27
  • lifetime-110, 1:8
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3
Q

Which members of the multidisciplinary team are involved in the treatment of breast cancer?

A
  • Breast surgeon
  • GP
  • Radiology
  • Nurses
  • Cytology
  • Pathologist
  • Clinical Oncology
  • Nurse councellor
  • Physcologist
  • Reconstructive surgeon
  • Patient and partner
  • Palliative
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4
Q

What are the two types of breast cancer?

A
  • In situ carcinoma
  • Invasice carcinoma
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5
Q

What are the subtypes of in situ carcinoma?

A
  • Ductal carcinoma in situ
    • 3% symptomatic
    • 17% screen detected
  • Lobular carcinoma in situ
    • 0.5% symptomatic
    • 1% screen tested
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6
Q

What are the subtypes of invasive carcinoma?

A
  • Ductal
  • Lobular
  • Tubular
  • Cribriform
  • Medullary
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7
Q

In what two ways are people found to have breast cancer?

A
  • Via presenting with a symptom
  • Or breast screen symposium
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8
Q

5 principles of management with breast cancer?

A
  • Establish diagnosis
  • Stage (assess the severity)
  • Treat the underlying cause
  • General measures
  • Specific measures
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9
Q

In what ways can we establish a diagnosis?

A
  • History and Clinical examination
  • Mammography
  • Ultrasonography
  • Magnetic resonance mammography
  • Cytology (FNAC)
  • Core biopsy
  • Image guided cytology or core biopsy
  • Open (surgical) biopsy
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10
Q

What are the main RF for breast cancer?

A
  • Family history
  • Age
  • Age and menarche/menopause
  • Previous benign breast disease
  • Cancer in other breast
  • Radiation
  • COCP
  • HRT
  • Lifestyle: obese/alcohol
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11
Q

Signs and symptoms of breast cancer?

A
  • Lump or thickening in breast (most common)
  • Discharge or bleeding
  • Change in size/contours of breast
  • Change in colour/appearance of areola
  • Redness or pitting in the breast, like skin of an orange
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12
Q

What are the investigations and how sensitive are they?

A
  • Clinical examination: 88% sensitive
  • Mammography: 93%
  • USS: 88%
  • FNA cytology: 94%
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13
Q

What investigations are used for staging?

A
  • Hb, Us+Es, LFTs
  • Chest xray
  • Isotope bone scan
  • Others as clinically indicated
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14
Q

Explain TNM staging.

A

Tumour (T)

  • T1: 0-2cm
  • T2: 2-5cm
  • T3: >5cm
  • T4: fixed to skin

Nodes (N)

  • N0: none
  • N1: nodes in axilla
  • N2: large or fixed nodes in axilla

Metastases (M)

  • M0: none
  • M1: mets
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15
Q

Specific measures for:

Primary breast cancer

Regional tumour draining nodes

Micrometastases

A
  • Primary breast cancer: (local control, eradicate disease)
  • Regional tumour-draining nodes: (regional control, staging, eradicate disease)
  • Micrometastases (eradicate disease)
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16
Q

What are the two main types of breast surgery?

A
  • Breast conservation surgery (Wide local excision, quadrantectomy or segmentectomy)
  • Mastectomy
17
Q

Which patients are suitable for breast conservation?

A
  • Tumour size <4cm (clinically)
  • Breast/Tumour size ratio
  • Suitable for radiotherapy
  • Single tumours – but now we do sometimes offer multiple tumours
  • Patient’s wish – most important!!
18
Q

What is interesting to node about tumour size and risk of other invasive/in situ cancer?

A
  • The bigger the tumour the lower the risk of other invasive/in situ cancer…
19
Q

Why do we carry out a sentinal node biopsy?

A
  • First node to recieve lymphatic drainage
  • First node to which tumour spreads
  • If negative, rest of nodes in lymphatic basin are negative
  • “skip” metastases do not occur
20
Q

How do we treat the lymph nodes of the axilla?

A
  • If SLN is clear of tumour – no further treatment required
  • If SLN contains tumour – either remove them all surgically (clearance) or give radiotherapy to all the nodes in the axilla
21
Q

What are the steps of axillary clearance?

A
  • All patients with breast cancer have FNAC at clinic – if shows malignant cells
  • All nodes removed from axilla
  • No radiotherapy given, even if nodes involved with tumour
  • More morbidity than other types of axillary surgery
22
Q

What are some complications when treating the axilla?

A
  • lymphoedema
  • sensory disturbance (intercostobrachial n.)
  • decrease ROM of the shoulder joint
  • nerve damage (long thoracic, thoracodorsal, brachial plexus)
  • vascular damage
  • radiation-induced sarcoma
23
Q

What are RF for metastatic disease?

A
  • age >50 years
  • family history of breast and/or ovarian cancer
  • BRCA1 (breast cancer type 1, early onset) or BRCA2 (breast cancer type 2 susceptibility protein) mutation present in either parent
24
Q

Main types of treatment for micrometastases?

A
  • Hormone therapy
  • Chemotherapy
  • Targeted therapy
25
Q

Explain the hormonal therapy used to treat micromestasteses?

A
  • Effects the oestrogen receptors
  • Only given if hormone receptors are present
  • Blocks stimulation of cell growth by oestrogen
  • If premenopausal – tamoxifen for 5 years
  • If postmenopausal – tamoxifen for 5 years if excellent prognosis.
  • BUT others get an aromatase inhibitor, eg ANASTROZOLE for 5-10 years
26
Q

Explain the use of chemotherapy in treatment of micromestastases?

A
  • Better effects if age<50
  • Node positive or grade 3 – usually give
  • For others – balancing benefits versus toxicities, eg hasn’t spead to lymph nodes
  • “Oncotype DX” – 21 gene assay to determine whether chemotherapy likely to be of benefit
27
Q

What is the specific treatment for HER2 receptor?

A
  • Monoclonal antibody against her-2 receptor
  • Given to patients with over-expression of Her2 and chemotherapy
  • 50% decrease risk of recurrence
  • 33% increase in survival at 3 years!
28
Q

What is the follow up for breast cancer treatment?

A
  • Many different protocols – poor evidence base
  • Clinical examination 6 monthly for 3- 5 years
  • Discharge after 3- 5 years, or even sooner!
  • Mammogram of breast(s) at yearly intervals for 10 years

Reproductive (34 decks)

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