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Cancer Care > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are possible risk factors for breast cancer?

A 
Genetics - BRCA1/2 
Nullparity/late first pregnancy
Early Menarche + Late Menopause
Not breastfeeding
Obesity - post menopause 
COCP >4years before 1st pregnancy
HRT with unopposed oestrogen
Exposure to ionising radiation
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2
Q

How are patients with BRCA1/2 mutations treated when asymptomatic?

A

Prophylactic bilateral mastectomy

Annual MRI scans

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3
Q

What are the types of breast cancer?

A

Ductal Carcinoma In Situ (DCIS)

Lobular Carcinoma In Situ (LCIS)

Invasive Ductal Carcinoma

Invasive Lobular Carcinoma

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4
Q

What is DCIS?

A

Atypical proliferation of ductal epithelium that eventually plugs the duct.

It is maintained within the basement membrane

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5
Q

How would DCIS present?

A

Often no palpable lump so shown as an area of microcalcification on screening

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6
Q

How is LCIS found?

Where does LCIS spread to?

A

Incidentally during a biopsy since it is not palpable and won’t show as microcalcification

The contralateral breast

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7
Q

Which is the most common type of breast cancer?

A

75% are invasive ductal cell carcinomas

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8
Q

How do Invasive Ductal Carcinoma’s spread?

A

Regional nodes (internal mammary or axillary)

Systemically spread to bone, lung, pleura, liver, skin and the CNS

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9
Q

How is Invasive Ductal Carcinoma graded?

A

Histologically based on:

Tubule formation
Nuclear Pleomorphism
Mitotic frequency

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10
Q

Where can invasive Lobular Carcinoma’s spread to?

A

Peritoneum, meninges and uterus

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11
Q

What is Pagets disease?

A

eczematoid change in the nipple associated with an underlying invasive carcinoma in 90% of cases

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12
Q

What nipple changes are seen in Pagets?

A 
Roughened
Red
Ulcerated
Itchy
Yellow Discharge
Painful
Flattened
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13
Q

How can Pagets and Eczema be differentiated?

A

Eczema spares the nipple

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14
Q

What are ER + tumours and what prognosis do they have?

A

Dependent on oestrogen to control tumour growth

Good prognosis

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15
Q

What are HER2 + tumours and what prognosis do they have?

A

Dependent on HER2 which is a growth factor receptor gene

Aggressive behaviour with risk of lymphatic and haematogenous spread

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16
Q

How are HER2 + treated pharmacologically?

A

Herceptin (trastuzumab)

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17
Q

How are ER+ tumours treated pharmacologically?

A

Tamoxifen if pre-menopausal

Anastrazole - aromatase inhibitor if post-menopausal

18
Q

What is a triple negative cancer? How are they treated?

A

ER, PR and HER2 negative tumours

Respond to chemo

19
Q

What is done in a triple assessment?

A

History and Breast Examination

Mammogram/Ultrasound (<35/male)

Histology - core biopsy/fine needle aspiration (rare)

20
Q

What criteria can lead to referral to a breast clinic?

A 
New lump
Unilateral persistent pain in post menopausal women
Pain that interfere with life
Nipple discharge >50yo
Bloody/persistent/bilateral nipple discharge
Nipple retraction, distortion or eczema
Breast contour change
Abscess not settling after abx
Recurrent cyst
21
Q

What are the surgical management options for breast cancer and when would these be indicated?

A

Wide Local Excision - <4cm, peripheral, solitary mass

Mastectomy - >4cm, central, small breasts, multifocal mass

22
Q

What is done in a wide local excision of a breast cancer?

A

Excise tumour with 1cm margin of macroscopically normal tissue

23
Q

What are complications of axillary surgery?

A 
lymphoedema
long thoracic nerve damage - winging of scapula
arm pain
shoulder stiffness
skin numbness
24
Q

What 3 ways can breasts be reconstructed?

A

Lat Dorsi

TRAM - uses abdominal fat, muscle and skin

DIEP - uses abdominal fat and skin but leaves muscle meaning don’t lose as much strength

25
Q

How are bone metastases in breast cancer managed?

A

Low dose radiotherapy and bisphosphonates

26
Q

How does male breast cancer present?

A

Subareolar mass
Nipple retraction
Nipple bleeding

27
Q

How is male breast cancer managed?

A

Mastectomy + SLNB/axillary clearance

Adjuvant radio, tamoxifen, chemo should be considered

28
Q

What genetic abnormality is associated with male breast cancer?

A

Klinefelters Syndrome

29
Q

What is considered in the Nottingham Prognostic Index?

A

Size of tumour (x2)
+ Nodal Status (no. of axillary lymph nodes)
+ Grade (bloom richardson)

30
Q

What are some differentials for breast cancer? How would they classically present?

A

Periductal mastitis: in smokers, recurrent infections and indurated area

Duct ectasia: in elderly, nipple retraction and creamy discharge

Duct papilloma: blood stained nipple discharge

31
Q

What is inflammatory breast cancer?

A

cancerous cells block the lymph drainage leading to a swollen erythematous breast

32
Q

What is the current breast cancer screening programme?

A

age 47-73
every 3 years
mammogram

33
Q

If there are no palpable lymph nodes at presentation of breast cancer, how is she managed?

A

Pre-op USS and if +ve then SLNB at primary surgery

34
Q

If there is palpable lymphadenopathy at presentation of breast cancer what is done?

A

Axillary lymph node clearance at the primary surgery

35
Q

When is radiotherapy used in breast cancer?

A

Always post WLE

Post mastectomy if T3/T4 tumour or if >4 axillary nodes were +ve

36
Q

What hormonal therapy is used in breast cancer management and when?

A

Tamoxifen: pre-menopausal ER+ve
Anastrazole: post-menopausal ER+ve

+/- Goserelin: pre-menopausal

37
Q

What are the side effects/risks of tamoxifen?

A

endometrial cancer
VTE
menopause symptoms

38
Q

What are the side effects/risks of anastrazole?

A

osteoporosis

joint aches

39
Q

What are the side effects/risks of goserelin?

A

tumour flare initially
amenorrhoea
reduced libido
depression

40
Q

When is chemotherapy used in breast cancer management?

A

Neoadjuvant to downstage the primary lesion

After surgery if axillary node disease

Cancer Care (25 decks)

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