Breast Cancer Flashcards
What is the 10 year survival for Breast cancer?
80%
Describe the National Breast Cancer Screening
50-71 year olds are invited to screening every 3 years. There is currently a trial to examine effectiveness of extending age bracket. Those at moderate risk may be screened from 40 years old. If 71 or over, patients can self-refer. Screening is via a mammogram.
What are the risk factor for Breast cancer?
Age
Personal and family history (breast, ovarian)
Alcohol
Oestrogen exposure: early menarche, late menopause, late pregnancy, no or few children, contraceptive pill, HRT
Obesity
What genes are associated with breast cancer?
BRCA 1 and 2
CHEK 2
TP53
Where does breast cancer metastasise?
Bone Lung Liver Brain Adrenal Ovary
How might a patient with breast cancer present?
Nipple retraction Nipple discharge Crusting of areola Redness or pitting of skin Lump or thickening in breast or underarm that is painless Change in size of contours of breast
What is the NICE criteria for referral for Breast cancer via the suspected cancer pathway referral (two week wait)?
Women aged 30 and over with unexplained breast lump
Women aged 50 and over with symptoms in one nipple
What investigation is more sensitive if a patient is less than 35 years old?
USS of Breast (or MRI)
What are the two most common histological types of invasive breast cancer?
Invasive ductal carcinoma (80%)
Invasive lobular carcinoma (10%)
What is meant by “in-situ” carcinoma?
Cancerous cells in normal tissue do not breach the basement membrane
Which receptors guide choice of hormonal treatment?
HER-2
ER
PR
What imaging modality is more commonly used for young women and why?
USS. Young women have denser breast tissue (lots of glandular and connective tissue) and less fatty tissue.
What cause of a breast lump is commonest in younger patients?
Fibroadenoma
What age group do fibrocystic changes most commonly affect?
Ages 30-40
What non-malignant cause of a breast lump would you consider in a women aged 50 plus?
Cyst
What the life time risk for breast cancer?
1 in 8
What proportion of women who are sent for further assessment following a mammogram are diagnosed with breast cancer?
25% (1 in 4)
If someone stops their HRT, how long does it take for their risk of breast cancer to return to normal?
Straight away
If a women stops taking the contraceptive pill, how long does it take for their risk of breast cancer to return to normal?
Decreases once they stop taking the pill and risk is back to normal 10 years after stopping.
What are the types of biopsy that might be performed?
FNA for cytology - quick, lower morbidity, less uncomfortable
Core needle biopsy (most common) for histology - requires LA, takes longer, can determine receptor status and grade of tumour
Vacuum assisted core biopsy - takes multiple cores out of the tissue
Excisional biopsy - requires GA
What is the most common type of breast cancer?
Invasive ductal carcinoma (80%)
Invasive lobular carcinoma (10%)
What is meant by ‘in situ’ carcinoma?
Cancers cells in normal tissue do not breach the basement membrane
Outline the staging of breast cancer
TI: <2cm
TII: 2-5 cm and/or lymph nodes in armpit are affected
TIII: 2-5cm and May be attached to structures in the breast
TIV: tumour of any size and cancer has spread to other parts of the body
What is meant by the ‘grade’ of cancer?
Appearance of the cancer cells.
E.g. high grade (G3) - cells look very abnormal and are more likely to grow quickly
What is the definitive treatment of breast cancer?
Wide local excision
Mastectomy
Sentinel lymph node biopsy
Axillary clearance
What patients (thinking about receptors) should be offered new-adjuvant chemotherapy?
ER-negative invasive breast cancer as an option to reduce tumour siege
HER2-positive invasive breast cancer
Triple-negative invasive breast cancer
Compare local recurrence in women who do not have adjuvant radiotherapy to women who have it.
50 women per 1000 at 5 years
10 women per 1000 at 5 years
Overall survival at 10 years is the same with or without radiotherapy
What the acute side effects of radiotherapy?
Skin reaction
Fatigue
Chest wall pain
What are the chronic side effects of radiotherapy to the breast or chest wall?
Fibrosis
Atrophy
Telangiectasia
What is a common chemotherapy regime for patients post surgery and radiotherapy?
FEC + Taxane (Docetaxel)
F - fluorouracil
E - Epirubicin
C - cyclophosphamide
What type of adjuvant hormone therapy is first-line for men and premenopausal women with ER-positive invasive breast cancer?
Tamoxifen
What is the MoA of Tamoxifen?
Mixed antagonist and agonist at the ER receptor.
What are the cautions to advise a patient about with regards to Tamoxifen?
Increased risk of DVT
Increased risk of endometrial cancer (agonist in the uterus)
What are the side effects of Tamoxifen?
Menopausal symptoms - hot flushes, night sweats, sleep disturbance, vaginal irritation, loss of libido, mood changes
Effects on periods
Fluid retention
Vaginal discharge
Indigestion or nausea
Increased risk of thrombosis and endometrial cancer
Bone protective!
What would you advise a patient starting on Tamoxifen about contraception?
Patient should use contraceptives during and for two months after treatment has finished.
What is the MoA of Anastrozole?
Inhibits the enzyme Aromatase which catalyses aromatisation step in synthesis of oestrogen from androgen precursors
Who is anastrozole indicated for?
Post-menopausal women with ER-positive invasive breast cancer who are at medium or high risk of disease recurrence.
What are the side effects of Anastrozole?
Osteoporosis Joint and muscle pain Menopausal symptoms Skin rash Nausea Fatigue Reduced libido
How long to patients usually take Tamoxifen for?
5 years
What hormone therapy is an option for premenopausal women?
Goserelin
What targeted treatment are available for breast cancer?
Trastuzumab (herceptin)
Pertuzumab
What are the side effects of trastuzumab?
Pancytopenia - increase risk of infection, breathlessness, bruising
Heart problems - requires regular ECG monitoring
Allergic reaction
Joint or muscle pain
Fatigue
Mouth sores and ulcers
Who should be offered adjuvant therapy with bisphosphonates?
Postmenopausal women with node positive invasive breast cancer
