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Repro > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

what different types of invasive carcinomas can you get in breast cancer?

A 
> cribriform
> medullary
> tubular
> lobular
> ductal
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2
Q

what is a carcinoma in situ?

A

cell have malignant appearance but are contained in the basement membrane

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3
Q

what is the commonest type of carcinoma in situ?

A

ductal

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4
Q

what are the risk factors for breast cancer?

A 
> family history
> pregnancy
> older age at menopause
> younger age of menarche
> previous benign or malignant disease
> radiation (hodgkins disease)
> obesity
> alcohol
> HRT/OC
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5
Q

how can breast cancer present?

A 
> lump
> thickening
> discharge
> change in
 - size
 - contours
 - areola colour and appearance
> peau d'orange
 - redness
 - pitting
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6
Q

what does peau d’orange presentation suggest?

A

inflammatory breast cancer (bad prognosis)

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7
Q

what are the 3 main investigations of breast cancer?

A

> clinical examination
mammography
ultrasound scan

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8
Q

when would you do a mammography?

A

> over 40 yrs old

> less than 40 but family history or any increased suspicion of breast cancer

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9
Q

what might be seen on mammography with benign disease?

A

> lobulated
halo
normal density

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10
Q

what might be seen on mammography with metastatic disease?

A

> irregular
spiculated
dense
distortion of architecture

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11
Q

what might benign disease look like on the ultrasound?

A

> smooth outline
oval shaped
acoustic enhancement

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12
Q

what might malignant disease look like on the ultrasound?

A

> interrupted breast architecture
anterior halo
irregular outline
acoustic shadowing

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13
Q

when would you do an MRI?

A

> recurrent disease
implants
indeterminant lesion after triple assessment

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14
Q

what are the limitations of cytology?

A

> invasion not assessed
grading not done
false positives and negatives

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15
Q

what information can a core biopsy give you?

A

> confirmation of invasion
tumour typing and grading
immunohistochemistry

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16
Q

what on cytology of a FNA suggests benign disease?

A

> low cellularity
cohesive groups
bipolar nuclei in background

17
Q

what on cytology of a FNA suggests malignant disease?

A

> high cellularity
nuclear dysmorphism
absence of bipolar nuclei
loss of cohesion

18
Q

what are some complications of FNA?

A

> pain
haematoma
fainting
(pneumothorax, infection)

19
Q

what investigations would you carry out to stage breast cancer?

A 
> LFT's
> Hb
> FBC
> U+E'S
> isotope bone scan
20
Q

describe the T stages in the staging of breast cancer?

A
  1. 0-2cm
  2. 2-5cm
  3. more than 5cm
  4. fixed to skin or muscle
21
Q

what patients are suitable for breast conversion?

A

> patients wish
single tumour
suitable for radiotherapy

22
Q

what is the management of micro-metastasis?

A

> hormone therapy
chemotherapy
anti-HER2 therapy

23
Q

what hormone therapy is available?

A

> tamoxifen (pre and post menopausal women) for 5 years
aromatase inhibitors
(can only work if oestrogen receptors are present)

24
Q

what is carried out to determine if chemo will benefit?

A

21 gene assay

25
Q

when is chemo offered?

A

> node positive

> grade 3

26
Q

what is anti HER2 therapy?

A

a monoclonal antibody against a HER2 receptor used in patients with over expression of HER2

27
Q

name ANTI HER2 therapy

A

trastuzumab

28
Q

what are the effects of anti HER2 therapy?

A

> 33% increase in survival of 3 years

> 50% decrease risk of recurrence

29
Q

what is the follow up of breast cancer?

A

> mammogram of breast at 1 year intervals for 10 years

> clinical examination 6 monthly for 3-5 years

30
Q

how are the lymph nodes investigated?

A

sentinel node biopsy: first node to receive drainage from the cancer

31
Q

what is the treatment for spread to the axillary nodes?

A

axillary node clearance

32
Q

what are the complications of axillary node clearance?

A 
> decreased movement of the shoulder
> nerve damage (brachial plexus, thoracodorsal, long thoracic)
> vascular damage
> sensory disturbance
> lymphadenopathy

Repro (22 decks)

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