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Cancer care > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

How common is breast cancer

A

Most common cancer in U.K.

Women have 1/8 lifetime risk

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2
Q

Risk factors for breast cancer

A 
Increasing age 
Previous history
Family history
HRT
Early menarche
Late menopause
Low parity
Obesity
High alcohol consumption
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3
Q

Differential for nipple discharge

A 
Duct ectasia
DCIS
Papilloma
Infection/abscess
Physiological
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4
Q

Differential for areolar change

A

Eczema

Paget’s disease

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5
Q

Differential for breast lump

A

Cancer
Cyst
Fibroadenoma
Fibrocystic change

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6
Q

Differential for breast redness

A

Mastitis
Abscess
Cancer - peau d’orange

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7
Q

What is the triple assessment of breast referrals

A

Clinical examination
Imaging - USS or mammogram
Pathology - biopsy histology or fine needle aspiration cytology

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8
Q

Views of a mammogram

A

Caudio-cranial

Oblique

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9
Q

What determines which form of imaging used

A

<40 use USS
>40 use mammogram
MRI for investigating breast implants, for high risk patient screening and to exclude multifocal disease

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10
Q

Benefits of core biopsy histology

A

Can determine receptor status (ER and HER-2)

Can determine grade

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11
Q

What USS features suggest benign disease

A

Well circumscribed

Hyper-echoic shadow

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12
Q

What features of mammography suggest malignant disease

A

Lots of microcalcification

Irregular

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13
Q

What proportion of breast cancers are ER+

A

2/3

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14
Q

What proportion of breast cancers are HER-2+

A

1/3

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15
Q

What proportion of breast cancers are ER+ and HER-2+

A

20%

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16
Q

What proportion of breast cancers are not receptor positive

A

15-20%

17
Q

Stepwise treatment for breast cancer

A
  1. Neoadjuvant chemo
  2. Surgery
  3. Chemo and/or radiotherapy (if both, chemo first)
  4. Biological and/or hormonal treatment
18
Q

What is the chemotherapy for breast cancer

A

FEC +/- taxanes

19
Q

What is the biological treatment and how long do you take it for

A

Herceptin for 1 year

20
Q

What is the hormonal treatment and how long do you take it for

A

Oestrogen antagonists e.g tamoxifen
Aromatase antagonists e.g anastrozole
5-10 years

21
Q

Surgical options for breast cancer

A

Mastectomy
Wide local excision
Sentinel lymph node biopsy
Axillary clearance

22
Q

When is a mastectomy preferred over WLE

A

Multifocal disease
Locally advanced: invading muscle/fascia, >5cm diameter (limit smaller for smaller breasts), skin ulceration
Patient choice
BRCA mutation

23
Q

Describe SLNB

A

Sentinel node is the first draining lymph node of the tumour found by injecting a dye or radioisotope

24
Q

Examples of breast reconstruction surgery

A

Implants only
Lat dorsi flap
Plastics - TRAM and DIEP

25
Q

Side effects of breast/chest wall radiotherapy

A

Acute: skin reaction, pain
Chronic: fibrosis, atrophy, telangiectasia

26
Q

Disadvantages of oestrogen antagonists

A

Increased DVT risk
Increased endometrial cancer risk
Increased stroke/MI risk

27
Q

Disadvantages of aromatase inhibitors

A

Increased osteoporosis risk
Reduced oestrogen production in post menopausal women
Can only be used in post menopausal women

28
Q

How to calculate prognosis

A

Nottingham prognostic index:

(Cancer size in mm x 0.2) + grade + node stage

Gives a number which can be converted to a 10 year survival rate prediction

29
Q

What determines prognosis

A

Better prognosis with:
Lower NPI (smaller tumour, lower grade, lower node stage)
Younger age

30
Q

Median survival with metastatic breast cancer

A

18-24 months

31
Q

Lifetime risk of breast and ovarian cancer with BRCA 1/2 mutation

A

BRCA1: 75% breast cancer, 50% ovarian cancer

BRCA2: 50% breast cancer, 30% ovarian cancer

32
Q

Why do you need to determine lobular or ductal

A

Lobular requires MRI before surgery because need accurate sizing, more likely to be multifocal and more likely to be bilateral

33
Q

When can you do an oncogene assay

A

ER positive
HER2 negative
Intermediate prognostic score

34
Q

Outcome of oncogene assay test

A

Gives score of 0-100 of risk of recurrence
>35 need adjuvant chemo
<25 adjuvant chemo has no benefit

Cancer care (12 decks)

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