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SPM- Oncology and Palliative Care > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the lifetime risk of developing breast cancer in women?

A

1 in 8 women will develop breast cancer

(It is 1 in 868 in men so it is much rarer for breast cancer to develop in women?

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2
Q

What are some modifiable risks for breast cancer?

A 
Smoking
Obesity (Adipose tissue produces oestrogen)
Alcohol consumption
OCP use
HRT use
Fewer pregnancies
Late first pregnancy
Radiation exposure- e.g. previous radiotherapy for breast cancer
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3
Q

What are some non-modifiable risks for breast cancer?

A

Female gender
Inherited gene mutations- BRCA1 and BRCA2
Age of first menarche
Late menopause
Increasing age
Family History (having one first degree relative with breast cancer doubles the risk)
Presence of precancerous lesions- DCIS

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4
Q

What are some signs and symptoms of breast cancer?

A 
Many are asymptomatic and are picked up on screening
Breast lump
Axillary lump
Change in breast consistency
Breast asymmetry
Puckering of the skin/ Peau d'orange
Bleedings/Discharge from the nipple
Inversion of the nipple

Non-specific sx- Weight loss, fatigue, bone pain, liver capsular pain

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5
Q

What is inflammatory breast cancer?

A

This is a form of breast cancer which can easily be missed. Malignant cells block the lymphatic vessels and there are inflammatory symptoms. For example: Itching, pain, redness, nipple inversion, skin puckering. This can progress to Paget’s disease of the breast which eczema like changes around the nipple (redness, pain, tenderness, flaking skin) sometimes with bloody discharge of the nipple

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6
Q

What is paget’s disease of the breast?

A

Form of breast cancer that causes eczema like features around this nipple- itching, redness, pain. May be bloody discharge from the nipple.

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7
Q

What are the features of inflammatory breast cancer?

A 
Redness
Tender breast
Firm or hard to the touch
Swelling of the breast
May be hot to touch

It is due to malignant cells blocking the small lymphatic channels in the breast. It is often misdiagnosed for mastitis and should be one of the differentials if suspecting breast cancer

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8
Q

Who is mastitis rare in and if presenting in these groups it should raise the suspicion of inflammatory breast cancer?

A

Women who aren’t pregnant
Women who aren’t breastfeeding
Women who have had their menopause

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9
Q

What is the NHS breast cancer screening programme?

A

Women aged 50-70 are invited for a mammogram every three years

Note- in some parts of england this have been extended to 47-53

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10
Q

Why are mammograms not great in younger patients?

A

The breast tissue of younger patients is much denser and means a mammogram is less useful at identifying any lesions. USS may be better

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11
Q

What are the tumour markers that can be investigated for in breast cancer, their presence will indicate the need for some different treatment options?

A

Oestrogen Receptor Positive
Progesterone Receptor Positive
HER2 Positive

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12
Q

What is HER2?

A

HER2 is a gene that causes over-expression of human EGFR which drives tumour cell growth and division. It can be targeted using trastuzumab/ herceptin

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13
Q

When should an urgent 2 week wait referral for suspected breast cancer be considered?

A

Anyone aged 30 or over with an unexplained breast lump with or without pain
Anyone aged 50 or over with discharge, retraction or any other changes of concern to the breast or nipple

Consider if any skin changes that could indicate breast cancer or an unexplained lump in axilla of patients over 30.

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14
Q

What is carried out for a 2WW referral for breast cancer?

A

Triple assessment-
Clinical Assessment/Examination by a breast surgeon
Radiological Assessment- Mammogram/USS
Pathological Assessment- FNAC or Core Biopsy

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15
Q

How is breast cancer staged?

A

TNM Staging (Live every other cancer)

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16
Q

What is a DCIS?

A

This stands for ductal carcinoma in situ, it is a premalignant lesion that has not invaded beyond the basement membrane. A large proportion do not develop into cancer.

17
Q

What are they types of breast cancer?

A

Lobular
Ductal
Special Type/Mixed

All breast cancers are adenocarcinomas as they arise from glandular tissue

18
Q

What guides the treatment decisions for breast cancer?

A

TNM staging guides the treatment options. For example surgery is possible in more localised disease but not for metastatic disease.

19
Q

Outline the treatment categories for breast cancer

A

Surgery- Wide local excision, Mastectomy, Axillary node clearance
Chemotherapy- Adjuvant/Neoadjuvant
Radiotherapy
Targeted therapies if ER/PR/HER2 positive

20
Q

What are the surgical treatment options for breast cancer?

A

Wide local excision with sentinel node biopsy
Mastectomy
Axillary node clearance- if sentinel node positive for metastatic cells

21
Q

Why is a sentinel node biopsy carried out?

A

A sentinel node biopsy checks for the presence of malignant cells in the lymph node that drains the tumour. The presence of malignant cells in the sentinel nodes indicates nodal involvement and so an axillary node clearance + chemotherapy is indicated

The sentinel lymph node is identified by injected dye into the tumour

22
Q

What is the role of chemotherapy in the treatment of breast cancer?

A

Neoadjuvant chemotherapy may be done before surgery to shrink the tumour bulk. This can make surgery a more suitable option.

Adjuvant chemotherapy- Used after surgery to reduce the risk of micro-metastases and recurrent disease. Indicated is there is any spread to the lymph nodes.

Chemotherapy is also indicated in metastatic disease where surgery may not be suitable.

Palliative- to reduce the symptoms created by tumours but with no curative intent

23
Q

What chemotherapy agents are mainly used in breast cancer?

A

Anthracyclines- e.g. Epirubicin. Intercalate between the base pairs of DNA and therefore prevent replication
Taxanes- e.g. Docetaxel. Binds and stabilises microtubules so prevents mitosis.

24
Q

What is the role of radiotherapy in the treatment of breast cancer?

A

Adjuvant radiotherapy may be offered after breast surgery if there has been spread to lymph nodes or to reduce the risk of cancer returning locally.

Palliative radiotherapy may be carried out to shrink tumours to relieve symptoms

25
Q

Why are breast cancers tested for ER/PR positivity?

A

Breast cancers are an example of a hormone driven cancer, increased oestrogen exposure increases an individual’s risk of developing breast cancer. These can be targeted with medical therapy to reduce the stimulus for cancerous cell growth/division.

26
Q

What therapies are offered if a woman is found to have ER/PR positivity?

A

Premenopausal: Tamoxifen
Postmenopausal: Aromatase Inhibitors

27
Q

What is tamoxifen?

A

It is an oestrogen receptor antagonist that is offered to -pre-menopausal women with breast cancer who have been found to be ER positive

28
Q

Why are aromatase inhibitors used in the treatment of postmenopausal women with ER positive breast cancer?

Give an example of an aromatase inhibitors.

A

In post menopausal women oestrogen production is due to peripheral conversion of testosterone to oestrogen by the aromatase enzyme. Aromatase inhibitors prevent the peripheral conversion and so reduce to drive for tumour growth.

Anastrozole/ Exemestane are examples of aromatase inhibitors

29
Q

When is trastuzumab/herceptin indicated in the management of breast cancer?

A

HER2 positive breast cancers should be treated using Herceptin/Trastuzumab. This is anti-EGFR and so reduces the drive for tumour growth that comes with EGFR over-expression

30
Q

What is an important side effect of trastuzumab?

A

Can decrease left ventricular ejection due to cardiomyopathy.

Requires monitoring with ECHO.

31
Q

What genes can increase a woman’s risk of developing breast cancer?

A

BRCA 1- 65% lifetime risk, mediant age 43
BRCA 2- 45% lifetime risk, median age 41

Also increase risk of Ovarian cancer (CA-125)

32
Q

What should women of childbearing age due to start chemotherapy be counselled on?

A

Risk of infertility and discussion of preservation techniques such as egg harvesting and storage. Often normal menstruation returns after 1 year.

33
Q

What are the T stages for breast cancer?

A 
Tis= DCIS/LCIS
T1- 2cm or less
T2- 2-5 cm
T3- More than 5 cm
T4- Any size with direct extension into chest wall or skin
34
Q

What tumour marker might be sued in the monitoring of breast cancer?

A

CA- 15-3

35
Q

What are some differential diagnoses for a breast lump?

A 
Malignancy
Abscess
Mastitis
Cyst
Fibroadenoma
Trauma- causing fat necrosis
Haematoma

SPM- Oncology and Palliative Care (10 decks)

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