Breast Cancer Flashcards
1
Q
Where are majority of breast cancers derived?
A
- epithelial tissue of lactiferous ducts and lobules
2
Q
Drainage of breast
A
- axillary lymph nodes
- or alternative -> internal mammary chain in sternum (minor route)
3
Q
Risk Factors
A
- age
- FH
- prior personal history of it
- increase oestrogen exposure = early menarche, late menopause, HRT
- nulliparity
- 1st pregnancy after 30
- diet and lifestyle (obesity, excessive alcohol consumption)
- radiation exposure before 40
- prior benign or premalignant breast changes = in situ cancer, atypical hyperplasia, radial scar
4
Q
Familial and Hereditary Breast Cancer
A
- genetic factor
- minority linked with BRCA1 and 2 inherited mutation
- high risk families = 4 or more relatives with breast/ovary c, 3 under age of 60, 2 under age of 40, 1 with both or bilateral breast cancer
5
Q
Lifestyle Risk Reduction
A
- early childbirth before 30
- exercise 3-5 hrs per week
- maintain normal weight
- avoid smoking/alcohol
- avoid LT HRT (especially combined oestrogen and progesterone)
6
Q
Early Detection
A
- national breast screening programme
- mammography every 3 years from menopause at 50-70
- only after menopause mammography is specific and sensitive
- otherwise on request
- investigation of MRI in premenopausal
7
Q
Types of Breast Cancer
A
NON INVASE CARCINOMA IN SITU - ductal carcinoma in situ - lobular carcinoma in situ INVASIVE CARCINOMA - infiltrating ductal or lobular carcinoma - medullary, mucinous and tubular carcinomas UNCOMMON TUMORS - inflammatory carcinoma - paget's disease
8
Q
General Breast Cancer Management
A
1 stop diagnosis - history and exam - mammography and US - fine needle aspirate cytology and core biopsy MDT Discussion Patient agreed treatment plan Personalised treatment
9
Q
Signs and symptoms at presentation
A
- mass or pain in axilla
- palpable mass
- thickening
- pain
- nipple discharge
- nipple retraction
- oedema or erythema of the skin
10
Q
Breast Cancer Staging
A
TX = primary tumor cannot be assessed T0 = no evidence of primary tumor Tis Carcinoma in situ = intraductal carcinoma, lobular carcinoma in situ or Paget's disease of nipple with no tumor T1 = tumour 2cm< T1a = 0.1-0.5cm T1b = 0.5-1cm Tc = 1-2cm T2 = 2-5cm T3 = >5cm T4a = any size with direct extension to chest wall T4b = any size with direct extension to skin (edema inc. peau d'orange or ulceration of skin or satellite skin nodules) T4c = T4a and b T4d = inflammatory carcinoma
11
Q
Early breast cancer treatment
A
LOCAL - surgery and radiotherapy - aesthetics and reconstruction SYSTEMIC TREATMENT FOR MCIROMETASTASES - endocrine - chemotherapy - targeted biologicals - bisphosphonates REHAB AND SURVEILLANCE
12
Q
Sites of distant metastases
A
- lymph nodes
- brain
- pleura
- lung
- skin
- liver
- bone
13
Q
Prognostic factors
A
- tumor size
- no. of positive axillary nodes
- lymphatic and vascular invasion
- histologic tumor type
- histologic grade
- oestrogen/progesterone receptors ER/PR
- HER2 overexpression
14
Q
Molecular prognostic factors
A
- proliferation index
- oncotype DX21 gene profile
- Amsterdam 70 gene profile
- blueprint 80 gene profile
15
Q
Early endocrine treatment
A
- before menopause
- tamoxifen for 5 years 25% relative reduction in risk of death
16
Q
Chemotherapy for early breast cancer
A
- cyclophosphamide, methotrexate, fluorouracil (CMF)
- fluorouracil, epirubicin, cyclophosphamide (FEC)
- docetaxel, doxorubicin, cyclophosphamide (TAC)
- docetaxel or AC and paclitaxel weekly (FEC-T)
17
Q
Targeted therapy for early breast cancer
A
- trastuzumab
18
Q
Adjuvant therapy Risk Reduction
A
- reduction in relative risk of death from breast cancer
- tamoxifen or anastrozole (25% reduction)
- chemo (20-35%)
- trastuzumab (33%)
- radiotherapy (5%)
- personalised treatment combined 50-80% reduction depending on grade and prognostic factors
19
Q
Purpose of treatment of metastatic breast cancer
A
- palliative
- serial treatments to induce remission and maintain QoL
- first endocrine response 20 m
- chemotherapy response 10m
- overall survival 24m
- to maximise quality and duration of life
- chronic illness relapsing and remitting over a number of years
20
Q
Advanced Breast Cancer Treatment
A
- endocrine anti-oestrogen
- chemo with 1 or 2 drug regimens
- targeted biologicals (trastuzumab, pertuzumab, lapatinib)
- radiotherapy
- surgery to chest wall
- supportive care (bisphosphonates)
- psychological support (art therapy)
21
Q
ECOG Grading Performance Status
A
0 = normal activity 1 = symptoms but ambulatory 2 = in bed <50% of time 3 = in bed >50% of time 4 = 100% bedridden
22
Q
KARNOFSKY Performance status
A
80-100% = can carry on normal activity, no special care needed 50-70% = unable to work, able to live at home, cares for most personal needs, varying amount of assistance 10-40% = unable to care for self, require equivalent of institutional or hospital care, disease may be progressing
23
Q
Breast Cancer endocrine treatment premenopausal examples
A
- oophorectomy
- GnRH analogues (goserlin, leuproprelin)
- SERMS (tamoxifen, fuvestrant)
- medroxy progesterone acetate
24
Q
Breast cancer endocrine treatment postmenopausal examples
A
- aromatas inhibitors (anastrozole, letrozole, exemestane)
- all of premenopausal treatments
25
Q
Supportive and Palliative Care Examples
A
- anxiety = communication
- pain = analgesic ladder
- anorexia = diet and antiemetics
- constipation = laxatives for analgesics
- metabolic = bisphosphonates
- psychologic = counselling and coping
