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Breast cancer Flashcards

1
Q

Incidence of breast cancer

A

Affects one in eight women

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2
Q

Risk Factors for breast cancer

A
  • Age: Increased incidence
  • Previous breast cancer
  • Genetic: BRCA1 and BRCA2 (5%)
  • Early menarche and late menopause
  • Late or no pregnancy
  • HRT
  • Alcohol (>14 units per week)
  • Weight
  • Post Radiotherapy treatment for Hodgkin’s disease
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3
Q

Presentation of breast cancer

A

Asymptomatic: breast screening (50-70 years)
Symptomatic: outpatient clinic
-Lump
-Mastalgia (persistent unilateral pain)
-Nipple discharge (blood-stained)
-Nipple changes (Paget’s disease, retraction)
-Change in the size or shape of the breast
-Lymphoedema (Swelling of the arm)
-Dimpling of the breast skin

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4
Q

Breast clinic

A 
Clinic: history and examination
Radiological: bilateral mammograms / USS
Cyto-pathological:
-FNA -cells only (cytology)
-Core biopsy -tissue (histopathology)
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5
Q

Breast cancer clinical assessment: history

A
  • presenting complaint
  • previous breast problems
  • family history
  • hormonal status
  • drug history
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6
Q

Breast cancer clinical assessment: examination

A
  • both breast
  • axilla
  • SCF
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7
Q

Pathological types of breast cancer

A 
Invasive
-80% Ductal Carcinoma
-10% Lobular Carcinoma
-10% Others
Non-Invasive
DCIS (Ductal Carcinoma In Situ)
LCIS (Lobular Carcinoma In Situ)
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8
Q

Management of Cancer steps

A

1) Diagnose the disease
2) Staging of the disease
3) Definitive treatment

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9
Q

Staging breast cancer

A
  • FBC, U&Es, LFTs, Ca2+/PO2-

- Chest x ray

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10
Q

TNM classification: T primary tumour

A 
Tx Primary tumour cannot be assessed
T0 Primary tumour not palpable
T1 Clinically palpable tumour -size < 2 cm
T2 Tumour size 2-5 cm
T3 Tumour size > 5 cm
T4a Tumour invading skin
T4b Tumour invading chest wall
T4c Tumour invading both
T4d Inflammatory breast cancer
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11
Q

TNM classification: N regional lymph nodes

A

N0 No Regional lymph nodes palpable
N1 Regional lymph node palpable- mobile
N2 Regional lymph node palpable- fixed

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12
Q

TNM classification: M regional lymph nodes

A

Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

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13
Q

Treatment of breast cancer

A

Surgery
+/- Radiotherapy
+/- Chemotherapy
+/- Hormonal Therapy

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14
Q

Two main types of surgical breast procedure

A
  • Breast conservation surgery

- Mastectomy

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15
Q

Patients suitable for

breast conservation surgery

A
  • Tumour size clinically<4cm -but depends on size of breast
  • Breast/Tumour size ratio
  • Suitable for radiotherapy
  • Single tumours
  • Patient’s wish
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16
Q

Sentinel lymph node biopsy

A
  • first node to receive lymphatic drainage
  • first node the tumour spreads to
  • if negative, rest of nodes in lymphatic basin are negative
  • only performed when preoperative axillary USS normal/benign
17
Q

Treatment of the axilla

A
  • If SLN is negative - no further treatment required

- If SLN contains tumour - either remove them all surgically or give radiotherapy to all the axillary nodes

18
Q

Complications of axillary treatment

A
  • lymphoedema (10-17%)
  • sensory disturbance (intercostobrachial n.)
  • decrease ROM of the shoulder joint
  • nerve damage (long thoracic, thoracodorsal, brachial plexus)
  • vascular damage
  • radiation-induced sarcoma
19
Q

Factors associated with increased risk of breast cancer recurrence?

A
  • Lymph node involvement
  • Tumour grade
  • Tumour size
  • Steroid receptor status (negativity- ER/PR neg)
  • HER2 status (positivity- HER2 pos)
  • LVI- lymphovascular invasion
20
Q

Prevention/adjuvant breast cancer treatment

A 
LOCAL
-Radiotherapy
SYSTEMIC
-Hormone therapy
-Chemotherapy  
-Targeted therapies
21
Q

HER2 positivity and Anti-Her2 therapy

A

Trastuzumab

  • Monoclonal antibody against Her-2 receptor
  • Given to patients with over-expression of Her2 and chemotherapy
  • 50% decrease risk of recurrence
  • 33% increase in survival at 3 years

Reproduction (34 decks)

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