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Third Year: Obs and Gynae general > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is breast cancer

Does it affect men?

A

A malignant change in the breast that affects 1 in 8 people in Britain. It accounts for 1/4 of female cancers. 46,000 new cases in Britain each year

Not as much only around 300 cases in men each year

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2
Q

What are some risk factors for breast cancer? (5)

A 
Age
Previous breast cacner
genetics
early menarche and late menopause (increased oestrogen exposure)
Late or no pregnancy
HRT
Alcohol
Weight
radiotherapy treatment for Hodgkin disease
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3
Q

How does breast cancer present (5)

What are the 5 year survival rates?

A

Through screening, mastalgia (breast pain), nipple discharge, nipple changes, chnages in breast size and shape, lymphoedema, dimping of breast skin, a lump

64%

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4
Q

Explain what is involved in history and examination when someone presents in clinic?

A 
Presenting complaint
Previous breast problems
FH
Hormonal status
DH
Examination of both breasts, axillae
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5
Q

What imaging can be used?

A

Mammography- not in woman under 35 as the glandualr tissue can be affected by radiation

ultrasound

MRI

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6
Q

What histological investigations can be carried out?

A

FNA cytology

Core biopsy (FNA + Sentient lymph node)

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7
Q

What is being assessed for in breast cancer imaging

A

Microdeposits, tiny deposit of calcium that appear anywhere in the breast often showing up on a mammogram. Most woman have one or more areas of microcalcifications

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8
Q

What are the two classes of non invasive breast cancer

What are the three classes of invasive breast cancers

A
  • Ductal carcinoma in situ
  • Lobular carcinoma in situ
  • Ductal carcinoma (80%)
  • Lobular carcinoma (10%)
  • Others (10%)
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9
Q

What is classed under the “others” category in invasive breast cancers?

How is breast cancer treated?

A

Mucinous, Tubualr, papillary, medullary , sarcoma, lymphoma

Diagnosis, staging, treating disease with MDT

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10
Q

Who is involved in the MDT of breast cancer treatment

A

Breast surgeo, Radiologist, Cytologist, Pathologist, Clinical oncologist, Medical oncologist, Nurse councillor, Pyschologist, Reconstructive surgeon, Patient and family, Palliative care team

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11
Q

How can you assess the severity and staging of breast cancer

How does breast cancer spread?

A

FBC, U&E’s LFT’S, CA, pO2
CXR
Other clinically indicated tests
NO RELIABLE TUMOUR MARKERS

Local spread through invasion into other tissues such as skin and pectoral muscles. Lymphatic spread can occcur through the axilla and internal mammary nodes. It can also spread through the blood to the bones, lungs liver and brain.

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12
Q

What is T in TNM classification for breast cancer

A 
Tx- Primary tumour cannot be assessed
T0- Primary tumour not palpable
T1- Clinically palpable tumour <2cm
T2- Tumour size 2-5cm
T3- Tumour size >5cm
T4a- Tumour invading skin
T4b- Tumour invading chest wall
T4c- Tumour invading both
T4d-Inflammatory breast cancer
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13
Q

What is N in TNM classification of breast cancer

What is M in TNM classification of breast cancer

A

N0- No regional lymph node palpable
N1- regional lymph node palpable, mobile
N2- regional lymph node palpable, fixed

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

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14
Q

What are the two main types of breast cancer surgical treatments

How does conservative treatment compare to other treatments

A

Breast conservation and mastectomy

For tumours under 4cm breast conservation and radiotherapy is as effective as a mastectomy

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15
Q

What is a sentinel node biopsy?

How do you interpret results?

If SLN is positive what happens next?

A

Biopsing the first node in a chain of nodes.

If the first node is postive, the rest of the chain may be positive. If the first node is negative then the rest of the chain will be negative

Radiotherapy or removal of the chain

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16
Q

What are the complications of breast cancer treatment (surgery and radiotherapy)?

A 
Lymphoedema
Sensory disturbance
Decreased ROM
Nerve damage
Vascular damage
Radiation induced sarcoma
17
Q

What factors are associated with disease recurrence

A 
Lymph involvement
Tumour grading
Tumour size
Steroid recpetor status
HER2 status
lymphovascular invasion
18
Q

How is radiotherapy used to treat breast cancer

What are the complications of radiotherapy

A

a 3 week course of treatment of the affected site, top up treatments reduce recurrence.

Skin reaction
radiation pneumonitis
Angiosarcoma
Cutanous radionecrosis

19
Q

How is hormone therapy used to treat breast cancer?

What are the two classes of hormone therapy?

A

Acts to stop cell growth via oestrogen.

There are two classes tamoxifen and aromatase inhibitors

20
Q

How is tamoxifen used in the hormonal treatment of breast cancer?

Who is given tamoxifen?

Does Tamoxifen have any side effects?

A

20mg once daily for 10 years
blocks directly on ER receptor

Effective in all age groups
More effective given after chemo

Can cause thromboembolic events

21
Q

How are aromatase inhibitors used in the hormonal treatment of breast cancer?

What groups are given aromatase inhibitors?

Do aromatase inhibitors have any side effects?

A

Arimidex (1mg)
Letrozole (2.5mg)

given once daily fro 5 years
inhibits ER synthesis
Should only be used in postmenopausal women
improves disease free survival
may cause oesteoperosis
22
Q

What are the advantages of using chemotherapy in treatment of breast cancer?

What is typically administered

A

Benefits younger woman and those with adverse prognostic factors.

CMF combinations (cyclophosphamide
methotrexate
5 fluorouracil)

Anthracyclie combinations (doxorubicin or epirubicin)

Taxane based combinations (e.g. docetaxel)

23
Q

How are monoclonal antibodies used to treat breast cancer?

How should patients be followed up after breast cancer treatment

A

Work against HER-2 receptors. It is given to patients with an over expression of HER-2 and chemotherapy. It results in a 50% decrease in risk of recurrence and 33% increase at survival at 3 years

poor evidence for following up. mammograms yearly fro 3-10 years, judge by individual patient

24
Q

How is cancer classified histologically?

A 
Tubular carcinoma
Mucious carcinoma
Carcinoma with medullary features
Metaplastic carcinoma
Others
25
Q

What does histology look for in order to classify?

A 
Invasice vs non invasice
Ductal vs lobular
Grade
Size
Margins
Lymphs
oestrogen/progesterone receptors
HER-2 receptors
26
Q

What does the prognosis of breast cancer depend on?

A 
Node status
Tumour size
Type
Grade
Age
Lymphovascular space invasion
Oestrogen receptors
Progesterone receptors
HER-2
proliferation rate of the tumour
Gene expressing and profiling
Nottingham prognostic index
27
Q

How can markers predict treatment responses?

A

ER/PR are strong predictors of response to hormonal therapies

ER/PR negative do not respond to hormonal therpaies

20-30% of HER-2 are positive predictors in response o trastuzumab (herceptin)

28
Q

What is the next big thing in breast cancer treatment?

A

i dont know i cant understand it

29
Q

What is an adenoma

What is the most common adenoma experienced by young woman

When does it typically develop and what may happen to it

A

A pre-cancerous disease of the breast comprised of proliferation of epithelium and stromatolites

Fibroadeoma- well circumscribed freely mobile non painful mass

20-30’s may regress with age or may become cancerous

30
Q

What other forms of adenomas can you get?

A

Tubular adenomas- less common in young woman, freely movable masses

Lactating adenomas- enlarging masses experineced during lactation or pregnancy that form a prominent secretory change

31
Q

What is an intraduct papilloma

A

benign epithelial tumour typically occurring in middle aged woman. May produce nipple discharge with hyperplasia which may be atypical

32
Q

What is the relative risk that an intraduct papilloma may turn into breast cancer

A

Depends on the class of lesion

Epith proliferation without atypia-1.5-2x
with atypia ductal or lobular- 4-5x

Third Year: Obs and Gynae general (26 decks)

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