Breast Cancer Flashcards
What is breast cancer
Does it affect men?
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
What are some risk factors for breast cancer? (5)
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
How does breast cancer present (5)
What are the 5 year survival rates?
Through screening, mastalgia (breast pain), nipple discharge, nipple changes, chnages in breast size and shape, lymphoedema, dimping of breast skin, a lump
64%
Explain what is involved in history and examination when someone presents in clinic?
Presenting complaint Previous breast problems FH Hormonal status DH Examination of both breasts, axillae
What imaging can be used?
Mammography- not in woman under 35 as the glandualr tissue can be affected by radiation
ultrasound
MRI
What histological investigations can be carried out?
FNA cytology
Core biopsy (FNA + Sentient lymph node)
What is being assessed for in breast cancer imaging
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
What are the two classes of non invasive breast cancer
What are the three classes of invasive breast cancers
- Ductal carcinoma in situ
- Lobular carcinoma in situ
- Ductal carcinoma (80%)
- Lobular carcinoma (10%)
- Others (10%)
What is classed under the “others” category in invasive breast cancers?
How is breast cancer treated?
Mucinous, Tubualr, papillary, medullary , sarcoma, lymphoma
Diagnosis, staging, treating disease with MDT
Who is involved in the MDT of breast cancer treatment
Breast surgeo, Radiologist, Cytologist, Pathologist, Clinical oncologist, Medical oncologist, Nurse councillor, Pyschologist, Reconstructive surgeon, Patient and family, Palliative care team
How can you assess the severity and staging of breast cancer
How does breast cancer spread?
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.
What is T in TNM classification for breast cancer
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
What is N in TNM classification of breast cancer
What is M in TNM classification of breast cancer
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
What are the two main types of breast cancer surgical treatments
How does conservative treatment compare to other treatments
Breast conservation and mastectomy
For tumours under 4cm breast conservation and radiotherapy is as effective as a mastectomy
What is a sentinel node biopsy?
How do you interpret results?
If SLN is positive what happens next?
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
What are the complications of breast cancer treatment (surgery and radiotherapy)?
Lymphoedema Sensory disturbance Decreased ROM Nerve damage Vascular damage Radiation induced sarcoma
What factors are associated with disease recurrence
Lymph involvement Tumour grading Tumour size Steroid recpetor status HER2 status lymphovascular invasion
How is radiotherapy used to treat breast cancer
What are the complications of radiotherapy
a 3 week course of treatment of the affected site, top up treatments reduce recurrence.
Skin reaction
radiation pneumonitis
Angiosarcoma
Cutanous radionecrosis
How is hormone therapy used to treat breast cancer?
What are the two classes of hormone therapy?
Acts to stop cell growth via oestrogen.
There are two classes tamoxifen and aromatase inhibitors
How is tamoxifen used in the hormonal treatment of breast cancer?
Who is given tamoxifen?
Does Tamoxifen have any side effects?
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
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?
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
What are the advantages of using chemotherapy in treatment of breast cancer?
What is typically administered
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)
How are monoclonal antibodies used to treat breast cancer?
How should patients be followed up after breast cancer treatment
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
How is cancer classified histologically?
Tubular carcinoma Mucious carcinoma Carcinoma with medullary features Metaplastic carcinoma Others
