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Y4: Breast and abdominal wall surgery > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

What are the risk factors for breast carcinoma?

A
  • Age
  • HRT
  • Obesity
  • BRCA genes
  • Family history
  • Nulliparity, 1st pregnancy >30 yrs old, not breastfeeding
  • Early menarche, late menopause
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2
Q

Describe the pathology of Non-invasive ductal carcinoma in situ (DCIS)?

A
  • Premalignant
  • Seen as microcalcification on mammography
    • unifocal or widespread
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3
Q

Describe the pathology of Non-invasive lobular CIS?

A
  • Rare
  • Tends to be multifocal
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4
Q

Describe the pathology of Invasive ductal carcinoma?

A
  • Most common breast carcinoma
  • Further classified:
    • tubular, cribiform, papillary, mucinous, medullary
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5
Q

Describe the genetics of breast carcinoma?

A
  • 60-70% oestrogen receptor positive
    • => better prognosis
  • 30% over-express HER2
    • => aggressive disease and poor prognosis
  • Gene abnormalities: BRCA1/2, Li-Fraumeni, Cowden
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6
Q

Describe Invasive lobular carcinoma?

A
  • More common in older women
  • Diffuse (stromal) pattern of spread => makes detection more difficult
  • Tumours are often large at time of diagnosis
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7
Q

Describe Fibrocystic change?

A
  • Lumpy bump breast tissue
  • May be a discrete focal area of fibrosis that is more dominant
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8
Q

Differentials for breast cancer?

A
  • Benign tumours
  • Breast cysts
  • Breast abscess
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9
Q

Describe the prognosis in breast cancer?

A
  • Nodal status is most important prognositc factor
  • Size, grade, receptor status also important
  • Nottingham prognostic index can be used
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10
Q

Describe the Nottingham prognostic index (NPI)?

A
  • (Size x 0.2) + Nodal status + Grade
    • Grade is based on Bloom-Richardson classification
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11
Q

Describe the breast screening programme in the UK?

A
  • Women 50-70 years old
  • Mammogram every 3 years
  • Abnormalities referred to breast clinic for clinical assessment
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12
Q

Describe the staging of breast cancer?

A
  • Stage 1: Confined to breast, mobile
  • Stage 2: Growth confined to breast, mobile, lymph nodes in ipsilateral axilla
  • Stage 3: Tumour fixed to muscle, fixed lymph nodes, skin involvement
  • Stage 4: Complete fixation to chest wall, distant mets
  • Also TNM staging:
    • T1(<2cm), T2(2-5cm), T3(>5cm) T4(fixity to chest wall or peau d’orange)
    • N1 (mobile ipsilateral nodes), N2 (fixed nodes)
    • M1 (distant mets)
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13
Q

Describe the treatment for local breast cancer?

A
  • Surgery
    • Wide local excision (WLE) or mastectomy +/- reconstruction
    • Axillary node sampling/surgical clearance or sentinal node biopsy
  • Radiotherapy
    • All patients with invasive cancer after WLE
  • Chemotherapy
    • Improves survival and reduces recurrence
    • Epirubicin + CMF
  • Endocrine agents
    • Reduces oestrogen activity in ER and PR positive disease
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14
Q

Side effects of radiotherapy in breast cancer?

A
  • Pneumonitis
  • Pericarditis
  • Rib fractures
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15
Q

What are the chemotherapy drugs often used in breast cancer?

A
  • Epirubicin + CMF
  • CMF:
    • Cyclophosphamide
    • Methotrexate
    • 5-FU
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16
Q

Describe the use of endocrine agents as a treatment for breast cancer?

A
  • Reduce oestrogen activity in ostrogen and progesterone receptor positive disease
  • Tamoxifen: ostrogen receptor blocker
    • (risk of uterine cancer)
  • Aromatase inhibitors: target peripheral oestrogen synthesis
    • (only used if post-menopausal)
  • If oestrogen receptor positive and pre-menopausal:
    • Ovarian abaltion via surgery or radiotherapy
17
Q

Name some surgical options for breast reconstruction?

A
  • Tissue expandors
  • Implants
  • Nipple tattoos
  • Latissimus dorsi flap
  • TRAM flap
    • (transverse rectus abdominis myocutaneous)
18
Q

Describe the treatment for distant breast cancer disease?

A
  • Painful bony lesions:
    • Radiotherapy
    • Bisphosphonates (reduce pain and fracture risk)
  • ER+ve tumours:
    • Tamoxifen
  • HER2+ve tumours:
    • Trastuzuman + chemotherapy
19
Q

Flow chart for the management of a breast lump

A
20
Q

Describe the process of a sentinal node biopsy?

A
  • Decreases needless axillary clearances in lymph node negative patients
    • Dye is injected into periareolar area
    • Sentinal node is biopsied
      • Histology +/- immunohistochemistry
    • Axillary clearance if node positive
21
Q

Describe Paget’s disease of the nipple?

A
  • Roughening, reddening and slight ulceration of the nipple
  • The majority of people will have an underlying neoplasm
  • Microscopically:
    • Involvement of the epidermis by malignant carcinoma cells
22
Q

How can Paget’s disease be differentiated from dermatitis?

A
  • Paget’s
    • Affects nipple then areola secondary
  • Dermatitis
    • Only involves areola
23
Q

Describe the difference between a screening and diagnostic mammogram?

A
  • Screening:
    • Asymptomatic women to look for occult breast cancer
    • 2 views of each breast are obtained
  • Diagnostic:
    • Pays attention to area of clinical concern
    • Additional views at multiple angles or compressions
24
Q

Techniques available for diagnosis of a palpable, solid breast mass?

A
  • Fine needle aspiration (FNA)
  • Core biopsy
  • Excisional biopsy
25
Q

Describe FNA?

A
  • Recovers cells from the mass
  • Requires cystopathologist for interpretation
  • Cannot discriminate between invasive and in-situ
26
Q

Describe core biopsy?

A
  • Removes 14- to 18-gauge pieces of tissue
  • Risk of missing the lesion and obtaining a false-negative
27
Q

Describe an excisional biopsy?

A
  • Completely removes the target lesion
  • Provides the mos ttissue for evaluation
  • Can be diagnostic and therapeutic
28
Q

Where can invasive breast cancer spread to?

A

Bones, brain, liver, lung

29
Q

Chemotherapy regimes for breast cancer?

A
  • Node positive disease
    • FEC-D chemotherapy
  • Node negative disease
    • FEC chemotherapy
30
Q

Differences between the use of mastectomy of wide load excision

A
31
Q

A 74 year old oman presents with a breast lump. On examination, it has a soft consistency. The lump is removed and sliced apart. Macroscopically there is a grey, gelatinous surface.

What is the most likely cause of the lesion?

A

Mucinous carcinoma

32
Q

A 74 year old woman presents with a erythematous rash originating in the nipple. It is spreading to the surrounding areolar area and the associated normal tissue.

What is the most likely cause of the lesion?

A
  • Paget’s disease of the nipple
    • usually diagnosed by punch biopsy
33
Q

A 53 year old woman presents with a bloody nipple discharge. On mammogrpahy there is calcification behind the nipple areolar complex. A core biopsy shows background benign change but cells that show comedo necrossis which have not breached the BM

What is the most likely cause of the lesion?

A
  • Ductal carcinoma in situ (DCIS)
    • Comedo necrosis is a feature of high . nuclear grade DCIS
    • High risk of being associated with foci of invasion
34
Q

A 57 year old woman with a recent diagnosis of breast cancer is found to be positive for a BRCA1 gene mutation on genetic screening. She has a strong family history of breast . cancer, with both her mother and aunt receiving treatment for the condition at a young age. She is concerned that she has passed the gene onto her son and daughter and is also worried about her sister having the gene.

What is the likelihood of her son, daughter and sister having the gene?

A

Both children and her sister have a 50% chance of inheriting the gene

Y4: Breast and abdominal wall surgery (5 decks)

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