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Breast > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What in situ

A

Malignant cells
Contained in BM
No metastatic spread

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2
Q

What are two types

A

Ductal - DCIS

Lobular - LCIS

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3
Q

DCIS

A

Invasive in same breast and place
+Ve EVAD
Most common
Seen as microcalcification on mammogram

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4
Q

LCIS

A

Invasive in different breast or area
Bilateral
Multicentricity
-ve ECAD

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5
Q

What are invasive cancer types

A

Ductal = 70%

Lobular

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6
Q

What type of cancer

A

Adenocarcinoma

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7
Q

What are special types

A

Tubular
Cribriform
Medullary

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8
Q

What else can you get in breast

A

Other types of cancer

e.g. sarcoma / neuroendocrine

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9
Q

Why are they. special type

A

Good prognosis

Oestrogen +VE

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10
Q

Why does breast cancer kill

A

Mets

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11
Q

Where does it metastasis too

A 
Skin / pec
Axillary + internal mammary nodes
Lung
Liver 
Bone 
Brain
Lymphaics
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12
Q

What does it cause in lymphatics

A

Lymphagitis carcinomatosis

Needs biopsy

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13
Q

What are genes associated with breast

A 
BRCA 1+2 - AD
- 50-85% increased risk 
- Increased risk of ovarian as well 
TP53
PTEN
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14
Q

What does triple assessment do

A

Scores lump on likelihood of malignancy
B - biopsy score
U or M - imaging score
E - examination

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15
Q

What is the scoring

A 
1 = unsatisfactory or normal
2 = benign 
3 = atypia likely benign but Ix
4 = suspicious 
5A = in situ 
5b = invasive
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16
Q

How is cancer grade

A

1,2,3

Rate of mitosis

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17
Q

Stages of breast cancer

A 
1 = confined breast
2 = breast + LN of same breast
3 = fixed to muscle 
4 = chest wall or skin
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18
Q

Symptoms of breast cancer

What is lump like

A 
Asymptomatic 
Painless lump = most common
- Commonly hard, irregular and painless 
- Tethered to skin or chest wall 
Discharge
Bleeding 
Abnormal contour
Skin dimpling 
Change in colour / appearance of aerola
Nipple inversion
Nipple deviation
Nipple retraction 
Peu d'orange
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19
Q

If bleeding

A

Malignant until proven otherwise

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20
Q

What is peu d’orange

A

Redness / Pitting of skin
Inflammatory carcinoma
Often misDx as abscess or infection

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21
Q

RF for breast cancer

A 
Genetics 
FH
Age 
Female 
Exposure oestrogen 
- Early menarche
- Late menopause
- Nulliparity
- No breastfeeding
Radiation / RT
Previous cancer
Prolonged HRT
COCP 
Obesity
Alcohol
Smoking
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22
Q

What do people who have had Rx for Hodgkin’s / BRCA1 +2 +Ve get = high risk

A

Prophylactic mastectomy
1/3 get breast cancer
Can do annual mammography + MRI

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23
Q

What increases FH risk

A

Early onset
Multiple
Ovarian
Male

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24
Q

When do you do a genetic referral

A 
1st degree <40
Male breast
Bilateral <50
Breast + ovarian
3x 1st or 2nd degree
Multiple at young age
Known gene

Can test for BRCA1,2, TPEN, PT53

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25
Q

What is important to ask in FH

A 
Age of onset
- Any other early 
Any bilateral
Multiple
Any ovarian
Any male
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26
Q

How do you investigate

A

Triple assessment
H+E
Imaging - mammogram or USS
FNAC / biopsy

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27
Q

Sensitivity of H+E

A

88%

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28
Q

Sensitivity of imaging

A 
M = 93%
U = 88%
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29
Q

Sensitivity of biopsy

A

94%

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30
Q

What do you do if solid lump

A

Biopsy

USS guided best if new

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31
Q

What do you do if cystic

A

FNA
If bloody = cytology
If clear = reassure

32
Q

What do you do to stage

A 
Bloods 
CXR
Isotope bone scan 
Liver USS
CTCAP
PET-CT
33
Q

What bloods

A

FBC
U+E
LFT
Bone - Ca + phosphate

34
Q

When do you do bone scan

A

Spread to LN

35
Q

What is imaging of choice for staging

A

CTCAP

36
Q

When do you do CTCAP

A

If 4+ nodes

37
Q

What molecular markers is there

A

ER - best prognosis
PR
HER-2 - aggressive

38
Q

Who is high risk

A

Gene carrier

RT in the past

39
Q

What do high risk patient get

A

Annual mammography +MRI

Prophylactic mastectomy / tamoxifen

40
Q

When do you investigate axilla and how

A

USS

Every invasive cancer undergoing Rx

41
Q

What do you do if axilla normal

A

SNB if no abnormal nodes found prior to surgery

42
Q

If SNB +ve

A

Axillary node clearance OR

New trial

43
Q

What do you do if USS abnormal

A

USS guided core biopsy

44
Q

If biopsy +ve or symptomatic

A

Axillary node clearance

No need to do SNB before op

45
Q

If biopsy -ve / suspicious

A

SNB

46
Q

What do you do if mastectomy for DCIS

A

Do SNB anyway as may actually be invasive

47
Q

Can you do WLE for DCIS

A

Yes

48
Q

What is local Rx for breast cancer

A

Wide Local Excision

Mastectomy

49
Q

What do you always give after WLE

A 
RT 
Unless CI
Risk of focal disease not detected 
1cm = 60%
2cm = 40%
3cm = 20%
50
Q

WLE

A

Can do wire guided if can’t feel or DCIS so know where
X-ray after to make sure removed
Remove with 1mm margin

51
Q

When would you do mastectomy over WLE

A 
INFLAMMATORY 
RT not an option 
Size ratio of tumour / breast
Tumour >4cm
DCIS >4cm
Not enough clearance
Extensive disease
Multifocal
High risk of another cancer
FH
Site of tumour - central 
Cosmesis  
Patient choice
52
Q

What can you do in axilla

A

Clearance if evidence of disease in nodes
RT if don’t want clearance
Neoadjuvant chemo
SNB if not been proven disease

53
Q

How do you treat DCIS

A

Mastectomy

WLE

54
Q

When do you treat axilla in DCIS

A

If big enough to need mastectomy as risk of invasive

55
Q

Reconstruction option

A

Can be immediate or delayed after mastectomy
Not always possible if co-morbid, RT, chemo
Implants
Lat dorsi flap
TRAM flap

56
Q

What has poor prognosis

A 
LN status = best
Tumour size
Tumour grade
Tumour type 
Age 
Absence of ER / PR
Presence of HER-2 
NPI
57
Q

What improved HER-2 +Ve prognosis

A

Chemo

Tratuzumab

58
Q

What is NPI

A

Nottingham Prognostic Indicator
Size
Grade
Node

59
Q

How do you follow up

A

No clear evidence
6 monthly H+E
Yearly mammogram

60
Q

Complications of surgery

A

Serum fluid (inflammatory)
Wound infection
Bleeding
Psychological

61
Q

Complications of axilla surgery

A

Common
Lymphoedema
Firmness of breast / swelling

Uncommon 
Brachial plexus injury 
Muscle hameatoma 
Sensory loss / nerve damage 
Vascular
62
Q

Complications of RT

A 
General fatigue 
Local skin irritation 
Fibrosis of breast tissue 
Lymphoedema
Sensory disturbance - inner arm
Decreased ROM
Nerve and vascular damage
Rib fractures
Pneumonitis 
Radiation induced sarcoma
63
Q

What nerves damage

A

Long thoracic - serratus
Thoracodorsal - lat dorsi
Brachial plexus - pec

64
Q

How do you Rx lymph oedema

A 
Skin care
Exercise
Manual drainage
Support
Compression
65
Q

What is Paget’s Nipple Disease

A

Intraepithelial spread of DCIS or invasive ductal

66
Q

How does Paget’s present

A 
Erosion of nipple
Looks like eczema
Unilateral often
Pain
Itching
Scaling 
Redness 
Ulceration / crust
Serous or bloody discharge
Peu d'orange
67
Q

How do you investigate Paget’s / eczema on breast

A

3x assessment

68
Q

What do you do with skin lesion

A

Punch biopsy

69
Q

What do you do for any red scaly lesion of nipple

A

Punch Biopsy

70
Q

How do you differentiate from eczema / psoriasis

A

Erosion starts on nipple usually

Eczema = more on areola

71
Q

How do you Rx

A

WLE + SNB + RT

72
Q

When do you always give RT adjuvant

A

After WLE

73
Q

When do you give chest wall RT after mastectomy

A

DCIS
4+ node
5cm invasive T3
Inflammatory

74
Q

What are other uses of RT

A

Painful bony lesion

Brain mets

75
Q

What are CI ro RT

A 
Previous cancer in chest with RT Rx
Pacemaker
Pregnancy
Skin condition
Patient choice - travel / dependence
Shoulder injury as can't raise hands above head 
Excellent prognosis
Elderly
76
Q

Why is already had RT to chest

A

Higher risk of 2 cancer

Lung or heart damage

77
Q

What do all male breast cancer need

A

BRCA 2 test

Breast (6 decks)

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