Breast Cancer Flashcards
What is ductal carcinoma in situ (DCIS). (2)
It is carcinoma that has not penetrated the basement membrane.
It is considered to be pre-malignant.
What is the most common form of carcinoma in situ in the breast.
DCIS.
How is DCIS graded.
From low to high grade lesions on histopathology.
What are the clinical signs of DCIS. (3)
Lump.
Nipple discharge.
May be detected on screening (asymptomatic).
What is lobular carcinoma in situ. (2)
A rare form of breast cancer.
It is a pre-malignant condition.
What are the complications of lobular carcinoma in situ.
There is a high risk of progression to invasive carcinoma.
What is invasive ductal carcinoma of the breast.
It is the most common cancer in women. (70%)
What is the most common form of breast cancer.
Invasive ductal carcinoma.
What is the lifetime risk of developing invasive carcinoma.
1 in 10. (and increasing)
When does invasive carcinoma usually occur. (2)
It can occur at any age.
It is rare under 30.
What are the risk factors for breast cancer. (9)
Female. (less than 1% of breast cancers occur in men).
Increasing age.
Family history (genes such as BRCA1 and BRCA2).
Early menarche, late menopause.
Nulliparity, higher age at first pregnancy (ie >30).
Higher socioeconomic group.
Obesity.
Alcohol intake.
HRT (small effect).
What are the histological gradings of breast tumours.
1, 2, or 3 according to differentiation level.
What is the histological grading of breast tumours dependent on.
Differentiation of cells.
What does the TNM staging system look at. (3)
Tumour size.
Lymph node involvement.
Metastases.
What is Paget’s disease of the nipple. (2)
Eczematous skin change to the nipple due to underlying malignancy.
It is intra-epidermal spread of an intraductal cancer.
What associated symptoms may be present with paget’s disease of the nipple.
There may be an associated lump.
What screening is in place in the UK for detection of breast cancer. (4)
Self examination.
Two view mammography offered to women every 3 years to women aged 50-64.
After age 64, women can self refer for mammography if they wish.
Suspicious mammography signs a prompt recall.
What are the benefits to the UK screening system for breast cancer.
Screen-detected cancers generally smaller and lower grade than symptomatic lesions.
What are the drawbacks of the screening system for breast cancer in the UK. (2)
Cost.
Potential psychological morbidity of false positive.
What are the non invasive breast cancers. (2)
Ductal cancer in situ.
Lobular cancer in situ.
What are the invasive breast cancers. (6)
Infiltrating ductal cancer. Infiltrating lobular cancer. Mucinous cancer. Medullary cancer. Papillary cancer. Tubular cancer.
What are the ‘other’ breast cancers (ie rare). (5)
Adenoid cystic, secretory, apocrine cancers.
Paget’s disease of the nipple.
Phyllodes tumours.
What percentage of breast cancers does invasive ductal carcinoma account for.
70%
What percentage of women have familial breast cancer.
10%
What percentage of women with familial breast cancer have detectable mutations in BRCA1/2 and TP53.
3%
What are the genes that predispose to breast cancer. (2)
BRCA1/2.
TP53.
What are the most common symptoms that a women will present with (when she has breast cancer). (6)
Painless increasing mass.
May also be associated with: nipple discharge, skin tethering, ulceration, and in inflammatory cancers, oedema and erythema.
How do you differentiate a benign breast mass from a breast cancer. (3)
Palpation.
Radiology (mammography, ultrasound, MRI scans).
Fine needle aspiration cytology.
Is there a connection between the contraceptive pill and breast cancer.
None has been proven.
What are the most common sites for breast cancers to metastasise to. (7)
Bone. Lung. Liver. Pleura. Adrenals. Skin. Brain.
How is non-invasive ductal carcinoma in situ appear on a mammography.
Microcalcification.
What percentage of cancers does invasive lobular carcinoma account for.
10-15%.
What type of breast cancer tends to affect young patients.
Medullary cancers.
What percentage of breast cancers does medullary cancer account for.
5%.
Who does colloid/mucoid breast cancer tend to affect.
The elderly.
What percentage of breast cancers are mucoud/colloid.
2%
What conveys a better prognosis for breast cancer.
Oestrogen receptor positive.
What percentage of breast cancers are oestrogen receptor positive.
70%
What conveys a worse prognosis for breast cancer.
Over expression of HER2.
What percentage of breast cancers over express HER2.
30%
What should all breast lumps undergo.
Triple assessment.
What is a stage 1 breast tumour.
Tumour confined to breast.
What is a stage 2 breast tumour. (3)
Growth confined to breast.
Mobile.
Lymph nodes in ipsilateral axilla.
What is a stage 3 breast tumour. (4)
Tumour fixed to muscle, but not the chest wall.
Ipsilateral lymph nodes matted.
May be fixed.
Skin involvement larger than the tumour.
What is a stage 4 breast tumour. (2)
Complete fixation of the tumour to the chest wall.
Distant metastases.
What stage of the TNM tumour staging system is peau d’orange associated with.
T4.
