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Cancer > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

How can breast cancer present?

A 
Lump
Nipple discharge or inversion
Cutaneous changes
Skin dimpling/deformity/puckering
Axillary mass
Lymphoedema
US/Mammography detected
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2
Q

What cutaneous changes can breast cancer present with?

A

Erythema
Peau d’orange
Nipple ulcer/eczema

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3
Q

What makes up the triple assessment?

A

Clinical evaluation
Imaging (US/Mammography)
Tissue diagnosis with needle biopsy (FNAC, core biopsy +/- imprint cytology)

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4
Q

How do you interpret the diagnostic score from the triple assessment ?
P/E, M, U, C, B

A 
Normal = 1
Benign = 2
Intermediate = 3
Suspicious of malignancy = 4
Malignant = 5
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5
Q

Features of a fibroadenoma:

A

Mobile, firm breast lumps
12% of breast masses
Over 2 years, 30% will decrease in size
Confer no increased risk of malignancy

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6
Q

Management of fibroadenoma:

A 
Surgical excision if >3cm
Phyllodes tumours (rapidly growing sarcoma, 10% malignant) should be widely excised (mastectomy if the tumour is large)
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7
Q

Features of breast cysts:

A

Present as smooth, discrete lumps (may be fluctant i.e. moveable and compressible)
Small increased risk of breast cancer esp if younger
7% of all Western women will present at one point

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8
Q

Management of breast cysts:

A

Aspiration

If blood stained/persistently refill then should be biopsied/excised

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9
Q

Features of sclerosing adenosis (radial scars and complex sclerosing lesions):

A

Presents as breast lump or breast pain
Mammographic changes mimicking carcinoma
Distortion of distal lobar unit +/- hyperplasia
Disorder of involution, no increased risk of breast cancer

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10
Q

Management of sclerosis adenosis:

A

Biopsy

Excision not mandatory

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11
Q

Features of epithelial hyperplasia:

A

Variable presentation of different types of lump
Increased cells in terminal lobular unit (may be atypical)
Atypical features and FH of breast cancer confers greatly increased risk

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12
Q

Management of epithelial hyperplasia:

A

No atypical features = conservative

Atypical features = close monitoring/excision

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13
Q

Features of fat necrosis:

A

40% of cases have traumatic aetiology
Physical features may mimic carcinoma
Mass may initially increase in size

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14
Q

Management of fat necrosis:

A

Imaging and core biopsy

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15
Q

Features of duct papilloma:

A

Usually present with nipple discharge
If large, may present with a mass
No increased risk of malignancy

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16
Q

Management of duct papilloma:

A

Microdochectomy

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17
Q

Referral to clinic if a first/second degree relative developed breast cancer only in the context of one of the following…

A 
Age of diagnosis < 40
Bilateral breast cancer
Male breast cancer
Ovarian cancer
Jewish ancestry
Sarcoma < 45 years old
Glioma/childhood adrenal cortical carcinomas
Multiple cancers at a young age
Two or more relatives on the father's side
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18
Q

Early screening if (age)…

A

One first degree relative who developed cancer under 40

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19
Q

Early screening if (male)…

A

One first degree male relative at any age

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20
Q

Early screening if (bilateral)…

A

One first degree relative with bilateral if the first primary was diagnosed under the age of 50

21
Q

Early screening if (any age)…

A

2 first-degree/1 first-degree and 1 second-degree at any age

1 first/second degree relative diagnosed with breast cancer at any age as well as 1 first/second degree relative diagnosed with ovarian cancer at any age

3 first/second degree relatives diagnosed with breast cancer at any age

22
Q

Genetic risk factors for breast cancer:

A

BRCA1/2 confer a 40% lifetime risk

p53 mutations

23
Q

Menstrual/pregnancy risk factors for breast cancer:

A

Nulliparity
1st pregnancy >30 years old (twice risk of 1st at 25)
Not breastfeeding
Early menarche
Late menopause
Combined HRT, combined oral contraception

24
Q

Other risk factors for breast cancer:

A

Obesity
Previous surgery for benign disease (scar hides lump)
Ionising radiation

25
Q

What is immunohistochemistry used for in breast cancer?

A

Oestrogen receptor and herceptin status

26
Q

What may be seen on mammography of cancer?

A

Dystrophic calcification

27
Q

Most common type of breast cancer?

A

Invasive ductal carcinoma

some may arise from DCIS

28
Q

Why is a sentinel lymph node biopsy used?

A

To minimise the morbidity of an axillary dissection

29
Q

When would a mastectomy be performed?

A 
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
Patient choice
30
Q

When would a wide excision be performed?

A 
Solitary tumour
Peripheral tumour
Small lesion in large breast
DCIS <4cm
Patient choice
31
Q

DCIS =

A

Ductal carcinoma in situ

32
Q

LCIS =

A

Lobar carcinoma in situ

33
Q

Treatment options for DCIS?

A

Wide excision or mastectomy as well as any combination of RT and tamoxifen or reconstruction

34
Q

What are contraindications to breast-conserving surgery?

A

Diffuse disease
Multi-focal disease
Central disease
Large operable cancer

35
Q

What additional therapy to excision/mastectomy might invasive disease require?

A

RT
Onoplastic procedure
Reconstruction
Axillary surgery

36
Q

Management of large operable cancer?

A

Neo/adjuvant chemo-endocrine therapy
Mastectomy +/- reconstruction
Axillary surgery

37
Q

Management of locally advanced breast cancer (LABC) and inflammatory breast cancer (IBC)?

A

Multi-modality systemic treatment
Then surgery (BCS can be used, pending response but not for IBC; reconstruction contraindicated in IBC) - mastectomy
Followed by RT (+sCF)

38
Q

Management of stage 4 metastatic disease?

A

Generally palliative, however oligometastatic disease is managed with curative intent

39
Q

What is ALNC?

A

Axillary lymph node clearance
Levels I, II and III
Sentinel lymph node biopsy carried out

40
Q

Problems with ALNC?

A

More than 50% of patients have -ve nodes
Risk of lymphoedema in 25%
Damage to sensory nerves (interccostobrachial)
May lead to limitation of shoulder movement

41
Q

What is the management when there is axillary LN involvement?

A

Standard of care is ALNC
Alternatively you can have systemic treatment and sentinel lymph node biopsy based on the response
If SLNB +ve then ALNC/systemic treatment/local irradiation

42
Q

What do ER, PR and HER-2 denote about the cancer?

A

ER +ve = Estrogen receptors - give ET
PR +ve = Progesterone receptors
Her-2 +ve = Human epidermal growth factor receptor positive (1 in 5 breast cancers, herceptin recommended for almost all Her-2 +ve breast cancers)

43
Q

Indications for post-mastectomy RT?

A

Tumour larger than/equal to 5cm +/- 4 or more involved axillary lymph nodes
LABC

44
Q

What is Oncotype Dx?

A

Recurrence score between 0 and 100
Used to predict recurrence of ER +ve BC and DCIS
Based on age
Helps decide whether to use chemo on early stage hormone R+ve cancers or RT in DCIS

45
Q

BRCA1 risks:

A

Breast cancer = 40-50%
Second primary breast cancer = up to 60%
Ovarian cancer = up to 50%
Prostate cancer = minimal increase

46
Q

BRCA2 risks:

A 
Breast cancer = 60-85%
Second primary breast cancer = up to 60%
Ovarian cancer = up to 30%
Pancreatic cancer = 3%
Male breast cancer = 6%
Prostate cancer = 14% by age 80
Minimally increased risk of gastric, thyroid, gall bladder cancers and lymphoma
47
Q

TP53 risks:

A

Breast cancer = 80-90%
High risk of sarcoma and childhood leukaemia
Adrenal cancer
Li-Fraumeni syndrome

48
Q

Prophylactic mastectomy =

A

> 90% risk reduction

49
Q

Metastases of breast cancer?

A 
Lymph nodes
Liver
Lung
Bones
Brain

Cancer (10 decks)

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