Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y2 Cancer > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Describe the epidemiology of breast cancer

A

Breast cancer is the leading female cancer, accounting for almost 1 in 5 cancer deaths among women
Breast cancer incidence is increasing while mortality is decreasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some possible reasons for the changes in breast cancer incidence

A

Early Diagnosis
Chemo/Radiotherapies
Hormonal Therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the development of the mammary gland

A

Only organ that develops post-natally

Under the control of hormones (steroids like oestrogen and progesterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the cell types in the breast that can become cancerous

A

Lobule
Duct
Lactiferous sinus
Fat and connective tissue stroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common type of breast cancer

A

Carcinoma (cancer of epithelial cells - acini and ducts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are phyllodes tumours

A

They are of soft tissue rather than epithelium and are very aggressive but rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the structure of the mammary gland

A

A layer of myoepithelial cells, some of which are slightly vacuolated, is seen just around the luminal cells, making contact with the basement membrane
2 layers of epithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the luminal cells of the breast

A

Produce milk in response to various cues (including hormones)
Have receptors for the steroid hormones (estrogen and progesterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does oestrogen stimulate growth of the breast

A

Indirectly
Oestrogen stimulates paracrine secretions which stimulate growth in nearby cells
In cancers estrogen is often found to be stimulating growth directly: this is pathological.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which hormone regulates breast cancer and how

A

Oestrogen

  1. Binding to oestrogen receptor -> receptor
  2. Gene Expression is Induced by Binding to oestrogen Response Elements
  3. The oestrogen-Induced Gene Products Increase Cell Proliferation, Resulting in Breast Cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give examples of genes in the cell that oestrogen regulates

A

Cyclin D1
c-Myc
TGF-α
the progesterone receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what proportion of breast cancers is the oestrogen receptor over expressed and how does this affect

A

70%

Increased ER -> better prognosis in women, worse in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does progesterone receptor expression affect breast cancer

A

PR expression is associated with better responses to treatment
Progestin response in the breast influences both proliferation and function
Therapy can use high dose synthetic progestins (better absorbed than progesterone) e.g. megestrol acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the major treatment approaches to breast cancer

A

Surgery
Radiation therapy
Chemotherapy
Endocrine therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How successful is surgery in treating beast cancer and what are the

A

Can be very successful, and is more regularly used than for many other cancers

Lumpectomy - If the tumour can be confirmed to be confined to the lump
Full mastectomy - whole breast is removed
Oophorectomy - removal of ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

At which levels can endocrine therapy for breast cancer be achieved

A

Ovarian Suppression
Blocking oestrogen production by enzymatic inhibition
Inhibiting oestrogen responses

17
Q

What are the 2 mechanisms in which the body makes oestrogens

A

FSH + LH from pituitary -> ovary -> oestrogens, progesterone

ACTH from pituitary -> androgens from adrenals -> oestrogen

18
Q

What is ovary ablation and how is it carried out

A

Eliminates the ovaries as a source of oestrogen using LHRH

Surgical oophorectomy
Ovarian irradiation

19
Q

What are the problems with ovary ablation and how are they resolved

A

High morbidity and irreversibility

Luteinising hormone releasing hormone (LHRH) agonists to result in reversible ovarian suppression (pre-menopause)

20
Q

Describe the actions LHRH agonists

A

Synthetic LHRH agonists are hyperactive compared to endogenous LHRH
Over-stimulation of the negative feedback loop
Pituitary gland’s gonadotrophs remove LHRH receptors from their cell membrane, becoming unresponsive to it. Suppressing LH and FSH release inhibits ovarian function and thus estrogen production.

21
Q

Give examples of LHRH agonists

A

goserelin, buterelin, triptorelin, and leuprolide

22
Q

What is the major source of oestrogen for postmenopausal women and hence what is the treatment for breast cancer in these individuals

A

Conversion of adrenal hormones (androstenedione and testosterone -> oestroen)
Aromatase inhibitors

23
Q

How do aromatase inhibitors work and at what sites

A

Inhibits aromatase complex which converts androgens to oestrogens at extra-adrenal sites like liver, fat, and muscle

24
Q

What are the types of aromatase inhibitors and give examples

A

Type I - “suicide inhibitors”, covalently bind to aromatase’s active site e.g. exemestane

Type II - temporary, competitive antagonists e.g. anastrozole

25
Q

Describe the use of anti-oestrogens and give an example

A

Useful for both pre- and post-menopausal women
competitive inhibitors of oestradiol binding to the ER, blocking the action of oestrogen and causing the cell to be held at G1

e.g. Tamoxifen

26
Q

What are the side effects of tamoxifen therapy

A 
Hot flushes >
Thromoembolic episodes
Cataracts
Endometrial thickening -> cancer 
Hyperplasia 
Fibroids
27
Q

What are the desirable effects of tamoxifen treatment (besides breast cancer treatment)

A

ER agonist

Oestrogen effects in bone (+BMD)
Oestrogen effects in CVS

28
Q

What is the best endocrine therapy for metastatic disease post-menopause and what class of drugs does it belong to

A

Tamoxifen

SERMs (selective estrogen receptor modulators)

29
Q

Describe the use of tamoxifen prophylactically

A

Proven to be useful prophylactically for high risk patients (those with previous breast pathology or family history)
Reduces the incidence of contralateral breast cancer by 38% (a patient who already had breast cancer acquiring a new tumour in the other breast).

30
Q

What is ICI 182,780/faslodex/fulvestrant

A

True anti-estrogen that binds to the ER to stop all estrogenic effects
It has side effects like osteoporosis

31
Q

What can ICI 182,780/faslodex/fulvestrant be used for

A

Could be used as a first- line treatment for advanced breast cancer, as it decreases invasion and doesn’t stimulate endometrial hyperplasia. It could also be used as a second-line treatment in patients unresponsive to tamoxifen.

32
Q

What is raloxifene

A

SERM
anti-estrogen activity in the breast and uterus but agonist activity in bone.
It is also used simply for post-menopausal treatment of osteoporosis

Y2 Cancer (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions