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Reproductive > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

What are the risk factors for breast cancer?

A 
Age
Previous breast cancer
Genetic
Early menarche and late menopause
Late or no pregnancy
HRT
Alcohol
Weight
Post radiotherapy treatment for Hodgkin's
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2
Q

What are the genes most associated with breast cancer?

A

BRCA 1 and 2

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3
Q

How do assymptomatic breast cancers usually present?

A

Breast screening (50-70yrs)

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4
Q

What are the symptoms of breast cancer?

A 
Lump
Mastalgia
Nipple discharge (blood)
Nipple changes
Change in size or shape of breast
Lymphoedema (swelling of arm)
Dimpling of breast skin
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5
Q

What are some of the nipple changes that can occur in breast cancer?

A

Paget’s disease

Retraction

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6
Q

What is Paget’s disease of the nipple?

A

Red, scaly rash on skin of nipple and areola
Sore and inflammed
Ulceration
Itchiness, bleeding

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7
Q

What are the stages that occur in a new patient clinic for breast cancer?

A
  1. Clinical: history and exam
  2. Radiological: mammograms/US
  3. Cyto-pathological: FNA, core biopsy
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8
Q

What is the difference between FNA and core biopsy investigations for breast cancer?

A

FNA - cells only -> cytology

Core biopsy - tissue -> histo-pathology

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9
Q

What should you ask about that is different in a history for breast cancer?

A

Previous breast problems

Hormonal status

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10
Q

What are signs/symptoms of breast cancer on examination?

A 
Lump or thickening in breast - often painless
Discharge or bleeding
Change in size or contours of breast
Change in colour or appearance of areola
Redness or pitting of skin over breast
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11
Q

What are the imaging techniques used for the breasts?

A

Mammography
US
MRI

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12
Q

What is the most sensitive imaging investigation for looking at the breasts?

A

Mammography

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13
Q

Why is the sensitivity of mammography reduced in young women?

A

Presence of increased glandular tissue

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14
Q

What are the two main groups of pathological types of breast cancer?

A

Invasive

Non-invasive

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15
Q

What are the two main types of invasive breast cancer?

A

Ductal carcinoma

Lobular carcinoma

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16
Q

What are the main types of non-invasive breast cancer?

A

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)

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17
Q

What are the three steps (triple assessment) in management of breast cancer?

A
  1. Diagnose
  2. Staging
  3. Treatment
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18
Q

What are the investigations done to try and stage breast cancer?

A

FBC, U&Es, LFTs, Ca2+/PO2-
CXR
Others as clinically indicated

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19
Q

What are the tumour markers for breast cancer?

A

No reliable tumour markers

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20
Q

What staging system is used for breast cancer?

A

TMN

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21
Q

What does a T4 breast cancer stage automatically mean?

A

Involves other structures

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22
Q

What is T0 stage in breast cancer?

A

Primary tumour not palpable

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23
Q

*What is T1 stage in breast cancer?

A

Clinically palpable tumour <2cm

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24
Q

What is T2 stage in breast cancer?

A

Tumour size 2-5cm

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25
Q

*What is T3 stage in breast cancer?

A

Tumour size >5cm

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26
Q

What is N0 stage in breast cancer?

A

No regional lymph nodes palpable

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27
Q

What is N1 stage in breast cancer?

A

Regional lymph nodes palpable and mobile

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28
Q

What is N2 stage in breast cancer?

A

Regional lymph node palpable and fixed

29
Q

What is Mx stage in breast cancer?

A

Distant metastasis cannot be assessed

30
Q

What is M0 stage in breast cancer?

A

No distant metastasis

31
Q

What is M1 stage in breast cancer?

A

Distant metastasis

32
Q

What is the management for breast cancer?

A

Surgery

+/- radiotherapy/chemotherapy/hormonal therapy

33
Q

What are the two main types of surgical procedure for breast cancer?

A

Breast conservation surgery

Mastectomy

34
Q

Which patients are suitable for breast conservation surgery?

A

Depends on breast/tumour size ratio
Suitability for radiotherapy
Patient’s wishes

35
Q

What is a sentinel lymph node?

A

First node to receive lymphatic drainage and so first node tumour spreads to

36
Q

What is a sentinel lymph node (SLN) biopsy?

A

Biopsy first node tumour has spread to

37
Q

What does it mean if a sentinel lymph node (SLN) biopsy is negative?

A

Rest of nodes in lymphatic basin are negative

38
Q

When is a sentinel lymph node (SLN) biopsy performed?

A

When preoperative axillary USS normal/benign

39
Q

What is the treatment for the axilla if the SLN is negative?

A

No further treatment required

40
Q

What is the treatment for the axilla if the SLN contains tumour?

A

Remove them all surgically
OR
Give radiotherapy to all the axillary nodes

41
Q

What are the complications of axillary treatment in breast cancer?

A 
Lymphoedema
Sensory disturbance
Decrease ROM shoulder joint
Nerve damage
Vascular damage
Radiation-induced sarcoma
42
Q

What nerves can be damaged during axillary treatment for breast cancer?

A

Long thoracic
Thoracodorsal
Brachial plexus

43
Q

What factors are associated within increased risk of disease recurrence in breast cancer?

A 
Lymph node involvement
Tumour grade
Tumour size
Steroid receptor status
HER2 status
LVI - lymphovascular invasion
44
Q

What is the NPI in breast cancer?

A

Nottingham Prognostic Index (NPI)

Determines prognosis following surgery for breast cancer

45
Q

What three pathological criteria does the NPI look at in breast cancer?

A

Size of the tumour No of involved lymph nodes Grade of the tumour

46
Q

What is the local adjuvant treatment for breast cancer?

A

Radiotherapy

47
Q

What is the systemic adjuvant treatment for breast cancer?

A

Hormone therapy
Chemotherapy
Targeted therapy

48
Q

Which type of surgery for breast cancer receives radiotherapy as an adjuvant treatment?

A

Wide local excision (WLE)

49
Q

What are some complications of radiotherapy following breast cancer surgery?

A

Skin reaction - telangiectasis
Radiation pneumonitis
Cutaneous radionecrosis/osteonecrosis
Angiosarcoma

50
Q

What type of breast cancer responds to hormone therapy?

A

Oestrogen receptor positive (ER+)

51
Q

What does hormone therapy in oestrogen receptor positive breast cancer do?

A

Blocks stimulation of cell growth by oestrogen

52
Q

What are two types of hormone therapy used in breast cancer?

A

Tamoxifen

Aromatase inhibitors

53
Q

What are two examples of aromatase inhibitors used in hormone therapy?

A

Arimidex

Letrozole

54
Q

How does tamoxifen work?

A

Blocks directly on ER receptor

55
Q

When is tamoxifen more effect?

A

After chemotherapy

56
Q

What are the risks of tamoxifen?

A

Thromboembolic events

57
Q

How is tamoxifen taken?

A

20mg once daily 5-10yrs

58
Q

Which hormone therapy should only be used in postmenopausal women?

A

Aromatase inhibitors

59
Q

Which hormone therapy is suitable in all age groups?

A

Tamoxifen

60
Q

How do aromatase inhibitors work?

A

Inhibit ER synthesis

61
Q

What are the risks of using aromatase inhibitors?

A

Osteoporosis

62
Q

How long are aromatase inhibitors usually taken for?

A

Once daily for 5yrs

63
Q

Who does chemotherapy benefit most in breast cancer?

A 
Young women (<50)
Patients with increasing adverse prognostic factor
64
Q

What are the options for chemotherapy in breast cancer?

A

CMF combinations
Anthracycline combinations
Taxana based combinations

65
Q

What is an example of a targeted therapy for breast cancer?

A

Trastuzumab

66
Q

What is Trastuzumab a drug against?

A

Monoclonal antibody against Her2 receptor

67
Q

Who is Trastuzumab given to in breast cancer?

A

Patients with over-expression of Her2 and chemotherapy

68
Q

What is Her2?

A

Some breast cancer cells have a higher than normal level of a protein called HER2 (human epidermal growth factor receptor 2) on their surface, which stimulates them to grow

69
Q

What is the follow up for breast cancer?

A

Mammograms yearly intervals 3-10yrs
Clinical exam 1-5yrs
Patient exam

Reproductive (20 decks)

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