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Gynae AM > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

What are the types of breast cancer?

A 
Ductal carcinoma
Lobular carcinoma
Cancers of special type:
-tubular
-cribriform
-medullary
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2
Q

What is the most common type of breast cancer?

A

Ductal carcinoma

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3
Q

What is the second most common type of breast cancer?

A

Lobular carcinoma

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4
Q

What is the precursor to ductal carcinoma?

A

Ductal carcinoma in situ

Malignant, but non invasive, doesn’t cross basement membrane

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5
Q

What is the risk and management of ductal CIS?

A

2-4% risk of developing to invasive cancer annually

Excise

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6
Q

What is lobular carcinoma associated with?

A

Lobular carcinoma in situ- not a precursor but makes woman high risk for breast cancer

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7
Q

What is the management of lobular carcinoma in situ?

A

Annual mammogram for screening

High risk of cancer developing anywhere in breast

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8
Q

What type of cancer has the best prognosis?

A

Tubular- almost 100% cured

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9
Q

What are the risk factors for breast cancer?

A 
FH= breast and ovarian cancer at young age, men with breast cancer
BRCA 1 and 2
Oestrogen exposure:
-early menarche, late menopause
-combined OCP
-late age 1st pregnancy
-oestrogen HRT
PMH breast/ovarian cancer
Obesity
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10
Q

What is the presentation of breast cancer?

A 
Lump or thickening, usually painless
Discharge- blood stained
Skin changes= redness, pitting, contractures 
Abnormal contour, asymmetry
Change to nipple
Paget's disease of nipple
Lymphadenopathy
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11
Q

What are some red flags for cancer?

A

Blood stained discharge
Strong FH
BRCA +

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12
Q

What is Paget’s of the nipple?

A

Intraepithelial spread of ductal carcinoma

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13
Q

What is the presentation of Paget’s?

A

Pain, itching, scaling and/or redness of nipple

Serous/bloody discharge

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14
Q

How is breast cancer assessed?

A

Triple assessment:

  • history and exam
  • imaging
  • biopsy
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15
Q

What is the benefit of triple assessment?

A

Negates the change of missing anything

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16
Q

How sensitive is history and exam?

A

88%

17
Q

What imaging is first line in <35s?

A

US

18
Q

What imaging is first line in >35s?

A

Mammogram

19
Q

What investigations are used to stage breast cancer?

A 
Sentinel node biopsy
Biopsy of lymphadenopathy
CXR
CT
Isotope bone scan
20
Q

What are the principles of management of breast cancer?

A 
Surgery
Node clearance
Hormone therapy
Targeted therapy
Chemotherapy
21
Q

What are the surgical options in breast cancer?

A 
Breast conserving surgery
-wide local excision
-segmentetomy
-quadrantectomy
Mastectomy
22
Q

What patients are suitable for breast conserving surgery?

A

Tumour <4cm
Single tumour
High breast : tumour ratio
Suitable for radiotherapy

23
Q

When are axillary lymph nodes clearance?

A

Sentinel or any lymph node biopsy +

24
Q

What are the options for axillary node clearance?

A

Surgery= more common

Radiotherapy

25
Q

What are the complications of axillary node clearance?

A

Lymphoedema of arm and breast

Damage to long thoracic nerve= supplies serrates anterior –> winged scapula

26
Q

When can hormone therapy be used?

A

Oestrogen receptor + breast cancer

27
Q

What hormone therapy is used in premenopausal women?

A

SERM= tamoxifen

28
Q

What hormone therapy is used in post menopausal women?

A

Aromatase inhibitor= anastrazole

29
Q

What are the complications of hormone therapy?

A

Osteoporosis risk

Endometrial cancer risk

30
Q

When is targeted therapy used in breast cancer?

A

HER2 + cancer

31
Q

What breast cancer has the worst prognosis?

A

Triple negative

32
Q

What is the breast cancer screening?

A

Women aged 50-70 and registered with GP practice invited to attend for mammogram every 3 years

33
Q

What is the scoring system used when examining, looking at imaging and biopsy in breast issues?

A 
1= normal
2= benign
3= indeterminate
4= suspicious
5= malignant

Gynae AM (17 decks)

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