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Year 4: Oncology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

what is the tripple assessment

A
  1. clinical - history + exam
  2. radiological - mammogram/USS
  3. cytopathological– FNA/core biopsy
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2
Q

breast screening in Scotland

A

offered 3 YEARLY to women 50-70

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3
Q

what % of breast cancers are picked up by screening

A

50%

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4
Q

most common symptom of breast cancer

A

lump

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5
Q

genes associated with breast cancer

A

BRCA1 (chromosome 17)

BRCA2 (chromosome 13)

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6
Q

risk factors for breast cancer

A 
increased age 
previous breast cancer
\+ve family history
early menarche
late menopause 
no pregnancies 
HRT
alcohol consumption 
obesity
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7
Q

most common breast cancer

A

ductal carcinoma

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8
Q

presentation of ductal carcinoma

A

firm, defined lump

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9
Q

2nd most common breast cancer

A

lobular carcinoma

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10
Q

presentation of lobular carcinoma

A

softer, ill defined lump

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11
Q

what is a ductal carcinoma in situ

A

malignant changes present in epithelial cells but basement membrane remains intact
- no invasion is seen

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12
Q

presentation of ductal carcinoma in situ

A

majority are non-palpable

- detected by mammogram

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13
Q

ductal carcinoma in situ appearance on mammogram

A

micro calcifications

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14
Q

types of ductal carcinoma in situ

A

high grade: malignant cells with abundant cytoplasm, marked pleomorphism and increased mitoses
low grade: small, regular cells which form micropapillary strucutres
intermediate: in-between these two stages

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15
Q

what is pagets disease of the nipple

A

high grade DCIS that has spread into nipple

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16
Q

appearance of pagets disease of the nipple

A

‘eczema of nipple’ inflammatory changes

itchiness, burning, bleeding

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17
Q

what are the 2 forms of lobular in situ neoplasia

A

atypical lobular hyperplasia

lobular carcinoma in situ

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18
Q

what is atypical lobular hyperplasia

A

<50% of lobule involved

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19
Q

what is lobular carcinoma in situ

A

> 50% lobule involved

20
Q

what does ER positive mean?

A

grows in response to oestrogen

21
Q

what is HER2

A

member of human epidermal growth factor receptor family

encodes a transmembrane tyrosine kinase receptor

22
Q

how is HER2 tested for

A

FISH

23
Q

what drug is given for HER2 +ve tumours

A

herceptin

24
Q

what drug is given to premenopausal women who are ER +ve

A

tamoxifen

25
Q

what drug is given to post menopausal women who are ER +Ve

A

letrozole/anastrazole

26
Q

what type of drug is letrozole

A

aromatase inhibitor

27
Q

why is letrozole only given to post menopausal women

A

increases risk of osteoporosis

28
Q

lymph node staging

A

stage 1: nodes -ve
stage 2: 1-3 nodes +ve
stage 3: >4 nodes involved

29
Q

surgery options for breast cancer

A

wide local excision
mastectomy
axillary node clearance/ sampling/ sentinel node biopsy

30
Q

what is given after surgery

A

radiotherapy

31
Q

types of flap in mastectomy

A

latissimus dorsi pedicled flap
deep inferior epigastric artery perforator free flap (DIEP)
inferior gluteal artery perforator free flap (IGAP)

32
Q

arteries used in flaps

A

deep inferior epigastric

inferior gluteal

33
Q

what other cancers are BRCA genes linked to

A

ovarian
prostate
bowel

34
Q

where does breast cancer metastasise

A

lung
liver
bones
brain

35
Q

management of DCIS

A

excision + adjuvant therapy (radiotherapy/tamoxifen)

36
Q

treatment of lobular carcinoma in situ

A

close monitoring

- 6 monthly exams, yearly mammogram

37
Q

who typically gets lobular carcinoma in situ

A

pre-menopausal women

38
Q

presentation of inflammatory breast cancer

A

worsening erythema + oedema of the breast in the absence of signs of infection e.g. fever, discharge, raised WBC, raised CRP

39
Q

when is a mastectomy performed

A

if tumour too large for wide local excision (>4cm)

patient choice

40
Q

what should women with no palpable axillary lymph nodes receive before surgery

A

axillary USS

- If positive should receive sentinel node biopsy

41
Q

tumour with grey gelatinous surface

A

mucinous carcinoma

42
Q

side effects of tamoxifen

A

DVT
Endometrial cancer
vaginal bleeding

43
Q

side effects of letrozole

A

osteoporosis

44
Q

what is Herceptin also known as

A

Trastuzumab

45
Q

contraindication to giving a patient Herceptin

A

heart disorders

46
Q

what patients should be referred to suspected cancer pathway

A
  • over 30 + unexplained lump

- over 50 + unilateral discharge / retraction / other suspicious changes

Year 4: Oncology (13 decks)

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