Brainscape's Knowledge GenomeTM

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


See full index

Obstetrics + Gynaecology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is carcinoma in situ and what are the main types?

A

Malignancies that are contained within the basement membrane tissue
Seen as ‘pre-malignant’
Typically found on imaging, rarely symptomatic

Two main types in breast:

  • Ductal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the features of DCIS?

A

Malignancy of the ductal tissue of the breast, confined within the basement membrane
20-30% will develop into invasive disease if untreated

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

How is DCIS diagnosed?

A

Detected during screening:

  • mammography shows micro calcifications, either localised or widespread
  • confirmed on biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is DCIS managed?

A

If localised –> wide local excision

If widespread or multifocal –> complete mastectomy

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

What are the features of LCIS?

A

Malignancy of the secretory lobules, contained within the basement membrane
Much rarer than DCIS
But greater risk of developing invasive disease
Usually diagnosed before menopause

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

How is LCIS diagnosed?

A

Incidental finding on biopsy of the breast

doesn’t show up on mammography

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

How is LCIS managed?

A

Low grade LCIS –> monitoring

If patient possesses BRCA1 or BRCA2 genes –> bilateral prophylactic mastectomy

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

How are invasive carcinomas of the breast classified?

A

Invasive ductal carcinoma (75-85%)
Invasive lobular carcinoma (10%)
Other subtypes e.g. medullary or colloid

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

What are the risk factors for breast cancer?

A 
Female sex
Age
BRCA1 + BRCA2
Family history in first degree relative
Previous benign disease
Obesity
Alcohol
Developed country
Exposure to unopposed oestrogen:
- early menarche, late menopause, nulliparity, first pregnancy age > 30, oral contraceptives or HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the clinical features of invasive carcinoma?

A

Asymptomatic via screening (esp for lobular carcinoma)
Breast lump, asymmetry or swelling
Abnormal nipple discharge
Nipple retraction
Skin changes: dimpling/peau d’orange or Paget’s like changes
Mastalgia
Palpable lump in axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is suspected breast cancer investigated?

A

TRIPLE ASSESSMENT:

  • history + examination
  • imaging
  • core biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which imaging is done during triple assessment?

A

Mammography
- detects mass lesions or microcalcifications
USS
- for women age < 35 and men due to density of breast tissue
- also used to guide core biopsy

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

What is the single most prognostic factor in breast cancer?

A

Nodal status (number of axillary lymph nodes involved)

0 nodes = 1
1-4 nodes = 2
> 4 nodes = 3

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

How is prognosis calculated for breast cancer?

A

Nottingham Prognostic Index (NPI):
(size x 0.2) + nodal status + grade

Vascular invasion + receptor status also influence prognosis

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

Which receptor statuses should breast malignancies be checked for?

A 
Oestrogen receptor (ER)
Progesterone receptor (PR)
Human epidermal growth factor receptor (HER2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is breast cancer screened for in the UK?

A

Women aged 50-70 invited for mammogram every 3 years

- if any abnormality, referred to breast clinic for triple assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Paget’s disease of the nipple?

A

Rare condition
Roughening, reddening and slight ulceration of the nipple
97% have an underlying neoplasm

18
Q

What are the clinical features of Paget’s?

A

Itching or redness of nipple and/or areola with flaking and thickened skin
Often painful and sensitive
Flattened nipple +/- yellow or bloody discharge may also be present

19
Q

How can Paget’s be distinguished from nipple eczema?

A

Paget’s always affects the nipple, only involving the areola as a secondary event
Eczema usually only involves the areola and spares the nipple

20
Q

How is Paget’s investigated?

A

Biopsy
+ complete breast and axilla examination
Imaging may also be warranted

21
Q

How is Paget’s managed?

A

Surgical removal of at least the nipple + areola

22
Q

How does the triple assessment grade suspicion of malignancy?

A 
Examination score (P)
Imagining score (mammography - M, ultrasound - U)
Histology score (B)
1 = normal
2 = benign
3 = uncertain/likely benign
4 = suspicious of malignancy
5 = malignant
23
Q

What are the different options for surgical management of breast cancer?

A

Breast conserving:
- wide local excision (WLE)
Mastectomy
Axillary surgery

24
Q

Who might be suitable for WLE?

A

Localised operable disease with no evidence of metastatic disease
Focal, small cancers
Also dependent on location and relative size of breast

25
Q

How is WLE done?

A

Excision of the tumour, ensuring a 1cm margin of macroscopically normal tissue taken along with the malignancy

26
Q

Which patients would require a mastectomy?

A 
Multi-focal disease
High tumour:breast tissue ratio
Disease recurrence
Patient choice
Risk reducing cases
27
Q

What is a risk reducing mastectomy?

A

Removal of healthy breast tissue in order to reduce the risk of developing breast cancer

28
Q

Which factors might warrant a risk reducing mastectomy?

A

Strong family history of breast or ovarian cancer
Testing positive for mutations such as BRCA1, BRCA2, PTEN or TP53
Previous history of breast cancer

29
Q

What does axillary surgery involve?

A

Performed alongside WLE or mastectomy in order to assess nodal status and remove any nodal disease

  • sentinel node biopsy
  • axillary node clearance
30
Q

What does a sentinel node biopsy involve?

A

Removing the first lymph nodes into which the tumour drains

  • identified by injecting a blue dye into peri-areolar skin
  • then removed and sent for histology
31
Q

What does axillary node clearance involve?

A

Removing all nodes in the axilla

32
Q

What are the complications associated with axillary node clearance?

A

Paraesthesia
Seroma formation
Lymphedema in the upper limb

33
Q

When are hormone treatments used in breast cancer management?

A

As an adjuvant in non-metastatic disease to reduce risk of replace (commenced after primary surgery)

Can be treatment of choice in elderly patients or those unfit for surgery

34
Q

What are the different hormone treatments used in breast cancer?

A

Tamoxifen
Aromatase inhibitors e.g. anastrozole, letrozole
Immunotherapy

35
Q

Which patients get tamoxifen and how does it work?

A

Pre-menopausal patients

- blockage of oestrogen receptors

36
Q

What are the risks associated with tamoxifen?

A

Increased risk of VTE

Risk of endometrial cancer

37
Q

How do aromatase inhibitors work and which patients are they used in?

A

Bind to oestrogen receptors to inhibit further malignant growth

Used in post-menopausal patients

38
Q

Give an example of immunotherapy used in breast cancer treatment?

A

Herceptin used in cancers that are HER2 positive

39
Q

What are the different types of oncoplastic surgery used for reconstruction following mastectomy?

A

Therapeutic mammoplasty
Flap formation:
- latissimus dorsi flap
- transverse rectus abdominal muscle (TRAM) flap
- deep inferior epigastric perforator (DIEP) flap

40
Q

What is therapeutic mammoplasty?

A

WLE combined with breast reduction technique

–> smaller, uplifted breast, preserving nipple and areola

Obstetrics + Gynaecology (22 decks)

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