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Year 3 - Met3b > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

How many women are affected by breast cancer

A

1 in 9 women are affected by breast cancer

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2
Q

How many males account for breast cancers

A
  • males account for 1% of breast cancers
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3
Q

What are the risk factors for breast cancer

A
  • family history and BRCA genes
  • past medical history of breast cancer
  • age
  • not breastfeeding
  • lifestyle
  • radiation exposure before 40
  • prior benign or premalignant breast changes such as radial scar, atypical hyperplasia

Increased oestrogen exposure

  • nulliparity
  • 1st pregnancy over the age of 30
  • early menarche
  • late menopause
  • HRT
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4
Q

What gene mutation is breast cancer linked to

A
  • Minority of breast cancers are linked with an inherited mutation e.g. BRCA1, BRCA 2
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5
Q

What are high risk families in having a genetic link to breast cancer

A
  • 4 or more relatives with breast/ovarian cancer
  • 3 relatives under the age of 60
  • 2 relatives under the age of 40
  • 1 relative with both or bilateral breast cancer
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6
Q

What are lifestyle risk reduction strategies of breast cancer

A
  • Early childbirth (younger than age 30)
  • Exercise 3-5 hours per week
  • Maintain normal weight
  • Avoid smoking/alcohol
  • Avoid prolonged hormone replacement especially with combined estrogen and progestin therapy
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7
Q

What is the presentation of breast cancer

A
  • Axilla = mass or pain
  • Breast - palpable mass, thickening, pain (less common)
  • nipple - discharge and retraction
  • Skin - oedema, Peau d’orange (pulling of the ligaments that tether hair follicle), erythema
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8
Q

What is the pathway of diagnosis of breast cancer

A
  • triple assessment
  • MDT discussion
  • personalised Treatment plan
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9
Q

What are the common sites of distant metastases in breast cancer

A
  • brain
  • pleura/lungs
  • lymph nodes
  • skin
  • liver
  • bone
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10
Q

Name the 4 stages of breast cancer

A

Stage 1
- confined to the breast, mobile

Stage 2

  • growth confined to the breast, mobile
  • lymph nodes in ipsilateral axilla

Stage 3

  • tumour fixed to muscle but not chest wall
  • lymph nodes in ipsilateral axilla and fixation
  • Skin involvement larger than tumour

Stage 4
- complete fixation to chest wall and distant metastasis

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11
Q

Describe the T part of the TNM staging in breast cancer

A
  • TX - primary tumour cannot be assessed
  • TO - no evidence of primary tumour
  • Tis - carcinoma in situ
  • T1 - tumour 2cm or less in greatest dimension - A = 0.1-0.5cm, B = 0.5-1cm, C - 1-2cm
  • T2 - tumour 2-5cm in greatest dimension
  • T3 - tumour >5cm in greatest dimension
    T4 - a) Fixation to chest wall; b) Oedema (peau d’orange) or skin ulceration; c) Both fixation to chest wall and oedema/peau d’orange; d) Inflammatory carcinoma
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12
Q

Describe the N and M stage of tumour staging in breast cancer

A

N0 – No lymph node involvement
N1 – Mobile ipsilateral nodes
N2 – Fixed nodes

M0 – No mets
M1 – Distant mets

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13
Q

What are the types of breast cancer

A
  • Non invasive ductal carcinoma in situ
  • non invasive lobular carcinoma in situ
  • invasive lobular carcinoma
  • invasive medullary carcinoma
  • invasive colloid/mucoid carcinoma
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14
Q

What is the most common type of breast cancer

A
  • Non invasive ductal carcinoma in situ
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15
Q

describe what non invasive ductal carcinoma in situ looks like

A
  • premalignant

- micro calcification on mammography (univocal or widespread)

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16
Q

describe non invasive lobular carcinoma in situ

A
  • rare

- tends to be multifocal

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17
Q

describe invasive lobular carcinoma

A
  • 10-15% of breast cancers

- less common

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18
Q

Describe who invasive medullary carcinoma affects

A
  • younger patients
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19
Q

Describe who invasive colloid/mucoid carcinoma affected

A
  • elderly patients
20
Q

What is an inflammatory carcinoma

A
  • rare but rapidly progressive form of breast cancer caused by obstruction of lymph drainage causing erythema and oedema
21
Q

How does inflammatory carcinoma present

A
  • progressive
  • erythema and oedema of the breast in the absence of signs of infection such as fever, discharge or elevated WCC and CRP
22
Q

How do you diagnose inflammatory carcinoma

A

CA 15-3 testing positive

23
Q

How many breast cancers are oestrogen receptor positive

A

60-70% of breast cancers are oestrogen receptor positive

24
Q

How many breast cancers express HER2 and what does this mean

A
  • 30% overexposes HER2 associated with poor prognosis and aggressive disease
25
What is the management of early breast cancer (stage1-2)
- Surgery - Radiotherapy - chemotherapy (6 weeks to act) - endocrine Treatment (3 months to act)
26
What surgery is used in early breast cancer (stage1-2)
- removal of tumour by wide local excision or mastectomy and reconstruction - also - axillary lymph node sampling/ surgical clearance or sentinel node biopsy
27
What are the complications of surgery for early breast cancer (stage1-2)
- arm lymphedema | - skin necrosis
28
What does radiotherapy do for early breast cancer (stage1-2)
- recommended for all patients with invasive cancer after surgery - increases survival and decrease 10 year reoccurrence - axillary radiotherapy if lymph nodes are positive and weren't cleared surgically
29
What are the side effects for radiotherapy in early breast cancer (stage1-2)
- pneumonitis - pericarditis - rib fractures
30
What mode is chemotherapy used in early breast cancer (stage1-2)
- adjuvant - consider in all but excellent prognosis patients - neoadjuvant chemotherapy has NO SURVIVAL BENEFITs
31
What chemotherapeutic agents are used in early breast cancer (stage1-2)
- Doxorubicin/epirubicin + CMF ( Cyclophosphamide + methotrexate + 5-FU)
32
How does endocrine treatment work in early breast cancer (stage1-2)
- reduces oestrogen activity and are use din ER+ and PR+ cases
33
What endocrine treatment is used in pre-menopausal women in early breast cancer (stage1-2)
- Anti-oestrogen's (ER antagonists) such as tamoxifen 20mg/d for 5 years post-op May also benefit from - ovarian ablation (oophorectomy) - GnRH analogues - such as goserelin
34
What are the side effects of Anti-oestrogen's (ER antagonists) such as tamoxifen
can lead to uterine cancer | - warn for vaginal bleeding
35
What endocrine treatment is given to post menopausal women in early breast cancer (stage1-2)
- Aromatase inhibitors (target peripheral oestrogen synthesis) such as anastrozole, letrozole and exemestane
36
What is the median overall survival for metastatic breast cancer
24 months
37
what is the aim of treatment of metastatic breast cancer
- remission and improved quality and duration of life
38
what treatment is used in metastatic breast cancer
- Tamoxifen (ER antagonist) - Chemotherapy if relapse after success of tamoxifen - Chemotherapy + biologicals, eg trastuzumab - Radiotherapy for painful bony mets and bisphosphonates (supportive) - Chest surgery to help wall - Psychological care
39
What palliative care is used for breast cancer
- psychological and anxiety - pain - analgesia - Anorexia - diet and antiemetics - constipation - laxatives - Metabolic - bisphosphonates
40
What are the prognostic factors for breast cancer
- Tumour size - Number of positive axillary nodes - Lymphatic and vascular invasion - Histological tumour type - Histologic grade - HER2 overexpression - Oestrogen/progesterone receptors HER
41
Name the molecular prognostic factors for breast cancer
- Proliferation index such as Ki67 - Oncotype – DX 21 gene profile – accepted as being a prognostic factor for ER positive node negative disease - Amsterdam 70 gene profile - BluePrint 80 gene profile
42
Name the percentage reduction in relative risk of death form breast cancer in adjuvant therapy
- Tamoxifen or anastrozole = 25% reduction - Chemotherapy = 20-35% reduction - Trastuzumab = 33% reduction - Radiotherapy = 5% reduction
43
Name the breast screening programme
- 50-70 year old are tested via mammography every 3 years
44
What new drug is being use in breast cancer
- Trastuzumab - used in HER2 positive patients
45
What are the radiological features of breast cancer?
- irregular shape - spiculated margins - microcalcifications - segmental distribution - pleomorphic shape

Year 3 - Met3b (26 decks)

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