Breast Cancer Flashcards
What is the triple assessment for breast cancer?
1) Breast examination
2) Imaging - US/mammography (XR)
3) Core biopsy (histology/cytology)
How do you diagnose breast cancer?
Biopsy
What targeted treatment can you use if a pt is HER2 positive?
Herceptin (trastuzumab) ± pertuzumab
What % of breast cancer patients are HER2 positive?
30%
What targeted hormone therapy can you use if a pt is ER/PR positive?
- Tamoxifen - premenopausal women
- Aromatase inhibitors (anastrozole + letrozole) - postmenopausal women
What type of medication is tamoxifen?
Selective Oestrogen Receptor Modulator (SERM)
What do aromatase inhibitors do?
Reduce peripheral oestrogen synthesis
What imaging do you do for staging breast cancer?
- MRI
- PET-CT
- FDG-PET
What other investigation can you do in breast cancer?
Genetic tests
What is a common treatment-related complication of breast cancer?
Lymphoedema - swollen arm
How do you curatively treat breast cancer?
- Surgery - WLE (wide local excision)/mastectomy
- Radio - adjuvant
- Chemo - Neo/adjuvant - anthracycline
± Targeted herceptin (HER2+)/hormone therapy (PR/ER_)
Is hormone therapy adjuvant or neoadjuvant?
Adjuvant
What might be the only sign present in early breast cancer?
Breast/axillary mass/lump (otherwise asymptomatic)
What are breast symptoms in breast cancer?
- Skin changes - puckering/deformity/dimpling, erythema, peau d’orange, nipple ulcer/eczema
- Nipple changes - discharge, inversion
What are risk factors for breast cancer?
- Early menarche/late menopause
- HRT/COCP
- Nulliparity
- Genetics (BRCA, TP53)
- FH
- Alcohol, obesity
- XR, RT
- Not breast feeding
- Caucasian
What % of all breast cancer cases are due to genetics?
25%
What are the 2 classifications of breast cancer?
- In-situ vs invasive
- Ductal vs lobular
What are the 4 types of breast cancer in decreasing order of how common they are?
1) IDC (invasive ductal carcinoma)
2) ILC (invasive lobular carcinoma)
3) DCIS (ductal carcinoma in situ)
4) LCIS (lobular carcinoma in-situ)
When would you do an urgent referral for breast cancer?
- > 30 yrs + unexplained lump
- >50 yrs + symptoms/change to a nipple
What procedure is done during breast cancer surgery?
Sentinel lymph node biopsy (SLNB)
What medication is used when cancer is resistant to tamoxifen?
Fulvestrant (full antagonist)
How is screening carried out for breast cancer?
Mammogram every 3 years for those aged 50-70
When does breast cancer start to often cause pain?
When it spreads
What is the most common cancer in women?
Breast cancer
Where does breast cancer typically metastasise?
- Brain
- Bone
- Liver
- Lung
