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Breast > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are the hereditary disorders that place people at increased risk of breast cancer?

A 
BRCA 1 & 2
Li Fraumini (p53 mutation) 
Cowdens syndrome (p10 mutation) 
Peutz-Jeghers syndrome (STK11 mutatio) 
CDK1 (associated with gastric cancer)
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2
Q

Having the BRCA 1 or 2 mutation increases a patients risk of breast cancer by how much?

A

10-20 fold increased risk

30-60%chance of having breast cancer by age 60

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3
Q

What does GAIL model assess (Breast cancer risk assessment tool)?

A

Estimates the risk of developing invasive breast cancer over the next 5 years and within lifetime.

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4
Q

What type of patient does the GAIL model exclude?

A

BRCA 1 & 2 mutations
Women with previous invasive or in situ breast cancer
Women with other risk factors such as prior radiation therapy, rare breast causing conditions (Li-Fraumeni syndrome)

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5
Q

What are the components of the GAIL model?

A

Age
Age at menarche
Age at time of first child born
Family hx breast can (mother, sister, daughter)
Number of past breast bx
Number of breast bx showing atypical hyperplasia
Race and ethnicity

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6
Q

What is the treatment for DCIS? How does this differ in post menopausal women?

A

Lumpectomy + radiation
HRT (if HR +ve) (tamoxifen for 5 years)

Consider mastectomy if women has a large lesion, multi quadrant disease, contra indication to post operative radiation. If doing a mastectomy, must do a sentinel LN bx.

Pot menopausal: Aromatase inhibitor

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7
Q

Why use post op radiation for DCIS after lumpectomy? Does post op radiation affect long term overall survival?

A

Post operative radiation for DCIS will decrease the risk of recurrence by 50%.
Though long term studies show this does not overall impact survival

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8
Q

Do patients have an increased risk of breast cancer with LCIS?

A

Yes, even though LCIS is not a pre malignant condition, it does mark an increase risk of breast cancer in both breasts (0.5% per year).

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9
Q

What is the treatment for LCIS?

A

WLE to rule out invasive component or DCIS.

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10
Q

Do you need negative margins in when excising LCIS?

A

No you dont need negative margins. However, you do want to council the patient there is an increased risk of breast cancer.

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11
Q

What are the tumour sizes for T staging?

A

T1 0-2cm
T2 2-5cm
T3 > 5cm
T4 invading skin or chest wall

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12
Q

What are the stages for nodes N?

A

N1 1-3 nodes
N2 4-9 nodes
N3 > 10 or supra/infraclavicular nodes

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13
Q

What does M1 mean?

A

Distal metastasis

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14
Q

What do the stages consist of?

A

Stage 1: small tumour with no nodes (T1,N0,M0)
Stage 2: larger tumour or having minor nodal involvement (T3N0 or T2N1)
Strage 3a/3b: local invasion or more nodes T4N0 or T3N2.
Stage 3c: any clavicular nodes ie N3 disease
Stage 4 : distal metastasis

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15
Q

What is the treatment for stage 1 or 2 breast cancer?

A

Surgery then adjuvant chemo and rads if indicated.

Lumpectomy and whole breast radiation (equivalent to mastectomy).

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16
Q

Which patients are contraindicated to breast conserving therapy?

A

Pregnant woman (unable to have post op radiation)
Multi centric breast cancer.
Positive pathological margins after re excision.

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17
Q

What are some relative contraindications to breast conserving therapy?

A

If they have had previous radiotherapy
Skin conditions such as scleroderma
Tumour > 5cm

18
Q

What is the treatment for stage 3a/3b patients? Locally advanced and operable

A

Surgery first or neoadjuvant therapy for down staging

19
Q

What is the treatment for stage 3b/c patients? locally advanced and inoperable

A 
Neoadjuvant therapy (down stage) 
Surgery if patient responds
20
Q

How do you manage stage 4 disease?

A

Chemotherapy primarily

21
Q

What is a “must do” for all patients that have an invasive cancer?

A

Sentinel lymph node biopsy (at least)

22
Q

What is the Z11 trial?

A

Compare pts with small tumours (T1-2) and small axillary disease (N1) to see whether they need axillary dissection or whether radiation can treat their axilla adequately

23
Q

What was the outcome of the Z11 trial?

A

RCT - no differrence in local recurrence, disease free survival and overall survival at median follow up 6.5 years

24
Q

Which patients require a level 1 or 2 axillary node dissection?

A

Clincally +ve nodes on FNA or core needle bx

SN not identified with blue ink or radiotracer

25
Q

When do you perform a level 3 axillary node dissection?

A

Metastatic melanoma

26
Q

Who gets chemotherapy in invasive breast cancer?

A

Tumours > 1cm, positive LNs, or triple negative nodes.

Caveats:
Patients with hormone +ve nodes, may be able to give hormone therapy alone.
Decision will also be based on:
- individual risk of relapse
- predicted sensitivity to treatment based on oncotyping

27
Q

What is the chemotherapy regimen?

A

TAC

Taxotere, Adriamycin and Cyclophosphamide

28
Q

What is the main side effect of Taxotere?

A

Peripheral neuropathy

29
Q

Main side effect of Adriamycin?

A

Cardiomyopathy

30
Q

Main side effect of Cyclophosphamide?

A

Haemorrhagic cystitis

31
Q

Who would you consider neoadjuvant chemotherapy for?

A

Locally advance or inoperable tumours
- Inflammatory, N2 or N3 or T4 lesions
Tumours too large for breast conservation therapy

32
Q

What is the benefit of radiotherapy in breast conservation surgery?

A

Whole breast radiation decreases local recurrence and improves survival.
Give radiotherapy after chemotherapy.

33
Q

Who gets radiotherapy post mastectomy?

A

+ve axillary LNs

tumours > 5cm

34
Q

Who gets hormonal therapy?

A

All hormone +ve tumours (5 years tamoxifen or aromatase inhibitor if post menopausal)

35
Q

What is inflammatory breast cancer?

A

Rapid diffuse involvement of entire breast

Peau d’orange

36
Q

How do you treat inflammatory breast cancer?

A

Chemoradiation first

If responds, modified radical mastectomy

37
Q

What is pagets disease of the breast?

A

Oedematous changes with scaling and ulceration of the skin and nipple (marker of underlying malignancy)
Cells will have a clear cytoplasm and enlarged nuclei

38
Q

How do you treat pagets disease of the breast?

A

Modified radical mastectomy (w nipple areolar complex) + SLNBx

39
Q

What are the risk factors for breast cancer in men?

A

Strong family hx
Klinefelter disease
BRCA 2

40
Q

How do you manage breast cancer during pregnancy?

A

1st trimester - modified radical mastectomy
(cannot undergo post op radiation)
2nd trimester (late or 3rd trimester) - breast conservation surgery + SLNBx with modified isotope dosing and delivery of chemo and post delivery radiation.
(methylene blue is contraindicated in pregnant patients)

41
Q

What are the most common sites for breast metastasis?

A

Bone, lung, brain and liver.

Breast (4 decks)

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