breast cancer JH Flashcards
what can breast cancer look/ feel like?
thick area, dimple, nipple crust, red or hot, new fluid, skin sores,bump, growing vein, sunken nipple, new shape/ size, orange peel skin
how does genetics influence breast cancer?
most of breast cancers are sporadic
family history is the strongest risk
what are the genes associated with breast cancer?
BRCA1andBRCA2
* Two major high-risk genesassociated with hereditarybreast cancer
* Inheritance of mutated BRCA gene confers 45-90% lifetime risk of breast cancer
what personal factors/ history may infleunce your chances of developing breast cancer?
- Age
- Previous breast cancer
- High breast density
- Previous exposure tor adiation(chest)
- Increased exposure to oestrogen
- Higher social/ economic status
- White ethnicity
how does ones lifestyle influence their chances of developing breast cancer?
exercise- lower incidence
obesity- higher incidence
alcohol- increased incidence when consumed regularly.
how is breast cancer screened?
mammogram is an x-ray
how do you diagnois breast cancer?
- Identified by self-examination or routine screening
- Diagnosis is usually facilitated using Triple Assessment:
- Clinical Examination
- Characteristics of the lump— size,
texture ,where it moves - Breast Imaging
- Mammography: X-rays of the breast to allow detailed imaging of the tissue
- Ultrasound: aids diagnosis
- can differentiate between solid or fluid filled lump
- Pathological Evaluation
- Biopsy-assessment of tissue from the lump
what is the first line treatment for breast cancer?
to remove the primary breast tumour via surgery
what are the different types of surgery?
wide local excision- small margin
radial- breast, pectoralis and muscle
conventional- breast, skin and nipple, musle
what is axillary surgery?
frequent site of lymph node metastases
to obtain lymph nodes for examination in breast cancers
what is lympoedema?
after surgery cut off lymph nodes- build up of fluid and swelling
how do you treat lymphoedema?
compression stockings, massage and specific exercises
what is your aim with lymphoedema?
aim to take BP, readings and give injections in other arm
when can radiotherapy be used?
after surgery for early BC
combined with systemic theraphy and surgery for local advanced cancer
combined with all systemic therapy for treatment of metastatic disease
what about post mastectomy radiotherapy?
most patients wont require
reduces risk of chest wall reoccurrence
considered for patients with high risk of re-occurrence
axcillary radiation not recommended after axillary dissection as 30-40% risk of significant lymphoedema
what are some adverse effects of radiotherapy?
early- skin in treatment areas becomes more senesitive, red and swollen, fatigue, hair loss
late- breast changes, bone damage, cardiac and respiratory toxicity
when should someone start adjuant chemo?
started within 31 days of surgery or earliest clinically appropiate date
what is taken into consieration with adjuvant chemotherapy?
nodal involvement
oestrogen receptor status
HER2 status
what are the different regimens?
node negative patients: anthracycline regimen
node positive- taxane containing regime
who is Neo-adjuvant chemotherapy considered for?
locally advanced disease and tumours where down staging may facilitate breast conserving surgery
what should be determined prior to neo-adjuvant chemo?
ER, PR and HER2 status
what are the different types of hormonal regulation
estrogen receptor- modulates circulation in blood stream
tamoxifen- pre- menopause
aromatase inhibitors- post menopause
what are the side effects of hormonal therapy?
bone loss- monitor/ bisphosphonate
menopausal symptoms
increased risk of VTE
what role does HER2 play in breast cancer?
Growth factor receptors have an essential role in proliferative and cell survival pathways
what is amplification/ overexpression of HER2 associated with?
accelerated cell growth/ proliferation
increased risk of disease reucrrence
shortened overall patient survival
what is trastuzumab- herceptin used for?
monoclonal antibody that blocks HER2 receotor
given with chemo and other cancer drugs
what are the s/e of herceptin?
neutropenia
aneamia
thromboctopenia
hypersensitivity reactions
CV disease
what is the treatment for hormone receptor positive patients?
endocrine therapy usually first- depends if pre or post menopause
what treatment is given in HER2 positive patients?
targeted in conjuction with chemo
what if the patient is tripple negative?
chemo
depends on patient factors
no optimal duration of treatment
how do you treat brain metastases?
surgery
whole brain radiotherapy
pallative care
what is ulcerating/ fungating disease?
grows in shape of a fungus
develops in untreated cancer
cancer growsupwards and breaks throughskin
