Breast Cancer lect Flashcards by Alyssa Patino

What is the approximate lifetime risk of being diagnosed with invasive breast cancer for females in the United States according to the sources?

Approximately 1 in 8

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What percentage of all cancer site diagnoses in females does breast cancer represent?

23%

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At what stage is breast cancer considered most easily treatable, and what is the 5-year relative survival rate at this stage?

The localized stage, with a 5-year relative survival rate of 99%

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What is the approximate average age at diagnosis for breast cancer?

62 years old

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Most common sites of breast cancer metastasis

Bone, brain, liver, lungs

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Born with a gene mutation that can remain inert or become activated
50% chance of inheriting
Can be a carrier or it can manifest to cancer

Genetically Inherited

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Proto-oncogenes are genes susceptible to mutation and manifest as cancer (become oncogenes- genes that in certain circumstances can transform a cell into tumor cell)

Genetic Susceptibility

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Describe the key characteristics of Stage 0 breast cancer.

Pre-invasive (in situ), also known as Ductal Carcinoma In Situ (DCIS) or Lobular Carcinoma In Situ (LCIS), non-invasive, and generally not life-threatening

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What is stage 1 breast cancer involve?

limited to organ of origin

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Describe what Stage 2 - 4 breast cancer is

2: In same anatomic region, may spread to area immediately near the original organ, may have spread to LOCAL lymph nodes.
3: Spread to region surrounding primary organ. High probability of metastatic spread.
4: Metastasis to distant sites

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What is the most common type of invasive breast cancer?

Invasive Ductal Carcinoma (IDC), accounting for approximately 80% of breast cancer diagnoses

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Which type of breast cancer is this: 80% of breast cancer, invasive- spread to surrounding tissue, can be LIFE THREATENING, can be in lymph nodes, and chemotherapy is common?

Invasive Ductal Carcinoma (IDC)

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Which breast cancer account for 20% of dx, stays inside milk duct, NON-INVASIVE, Stage 0, usually NOT life threatening, in situ (not lymph nodes), & don’t often have chemotherapy?

Ductal Carcinoma in Situ (DCIS)

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This patient has a breast cancer that involves staying inside the lobules (the glands where mild is produced), is NON-INVASIVE, usually NOT life threatening, in sit (not lymph nodes), and chemotherapy is possible, which cancer do they present with?

Lobular Carcinoma in Situ (LCIS)

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Which breast cancer is 10% invasive breast CA, invasive, has spread to neighboring tissue, can be life threatening, can be in lymph nodes, and chemotherapy is COMMON?

Invasive Lobular Carcinoma (ILC)

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How does Inflammatory Breast Cancer typically present, and what is a notable characteristic regarding its detection?

It often presents with the breast becoming red, inflamed, orange-peel and is not often found on mammogram or ultrasound. It accounts for 1-5%, shorten survival rate (34%) but at stage 3-4 -> 21-57 month survival, chemotherapy first, radiation, and surgery.

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What do the stages measure

Invasiveness, size, nodal involvement

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What are the key differences in lymph node involvement between Stage I and Stage II invasive breast cancer?

Stage I has no node involvement (N0) and < 2cm in size (T1), while Stage II involves 1-3 axillary nodes (N1) and is 2-5 cm (T2)

What is the difference between Stage 3A and Stage 3B?

Both are Invasive but:

Stage 3A: > 5cm in size (T3) , in 4-9 axillary nodes (N2)

Stage 3B: spread to skin, chest wall (T4), in internal mammary nodes in chest well > 9 nodes (N3)

Which diagnostic stage of Breast cancer involves : advanced stage, in axillary AND supraclavicular nodes, liver, lungs, bone, & brain?

Stage 4 (IV) - Metastatic (M1)

What are some tests used to diagnosis breast cancer?

Breast exam

Imaging tests (diagnostic mammography, US, MRI)

Biopsy

Genomic tests to predict recurrence risk

What does analyzing the biopsy sample involve?

Tumor features
ER and PR
HER2
Grade

What does the “grade” of a breast cancer tumor indicate?

How fast the tumor is growing, based on histological properties, mitotic figures, and degree of differentiation.
Involves Grades 1-3

What grade if breast cancer is this: poorly differentiated, growing quickly in irregular patterns, & high grade?

Grade 3

This grade of breast cancer involves moderate/intermediate grade, moderate cell differentiation, doesn't look like normal cells, growing & dividing faster than normal cells?

Grade 2

Grade 1 of breast cancer involves...

Low grade, well differentiated Resemble normal cells Few cells growing & dividing

What is the mechanism of action for Tamoxifen, and for which patient population is it typically prescribed?

For Pre-menopausal with ER+ breast cancer Targets estrogen receptors to slow growth and reproduction of breast cancer cells by blocking estrogen Shuts down the ovaries Decrease risk of reoccurrance by 50%

How do aromatase inhibitors work, and for which patient population are they indicated?

Postmenopausal women with ER+ breast cancer Arimidex blocks the aromatase enzyme that converts androgens into estrogen. Decreases risk of reoccurrence by 50%

What are some clinically relevant orthopedic side effects of hormonal treatments for breast cancer?

Loss of muscle tone and strength, loss of tensile strength in ligaments and tendons, decreased joint stabilization, and increased incidence of trigger finger, carpal tunnel syndrome, & plantar fasciitis Arthralgias Accelerates menopausal changes

Other clinically relevant side effect of hormonal tx are

early onset of menopause competes with estrogen to bind to receptors in breast cancer cells binds tor receptors in all estrogen needing tissues

What are the two main ways Herceptin works to treat Her2+ breast cancer?

Too many receptors —> divide uncontrollably 1) Binds to receptors and blocks them from dividing and growing. 2) Binds to receptors and signals the body's immune response to destroy cells

What is a significant cardiovascular side effect associated with Herceptin?

Weakening of the heart muscle - Cardiotoxicity Myelosuppression

**Bonus: Which of the following factors is MOST predictive of poor prognosis in breast cancer? A. Tumor size B. Lymph node involvement C. HER2 status D. Triple-negative classification

Triple-negative classification (Triple-negative breast cancer lacks targeted treatments and has a higher recurrence rate)

Describe the key characteristics of a lumpectomy.

Most effective breast-sparing procedure where only the tumor and an adequate amount of surrounding breast tissue are removed. often suggested for single tumors under 4cm or in situ tumors 50% occur in upper lateral quadrant, 20% around nipple testing for clear margins 10% three quadrants

Difference between positive surgical margins and negatives ones?

Positive (+) : cancer cells extend out to edge of tissue Negative (-) : no cancer cells found towards the edge of the tissue (this is what we want)

What two dissections are for lymph node involvement?

Sentinel lymph node dissection: not known until time of surgery, less than 55 or more nodes = axillary dissection

What is the difference between a simple mastectomy and a modified radical mastectomy

Simple mastectomy involves the complete removal of the breast with no lymph node removal and used in lower stages or for prophylactic surgery, while a Modified radical mastectomy includes complete removal of the breast and either axillary lymph node dissection or sentinel lymph node biopsy Both have pectorialis major muscle left intact

What are some common types of breast reconstruction following mastectomy?

Tissue expander placement - most of the time subpectoral Breast implant Latissimus Dorsi muscle flap Autologous flaps (TRAM, DIEP)

What is chemotherapy?

Systemic cancer treatment imparting mitosis preventing cell division Targets the food source of cancer triggers apoptosis (suicide) of cancer cells Stops the growth of new blood vessels to starve the tumor

What is the difference between adjuvant and neoadjuvant chemotherapy?

Adjuvant chemotherapy is given after surgery, while neoadjuvant chemotherapy is given before surgery

What are side effects to chemotherapy?

Vomiting Loss of appetite Hair loss Anemia Memory Impairment Deterioration of skin and nails

What is the primary mechanism of how radiation therapy works to treat cancer?

Used for generally localized cancer treatment Uses high-energy radiation to shrink or kill cancer cells by damaging their DNA and preventing them from dividing Damages both healthy & cancer cells

List three potential side effects of radiation therapy for breast cancer.

Hair loss at the treatment site (sometimes permanent), skin irritation at the treatment site, and fatigue

What are some key areas of focus for physical therapy in the rehabilitation of patients with breast cancer?

Range of motion (first 3 most important) Lymphedema management/fluid dynamics Postural retraining pain management fatigue management neuropathy/balance training cardiovascular function/endurance strength training