Breast Cancer Lecture Powerpoint

Question 1

2 big locations of 97% of breast cancers

Answer 1

Ductal or lobal carcinoma

Question 2

2 most common presentations of breast cancer

Answer 2

• mammographic abnormality on screening

- palpable mass discovered by provider or patient

Question 3

2 types of tissue composing breast

Answer 3

Glandular and stromal

Question 4

Risk factors for breast cancer (4)

Answer 4

• personal and family history
• genetics
• Age (increases with)
• reproductive factors (early menarche, age of first birth over 30 years, nulliparity, later onset of menopause)

Question 5

Combination estrogen-progesterone therapy (but not estrogen alone) is associated with increased risk of…

Answer 5

….invasive breast cancer

Question 6

Risk prediction model of breast cancer

Answer 6

Determines risk category to determine average, moderate, or high risk based on history, family history, genetic predisposition, or radiotherapy

Question 7

Average lifetime risk of being diagnosed with breast cancer with no significant risk factor

Answer 7

12.4% or 1/8

Question 8

3 of the breast cancer risk tool models

Answer 8

• Gail model
• Ontario family history risk assessment
• Manchester scoring system

Question 9

Screening recommendations for breast cancer should be…

Answer 9

…shared decision making by discussing benefits and harms of screening, duration and how long to continue screening should be based on risk and preference

Question 10

Women age 40-44 mammogram, 45-54, 55 and older, how long should it continue?

Answer 10

40-44: should have choice to start annual screenings
45-54: get mammogram every year
55+: mammograms every 2 years with choice to continue yearly
Screening should continue as long as woman is in good health and expected to live 10+ years

Question 11

Screening vs diagnostic mammograms

Answer 11

• Screening is 2 views and a radiologist doesn’t review prior to patient leaving facility (covered by insurance)
• Diagnostic examines patient and reviews previous sscreens, additional studies are ordered as needed such as ultrasound or additional mammographic views (often not covered and very expensive)

Question 12

Women with breast implants are still susceptible to breast cancer, however need to receive a ___ instead of a mammogram

Answer 12

MRI

Question 13

Mammographic densities

Answer 13

Either suspicious (irregular margins, spiculations, associated calcifications that are a new finding) or less suspicious (smooth margins, multiple densities, old and stable)

Question 14

Mammographic microcalcifications

Answer 14

Either suspicious (clustered, >6, unusual shape) or less suspicious (few in number, punctate shape)

Question 15

BI-RADS classification

Answer 15

Breast imaging reporting data system, a score to determine the probability of malignancy and follow up

Question 16

BI-RADS values

Answer 16

0 - needs additional eval (inconclusive)
1 - normal (yearly screening)
2 - benign (yearly screening)
3 - prob benign (short interval follow up)
4 - suspicious for malignancy (biopsy)
5 - highly suspicious for malignancy (biopsy)
6 - biopsy proven malignancy (pursue treatment)

Question 17

Types of biopsies definitions (FNA, core needle, ABBI, vacuum, open surgical)

Answer 17

FNA - under x ray supervision, aspirate and look at fluid under microscope
Core needle - pulling out a larger cross section of the tumor
ABBI - same as core needle but capture large portion
Vacuum - vaccum out part of the tumor
Open surgical - straight up removal

Question 18

BRCA1 and 2

Answer 18

Breast cancer genes, every human has and do not cause cancer but are tumor suppressor genes, mutation in them prevents ability to repair broken DNA, those with BCRA1 mutation almost 60% will develop breast cancer before age 70, BCRA2 50% will

Question 19

Ductal carcinoma

Answer 19

Starts in the tubes (ducts) that move milk from breast to nipple, most breast cancers are this type

Question 20

Lobular carcinoma

Answer 20

Starts in parts of the breast called lobules that produce milk

Question 21

Noninvasive/in situ

Answer 21

Referring to cancer that has not invaded into any other tissue

Question 22

Ductal carcinoma in situ

Answer 22

-typically affects 1 breast, most often identified on mammograms as clustered microcalcifications, rarely seen in men

Question 23

Invasive

Answer 23

A cancer that has spread beyond the borders of its tissue of origin with suspected or potential to metastasize

Question 24

Pagets disease of the breast

Answer 24

A rare cancer that begins with change of skin cells at the nipple (often normal in those breast feeding) scaling then eventually becoming red lesion, almost 100% are associated with ductal carcinoma in situ, symptoms include sensitivity, burning, pain, bloody discharge

Question 25

Inflammatory breast cancer

Answer 25

A rare type of cancer that blocks lymph vessels causing severe swelling and redness, edema of the breast can present as “peau d’orange”, seen in younger women and is much more aggressive

Question 26

TNM staging

Answer 26

Tumor (size), nodes (# of positive nodes), mets (0 or 1 - binary)

Question 27

Most common sites of breast cancer metastasis (5)

Answer 27

• bone
• brain
• pleura
• skin
• liver

Question 28

3 big chemotherapeutic drugs

Answer 28

Cyclophosamide
Methotrexate
5-FU

Question 29

Breast cancer treatment options (6)

Answer 29

• chemotherapy
• radiation
• masectomy
• lumpectomy (breast sparing)
• hormonal (tamoxifen and estrogen receptor down regulators)
• Complementary treatments used with conventional medicine (different from alternative which is used instead of conventional)