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Cancer > Breast cancer - see third year! > Flashcards

Breast cancer - see third year! Flashcards

1
Q

Presentation of breast cancer

A

Breast pain 5%
Breast enlargement 1%
Skin or nipple retraction 5%
Nipple discharge 2%, nipple crusting or erosion 1%
Breast lump through menstrual cycle
40% axillaty nodes

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2
Q

What is pagets disease

A

Of the nipple
Long history of skin change
Itching, burning, oozing, bleeding, palpable underlying lump
Intraductal carcinoma of terminal ducts
Eczemoid changes on nipple, breast mass and bloody discharge

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3
Q

Most common site of metastases breast cncaer

A

Bone

Then lung, liver, pleura, adrenals, skin, brain

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4
Q

What is strongest prognostic factor breast cancer

A

Involvement of acillary nodes

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5
Q

What is most common death of women 35-45 IL

A

Breast cancer

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6
Q

Why is breast cancer dangerous lon term

A

Unpredictable metastases up to 20 yeras after diagnosis

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7
Q

Epidemiology

A

1 in 9 lifetime risk
Higher SE background more likely
RUQ nad retroareolar regions

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8
Q

Hereditary breast cancer causes

A

BRCA1 and BRCA2 hereditary breast cancer, and Li–Fraumeni syndrome and other rare syndromes including; Cowden syndrome (breast & GI cancers, thyroid disease), ataxia telangiectasia and Peutz-Jeghers syndrome.

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9
Q

Most common breast cancer hitoloy

A

Invasive ductal carcinoma = DCIS
Invasice lobular carcinoma most of remaining cases

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10
Q

Characteristics of BRCA ass cancer

A

Younger age of onset
Frequent bilateral occurrence
Worse histological features
more aneuploidy
higher grade
higher proliferation indices
higher proportion hormone receptor negative

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11
Q

Risk factors breast cancer

A

Increasing age
FH/peronal history
Prev bening breast sidease, breast tissue density
Reproductive and menstrual history - early menarhce, late menopause, nulliparous or >35 first preganncy
Oestrogen therapy - HRT
Radiation to breast or chest
Obesity post menopausal
Alcohol intake

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12
Q

Greatest risk reduction cancer COPC

A

Ovarian

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13
Q

Investigations for breast cancer

A

Clinical examination
Breast imaging
Mammography: features suggestive of malignancy include asymmetry, microcalcifications, a mass and architectural distortion
Ultrasound
Magnetic resonance (MR)
Fine needle aspiration or core biopsy
Needle core biopsy
Mammotome (vacuum assisted biopsy)

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14
Q

DCIS what is it

A

Ductal carcinoma in su=iyu - 20% creen detected breast cancers

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15
Q

How does lymph node progression happen in breast cancer

A

Sytematically
Level 1-> 2-> 3
Prevents unneccessary removal of nodes as if first node clear next node will be

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16
Q

Risk factors for distant metastases in breast cancer

A

> 3 lymph nodes involved
10 involved nodes
T3/4 tumour

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17
Q

What should anyone with a tumour >5cm or >3 nodes involved have done

A

CXR
US of liver
Bone scan

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18
Q

When is a biopsy indiated for thought breast cyst

A

Bloody aspirate
Lesion doesnt resolve completely after aspiration
Cyst recurs after repeat aspirartions

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19
Q

INvestigaitons of solid breast mass

A

FNA - cytology exa
Core biopst
Excisional biopsy = definitive

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20
Q

How evaluate non palpable breast mass

A

Wire excision biopsy
Stereotatctic guided core biopsies
US guided core biopsies
Breast MR imaging to hcaracterise

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21
Q

tumor marker for breast cancer

A

CA15.3
used to detect relapse and severity of disease
no role in diagnosis

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22
Q
A

HER2 positive tumours can respond to anti-HER2 monoclonal antibody therapy

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23
Q

Who is adjuvant radiotherapy to post surgery offered to breast cancer

A

Anyone having breast conserving surgery

Post mastectomy if:
>5cm tumours
Tumours deep in breast - very close or positive deep margins of resection to primary tumour
where surgical clearance <3mm
4 or more lymph node mets

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24
Q

When can you give aromatase inhibitors vs tamoxifen to patietns with breast cancer

A

Post menopausal HER2 + = anastrazole
tamoxifen = pre menopausal
If small and low risk can be sole treatment

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25
Q

What medication for ER + breast tumour

A

Post menopausal - tamoxifen and araomatase inhibtior
Pre menopausal - Leutenising hormone releasing hormone analogue

26
Q

What patietns offered adjuvant chemotherapy

A

Higher risk of recurrnece -
Tumour >1cm
ER negative
Presnce of involved axillary nodes

27
Q

What can be used for early HER2 + breast cancer

A

Adjuvant trastuzumab (monoclonal antibody HER2)
Alongside standard chemo regime

28
Q

Management of mets in breast cancer

A

radiotherapy to palliate painful bone metastases, and second-line endocrine therapy with aromatase inhibitors, which inhibit peripheral oestrogen production in adrenal and adipose tissues. Advanced ER- disease may be treated with combination chemotherapy”1 and trastuzumab considered for patients with relapsed HER2+ disease. Bisphosphonates can treat hypercalcaemia and reduce skeletal morbidity in women with bone metastases.

29
Q

Advantgaes and disadvantages of preventative tamoxifen

A

+
50% less invasive cancer and DCIS
Prevents ER +tumours
-
2.5 x more likely endometrial cancer
Increased DVT and PE risk
No clear cut impact on survival

30
Q

Complications of breast cnacer

A

Local invasion -> lymphoedema, pleural effusion, ascites
Distant mets - bone, liver, lung, brain, spinal cord compression
Non metastatic - hypercalcemia

31
Q

Bone mets most common causes

A

Breast and prostate cancer
Kidney, thyroid cacner, multiple muelo a

32
Q

Management principles bone mets

A

[ainrelief
Preservation and restoration of function
Skeletal stabilisaiton
Local tumour control

33
Q

What cancer has the highest incidence of spinal cord compression

A

Breast

34
Q

What should bilateral UMN signs be considered as until proven otherwisse

A

Spinal cord compresison

35
Q

First sign of spinal cord compression

A

Vertebral pain espeically on coughing or sneezing

36
Q

Risk factors for male breast cancer

A

Oestrogen use
Radiation exposure to chest
Diseases ass w hypergonadism eg cirrhosis, kleinfelters
Inhertiance

37
Q

breast cancer in men- histology, hormone status, present

A

Infiltrating ductal cancer is most common type
Almost always hormone receptor positive whether ER, PR or HER
Present later than women
Usually retroareolar lump

38
Q

When is bilateral breast cancer more commona nd what reduces risk

A

Infiltrating lobular carconoma more common
Endocrine therapy reduces risk

39
Q

How is breast cancer staged

A

Tumor size.
Lymph node status.
Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
Human epidermal growth factor receptor 2 (HER2/neu) status in the tumor.
Tumor grade.
Menopausal status.
General health of the patient.

40
Q

Risk fo radiation therapy for breast cancer

A

Radiation penumonitis
Cardiac events
Arm lymphoedema
Brachial plexopathy - injury to brachial plexu
Contralateral breast acner if <45
Risk of scrondaru malignancy

41
Q

Effects of trastuzumab

A

Cardiac toxic effects

42
Q

Treatment for DCIS

A

Breast conserving surgery or mastectomy + radiation therapy with or without tamoxifen
Total mastectomy with or without tamoxifen

43
Q

Why dont give tamoxifen after menopause

A

Risk of endometrial cancer

44
Q

What is an aromatase inhibitor exmaple

A

anastrazole

45
Q

Where are BRAC1 vs BRAC 2

A

1 = chromosome 17 - also increased bowel and prostate cacner
2 = 13

46
Q

When do gneetic testing for BRACA

A

IF active breast cancer:
Manchester score >15 - allows calculation of probability for presence of mutations in families suspected
- Grade 3 triple negative breast cancer <50 years
- Breast cancer + Ashkenazi ancestry
- Can be screened if unaffected with:
- Manchester score >20
- 1st degree relative with breast or ovarian cancer

47
Q

Risk reduction pre vs post menopausal breast cancer medication

A
  • Pre-menopausal = tamoxifen 5 years; risk of endometrial cancer and VTEs
  • Post-menopausal = anastrozole 5 years
48
Q

What cells DCIS arise form

A

Epithelial

49
Q

What is LCIS

A

Pre-cancerous
Non detectable on US
Usually incidental on biospy
Close monitoring

50
Q

INflammatory breast cancer

A
  • Presents similarly to breast abscess or mastitis
  • Swollen, warm, tender breast with pitting skin (peau d’orange)
51
Q

When 2ww referral for breast cancer

A

> 30 unexplained breast lump
50 unilateral nipple changes

52
Q

Triple assessment braeast cancer

A

Clinical assess - hx and exam
Imaging - US <30 yes, mammograhy older women
Biopsy

53
Q

TMN stage 1

A

<2cm, 1 axillary node

54
Q

Stage 2 - TN

A

2 - 2-5cm, aciallary nodes clumpeed together or internal mammary nodes

55
Q

Stage 3 - TN

A

> 5cm
a = infraclavicular nodes
b = internal mammary and axullary
C = supraclavicularnodes

56
Q

4 stage TNM breast cancer

A

a - chest wall
b- skin
c - skin and chest wall
d = inflammatory carcinoma

57
Q

Node clearance when do

A

None plapable -> pre op acillary US, if negative sentinel node biospy
Palpable -> clearance

58
Q

Mastectomy vs wide local incision

A

Mastectomy - multifocal, central, large lesion small beast >4cm DCIS

Wide excision - Solitary, peripheral, small in large, DCIS<4cm

59
Q

When offer radiotherapy with mastectomy vs wide local excision

A

Mastectomy - T3-4 w >4 + axillary nodes
Whole breast radio if wide local exciison

60
Q

What type med is tamoxifeen

A

Selective oestrogen receptor modulator (SERM)
Blocks oestrogen in breast tissue, stimulates in uterus and bones

61
Q

Breast cancaer when screen UK

A
  • From 50-70 every 3 years
  • May be eligible before 50 if at higher risk of developing
  • > 71, women are still eligible, however this must be requested

Cancer (22 decks)

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