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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
What medication for ER + breast tumour
Post menopausal - tamoxifen and araomatase inhibtior Pre menopausal - Leutenising hormone releasing hormone analogue
26
What patietns offered adjuvant chemotherapy
Higher risk of recurrnece - Tumour >1cm ER negative Presnce of involved axillary nodes
27
What can be used for early HER2 + breast cancer
Adjuvant trastuzumab (monoclonal antibody HER2) Alongside standard chemo regime
28
Management of mets in breast cancer
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
Advantgaes and disadvantages of preventative tamoxifen
+ 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
Complications of breast cnacer
Local invasion -> lymphoedema, pleural effusion, ascites Distant mets - bone, liver, lung, brain, spinal cord compression Non metastatic - hypercalcemia
31
Bone mets most common causes
Breast and prostate cancer Kidney, thyroid cacner, multiple muelo a
32
Management principles bone mets
[ainrelief Preservation and restoration of function Skeletal stabilisaiton Local tumour control
33
What cancer has the highest incidence of spinal cord compression
Breast
34
What should bilateral UMN signs be considered as until proven otherwisse
Spinal cord compresison
35
First sign of spinal cord compression
Vertebral pain espeically on coughing or sneezing
36
Risk factors for male breast cancer
Oestrogen use Radiation exposure to chest Diseases ass w hypergonadism eg cirrhosis, kleinfelters Inhertiance
37
breast cancer in men- histology, hormone status, present
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
When is bilateral breast cancer more commona nd what reduces risk
Infiltrating lobular carconoma more common Endocrine therapy reduces risk
39
How is breast cancer staged
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
Risk fo radiation therapy for breast cancer
Radiation penumonitis Cardiac events Arm lymphoedema Brachial plexopathy - injury to brachial plexu Contralateral breast acner if <45 Risk of scrondaru malignancy
41
Effects of trastuzumab
Cardiac toxic effects
42
Treatment for DCIS
Breast conserving surgery or mastectomy + radiation therapy with or without tamoxifen Total mastectomy with or without tamoxifen
43
Why dont give tamoxifen after menopause
Risk of endometrial cancer
44
What is an aromatase inhibitor exmaple
anastrazole
45
Where are BRAC1 vs BRAC 2
1 = chromosome 17 - also increased bowel and prostate cacner 2 = 13
46
When do gneetic testing for BRACA
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
Risk reduction pre vs post menopausal breast cancer medication
- Pre-menopausal = tamoxifen 5 years; risk of endometrial cancer and VTEs - Post-menopausal = anastrozole 5 years
48
What cells DCIS arise form
Epithelial
49
What is LCIS
Pre-cancerous Non detectable on US Usually incidental on biospy Close monitoring
50
INflammatory breast cancer
- Presents similarly to breast abscess or mastitis - Swollen, warm, tender breast with pitting skin (peau d’orange)
51
When 2ww referral for breast cancer
>30 unexplained breast lump >50 unilateral nipple changes
52
Triple assessment braeast cancer
Clinical assess - hx and exam Imaging - US <30 yes, mammograhy older women Biopsy
53
TMN stage 1
<2cm, 1 axillary node
54
Stage 2 - TN
2 - 2-5cm, aciallary nodes clumpeed together or internal mammary nodes
55
Stage 3 - TN
>5cm a = infraclavicular nodes b = internal mammary and axullary C = supraclavicularnodes
56
4 stage TNM breast cancer
a - chest wall b- skin c - skin and chest wall d = inflammatory carcinoma
57
Node clearance when do
None plapable -> pre op acillary US, if negative sentinel node biospy Palpable -> clearance
58
Mastectomy vs wide local incision
Mastectomy - multifocal, central, large lesion small beast >4cm DCIS Wide excision - Solitary, peripheral, small in large, DCIS<4cm
59
When offer radiotherapy with mastectomy vs wide local excision
Mastectomy - T3-4 w >4 + axillary nodes Whole breast radio if wide local exciison
60
What type med is tamoxifeen
Selective oestrogen receptor modulator (SERM) Blocks oestrogen in breast tissue, stimulates in uterus and bones
61
Breast cancaer when screen UK
- 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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