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Reproduction Y3 > Breast cancer (zero to finals) > Flashcards

Breast cancer (zero to finals) Flashcards

1
Q

What is the most common cancer in the UK?

A

Breast cancer

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2
Q

Breast cancer can only occur in women. True/false?

A

False

It is most common in women however it can happen in men as well despite being rare (1% of cases)

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3
Q

What are risk factors for breast cancer?

A

Female (99% of breast cancers)

Increased oestrogen exposure (earlier onset of periods and later menopause)

More dense breast tissue (more glandular tissue)

Obesity

Smoking

Family history (first-degree relatives)

Drugs (some oral medication such as COCP can cause a slight risk increase in breast and cervical cancers for a period of 10 years after stopping pill)

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4
Q

What contraception type can increase breast cancer risk?

A

The combined contraceptive pill gives a small increase in the risk of breast cancer, but the risk returns to normal ten years after stopping the pill.

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5
Q

What particular type of HRT increases risk of breast cancer?

A

Combined HRT (containing both oestrogen and progesterone).

HRT specifically oestrogen only HRT can increase risk of endometrial cancer in women with a uterus.

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6
Q

What is referred to as the breast cancer gene?

A

BRCA gene

BRCA refers to the BReast CAncer gene.

The BRCA genes are tumour suppressor genes. Mutations in these genes lead to an increased risk of breast cancer (as well as ovarian and other cancers).

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7
Q

How many types of BRCA genes are there?

A

2 types

BRCA1 and BRCA2

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8
Q

What chromosome is BRCA1 gene on?

A

Chromosome 17

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9
Q

What chromosome is BRCA2 gene on?

A

Chromosome 13

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10
Q

Main types of breast cancer?

A

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)

Invasive ductal carcinoma

Invasive lobular carcinomas

Inflammatory breast cancer

Paget’s disease of the nipple

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11
Q

How often are mammograms offered and to what age groups?

A

Offered for ages 50-70 years every 3 years

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12
Q

What is the aim of breast cancer screening?

A

Screening aims to detect breast cancer early, which improves outcomes. Roughly 1 in 100 women are diagnosed with breast cancer after going for a mammogram.

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13
Q

What are the potential downsides to breast cancer screening?

A

Anxiety and stress

Exposure to radiation, with a very small risk of causing breast cancer

Missing cancer, leading to false reassurance

Unnecessary further tests or treatment where findings would not have otherwise caused harm

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14
Q

What patients are regarded as high risk for breast cancer?

A

Patients with:

A first-degree relative with breast cancer under 40 years
A first-degree male relative with breast cancer
A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
Two first-degree relatives with breast cancer

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15
Q

What chemo preventative medications can be offered to women with high risk of breast cancer?

A

Tamoxifen if premenopausal
Anastrozole if postmenopausal (except with severe osteoporosis)

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16
Q

What surgical treatments can be offered to patients at high risk?

A

Risk-reducing bilateral mastectomy or bilateral oophorectomy (removing the ovaries) is an option for women at high risk.

This is suitable for only a small number of women and requires significant counselling and weighing up risks and benefits.

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17
Q

Clinical presentation of breast cancer?

A

Lumps that are hard, irregular, painless or fixed in place

Lumps may be tethered to the skin or the chest wall

Nipple retraction

Skin dimpling or oedema (peau d’orange)

Lymphadenopathy, particularly in the axilla

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18
Q

Features of ductal carcinoma in situ (DCIS)?

A

Pre-cancerous or cancerous epithelial cells of the breast ducts

Localised to a single area

Often picked up by mammogram screening

Potential to spread locally over years

Potential to become an invasive breast cancer (around 30%)

Good prognosis if full excised and adjuvant treatment is used

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19
Q

Features of lobular carcinoma in situ (LCIS)?

A

A pre-cancerous condition occurring typically in pre-menopausal women

Usually asymptomatic and undetectable on a mammogram

Usually diagnosed incidentally on a breast biopsy

Represents an increased risk of invasive breast cancer in the future (around 30%)

Often managed with close monitoring (e.g., 6 monthly
examination and yearly mammograms)

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20
Q

Features of inflammatory breast cancer?

A

1-3% of breast cancers

Presents similarly to a breast abscess or mastitis

Swollen, warm, tender breast with pitting skin (peau d’orange)

Does not respond to antibiotics

Worse prognosis than other breast cancers

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21
Q

What breast cancer type has the worst prognosis?

A

Inflammatory breast cancer

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22
Q

Features of Paget’s disease of the nipple?

A

Looks like eczema of the nipple/areolar

Erythematous, scaly rash

Indicates breast cancer involving the nipple

May represent DCIS or invasive breast cancer

Requires biopsy, staging and treatment, as with any other invasive breast cancer

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23
Q

How often are mammograms offered in the NHS breast screening programme?

A

Mammogram every 3 years to women aged 50 – 70 years.

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24
Q

What is the triple diagnostic assessment?

A

Once a patient has been referred for specialist services under a two week wait referral for suspected cancer, 3 things are checked:

  • Clinical assessment (history and examination)
  • Imaging (ultrasound or mammography)
  • Biopsy (fine needle aspiration or core biopsy)
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25
Q

Typical imaging choice for suspected breast cancer in women under 30?

A

Ultrasound scans are typically used to assess lumps in younger women (e.g., under 30 years).

Helpful in distinguishing solid lumps (e.g., fibroadenoma or cancer) from cystic (fluid-filled) lumps.

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26
Q

Typical imaging choice for suspected breast cancer in women over 30?

A

Mammograms are generally more effective in older women. They can pick up calcifications missed by ultrasound.

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27
Q

Why are ultrasounds preferred as a method of breast imaging compared to mammograms in younger women?

A

Younger women generally have more dense breasts with more glandular tissue.

This makes it more difficult for mammograms to get the adequate view.

28
Q

When can MRI scans be used for breast imaging?

A

For screening in women at higher risk of developing breast cancer (e.g., strong family history)

To further assess the size and features of a tumour

29
Q

How is lymph node spread checked in breast cancer?

A

Women diagnosed with breast cancer require an assessment to see if cancer has spread to the lymph nodes.

All women are offered an ultrasound of the axilla (armpit) and ultrasound-guided biopsy of any abnormal nodes.

30
Q

When is a sentinel lymph node biopsy carried out?

A

May be used during breast cancer surgery where the initial ultrasound does not show any abnormal nodes.

31
Q

What is the process of sentinel lymph node biopsy?

A

Performed during breast surgery for cancer. An isotope contrast and a blue dye are injected into the tumour area.

The contrast and dye travel through the lymphatics to the first lymph node (the sentinel node).

The first node in the drainage of the tumour area shows up blue and on the isotope scanner.

32
Q

Breast cancer cells may have receptors that can be targeted with breast cancer treatments. These receptors are tested for on samples of the tumour and help guide treatment.

What are the 3 main receptor types?

A

Oestrogen receptors (ER)
Progesterone receptors (PR)
Human epidermal growth factor (HER2)

33
Q

What is a triple negative breast cancer?

A

Where the breast cancer cells do not express any of these three receptors. This carries a worse prognosis, as it limits the treatment options for targeting the cancer.

34
Q

4 most common sites of metastasise in breast cancer?

A

Can remember the notable locations that breast cancer metastasis occur using 2 Ls and 2 Bs:

L – Lungs
L – Liver
B – Bones
B – Brain

35
Q

First step carried out in staging of breast cancer?

A

Triple assessment (clinical assessment, imaging and biopsy).

36
Q

What additional investigations may be required to stage the breast cancer?

A

Lymph node assessment and biopsy

MRI of the breast and axilla

Liver ultrasound for liver metastasis

CT of the thorax, abdomen and pelvis for lung, abdominal or pelvic
metastasis

Isotope bone scan for bony metastasis

37
Q

What system can be used to stage breast cancer?

A

The TNM system is used to stage breast cancer. This grades the tumour (T), nodes (N) and metastasis (M).

38
Q

What are the 2 main tumour removal surgeries offered for breast cancer?

A

The objective is to remove the cancer tissue along with a clear margin of normal breast tissue. The options are:

Breast-conserving surgery (e.g., wide local excision), usually coupled with radiotherapy

Mastectomy (removal of the whole breast), potentially with immediate or delayed breast reconstruction

39
Q

When is axillary clearance carried out in breast cancer?

A

Removal of the axillary lymph nodes is offered to patients where cancer cells are found in the nodes. Usually, the majority or all lymph nodes are removed from the axilla.

40
Q

What can axillary clearance increase the risk of in the arm?

A

Increases the risk of chronic lymphoedema in the arm.

41
Q

What is chronic lymphoedema?

A

Lymphoedema is a chronic condition caused by impaired lymphatic drainage of an area.

Lymphoedema can occur in an entire arm after breast cancer surgery on that side, with removal of the axillary lymph nodes in the armpit.

The lymphatic system is responsible for draining excess fluid from the tissues. The tissues in areas affected by an impaired lymphatic system become swollen with excess, protein-rich fluid (lymphoedema).

42
Q

When is radiotherapy used for breast cancer?

A

Usually used in patients with breast-conserving surgery to reduce the risk of recurrence.

43
Q

What are common side-effects of radiotherapy?

A

General fatigue from the radiation

Local skin and tissue irritation and swelling

Fibrosis of breast tissue

Shrinking of breast tissue

Long term skin colour changes (usually darker)

44
Q

What are the 3 scenarios when chemotherapy should be used in breast cancer?

A

Neoadjuvant therapy – intended to shrink the tumour before surgery

Adjuvant chemotherapy – given after surgery to reduce recurrence

Treatment of metastatic or recurrent breast cancer

45
Q

Patients with oestrogen-receptor positive breast cancer are given treatment that disrupts the oestrogen stimulating the breast cancer. True/false?

A

True

46
Q

What are the 2 main first-line options for treatment of oestrogen-receptor positive breast cancer?

A

Tamoxifen for premenopausal women

Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)

47
Q

Mechanism of action for tamoxifen?

A

Tamoxifen is a selective oestrogen receptor modulator (SERM). It either blocks or stimulates oestrogen receptors, depending on the site of action.

It blocks oestrogen receptors in breast tissue, and stimulates oestrogen receptors in the uterus and bones.

This means it helps prevent osteoporosis, but it does increase the risk of endometrial cancer.

48
Q

Does tamoxifen increase risk of osteoporosis?

A

No, decreases the risk of osteoporosis by decreasing oestrogen receptors in the breasts to treat the tumour.

Stimulates oestrogen receptors in uterus and bones to reduce osteoporosis risk. HOWEVER, this increases risk of endometrial cancer due to unopposed oestrogen.

49
Q

How does tamoxifen increase risk of endometrial cancer?

A

It stimulates the oestrogen receptors in the uterus this increases risk of endometrial cancer due to increased unopposed oestrogen present.

To reduce risk, progesterone may be used alongside.

50
Q

When does tamoxifen not increase risk of endometrial cancer?

A

When patient has had a previous hysterectomy (removal of the uterus)

51
Q

What is aromatase?

A

Aromatase is an enzyme found in fat (adipose) tissue that converts androgens to oestrogen.

52
Q

Aromatase inhibitors work by blocking the creation of oestrogen in fat tissue. True/false?

A

True

53
Q

3 main types of targeted treatment for breast cancer?

A

Trastuzumab (Herceptin)

Pertuzumab (Perjeta)

Neratinib (Nerlynx)

54
Q

What is trastuzumab?

A

A monoclonal antibody that targets the HER2 receptor. It may be used in patients with HER2 positive breast cancer.

Notably, it can affect heart function; therefore, initial and close monitoring of heart function is required.

55
Q

What can be used alongside trastuzumab?

A

Pertuzumab (Perjeta) is another monoclonal antibody that targets the HER2 receptor.

Used in combination with trastuzumab (Herceptin).

56
Q

Reconstructive surgery is offered to all patients having a mastectomy, what are the 2 main options?

A

Immediate reconstruction, done at the time of the mastectomy

Delayed reconstruction, which can be delayed for months or years after the initial mastectomy

57
Q

After breast-conserving surgery, reconstruction may not be required. If required, what are the options?

A

Partial reconstruction (using a flap or fat tissue to fill the gap)

Reduction and reshaping (removing tissue and reshaping both breasts to match)

58
Q

After mastectomy, what are the options available for reconstructing the breasts?

A

Breast implants (inserting a synthetic implant)

Flap reconstruction (using tissue from another part of the body to reconstruct the breast)

59
Q

The breast can be reconstructed using a portion of the latissimus dorsi and the associated skin and fat tissue. True/false?

A

True

60
Q

What does “pedicled” mean in breast surgery?

A

Refers to keeping the original blood supply and moving the tissue under the skin to a new location.

61
Q

What is “free flap” in breast surgery?

A

refers to cutting the tissue away completely and transplanting it to a new location.

62
Q

What is the difference between an invasive ductal carcinoma and an invasive lobular carcinoma?

A

Invasive ductal carcinoma typically presents with a discrete lump, rather than an area of thickened breast tissue.

Invasive lobular carcinoma presents with a thickened area of breast tissue alongside changes to the nipple or to the skin.

63
Q

What is the 2nd most common type of breast cancer?

A

Invasive lobular carcinoma

64
Q

What does in-situ mean in ductal carcinoma in situ?

A

Means that the cancer cells remain confined to the ducts and don’t invade surrounding tissues.

65
Q

Main difference between ductal and lobular carcinoma in situ?

A

Lobular carcinoma in situ = not a cancer but area of abnormal cell growth that increases patients risk of developing invasive breast cancer later. Arises from lobules (milk producing glands in the breast). Unlike DCIS, does not produce a mass or tumour.

Ductal carcinoma in situ = non-invasive breast cancer that originates from the lining of the milk ducts in the breast. Often considered precancerous. Cells are confined to the ducts in the breast and have not spread to surrounding breast tissue

Reproduction Y3 (78 decks)

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