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Gen Surg (Breast and Thyroid) > Breast - Carcinoma > Flashcards

Breast - Carcinoma Flashcards

1
Q

What are some risk factors for breast cancer, relating to uninterrupted oestrogen exposure?

A

Early menarche, late menopause, nulliparity, not breastfeeding, first pregnancy aged > 30

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2
Q

What are some medications which are risk factors for breast cancer?

A

HRT and COCP

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3
Q

What histological type of cancer are breast cancers?

A

Adenocarcinoma

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4
Q

What are the two main types of breast cancer and how common is each?

A

Ductal (80%) and lobular (10-15%)

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5
Q

What type of breast cancer can also be known as ‘no specific type’?

A

Ductal carcinoma

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6
Q

What effect do ER and PgR positive breast cancers have on prognosis?

A

Improve prognosis

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7
Q

What effect do HER2 positive breast cancers have on prognosis?

A

Worsen prognosis

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8
Q

HER2 positive breast cancers preferentially metastasise to where? Therefore, you should always be aware when these patients present with what symptom?

A

CNS / headache

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9
Q

Which combination of hormone receptors seen in breast cancers is associated with the best prognosis?

A

ER+, PgR+, HER2-

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10
Q

Which combination of hormone receptors seen in breast cancers is associated with the worst prognosis?

A

ER-, PgR-, HER2-

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11
Q

How is a malignant breast lump most likely to feel on examination?

A

Painless, hard, fixed, irregular

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12
Q

Any red, scaly lesion around the nipple should always be biopsied to check for what diagnosis?

A

Paget’s disease of the nipple

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13
Q

How often, and for what age range, is mammographic breast screening provided for women in the UK?

A

Every 3 years for women aged 50-70

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14
Q

Peau d’orange is usually a feature of what type of breast cancer?

A

Inflammatory breast cancer

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15
Q

What is the most widely accepted tool for calculating the prognosis of a breast cancer?

A

Nottingham Prognostic Index

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16
Q

For women with no palpable axillary lymphadenopathy at presentation, what investigation should they undergo before their primary surgery?

A

Axillary ultrasound

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17
Q

If a woman has no palpable axillary lymphadenopathy and an axillary ultrasound has come back positive, what should be done with regards to lymph nodes at their primary surgery?

A

Sentinel node biopsy

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18
Q

If a woman has palpable axillary lymphadenopathy, what should be done with regards to lymph nodes at their primary surgery?

A

Axillary node clearance

19
Q

What are the two main complications of axillary node clearance?

A

Lymphoedema and functional arm impairment

20
Q

What is the preferred surgical treatment for breast cancer? What must be performed in addition?

A

Breast conserving surgery (WLE) with adjuvant radiotherapy

21
Q

What structures are removed in a modified mastectomy?

A

The entire breast, the overlying skin and the axillary lymph nodes

22
Q

What structure is spared in a modified mastectomy?

A

Pectoralis minor muscle

23
Q

How long is radiotherapy required for after WLE for breast cancer?

A

5 days per week for 3-6 weeks

24
Q

Why is radiotherapy required in addition to WLE for breast cancer?

A

To reduce the risk of recurrence and improve overall survival

25
Q

What are the indications for radiotherapy post-mastectomy?

A

Tumour > 5cm, involvement of > 3 lymph nodes, positive surgical margins

26
Q

If axillary lymph nodes are found to be positive on sampling, but clearance is not performed at primary surgery, what should be done?

A

Axillary radiotherapy

27
Q

What are some side effects of breast radiotherapy?

A

Skin reactions, pneumonitis, pericarditis, rib fractures

28
Q

Why is neoadjuvant chemotherapy sometimes useful in the treatment of breast cancer?

A

To shrink the tumour to allow breast conserving surgery instead of mastectomy

29
Q

Other than radiotherapy, what are some adjuvant treatment options for breast cancer?

A

Chemotherapy, endocrine therapy, targeted therapy

30
Q

In which breast cancers can endocrine therapy be used adjuvantly?

A

In those which are ER or PgR positive

31
Q

What type of drug is Tamoxifen?

A

Oestrogen receptor blocker

32
Q

Which endocrine therapy drug is given to women with ER/PgR positive breast cancers who are pre-menopausal?

A

Tamoxifen

33
Q

How long should patients be on Tamoxifen for after surgery for breast cancer?

A

5-10 years

34
Q

Which endocrine therapy drug is given to women with ER/PgR positive breast cancers who are post-menopausal?

A

Aromatase inhibitors e.g. letrozole

35
Q

What are some potential side effects of Tamoxifen?

A

Increased risk of endometrial cancer and VTE, menopausal side effects

36
Q

What treatments can be given neoadjuvantly in breast cancer to shrink a tumour before surgery?

A

Chemotherapy, endocrine therapy

37
Q

What targeted therapy drug can be given to patients with HER2+ breast cancers?

A

Trastuzumab (Herceptin)

38
Q

How is traztuzumab (Herceptin) given and how long for?

A

SC injection every 3 weeks for 1 year

39
Q

What is the main side effect of trastuzumab (Herceptin) to be aware of? For this reason, who should the drug be avoided in?

A

Cardiac failure - avoid in those with pre-existing cardiovascular disease

40
Q

What scan is used to assess for complications of treatment with trastuzumab every 4 months?

A

ECHO

41
Q

Which systemic therapies for breast cancer can be used palliatively?

A

Chemotherapy and endocrine therapy

42
Q

When may radiotherapy be used palliatively for breast cancer?

A

For fungating breast disease or bony metastases

43
Q

What medication can be given to breast cancer patients with bony metastases to reduce the risk of pathological fractures and to improve pain?

A

Bisphosphonates

Gen Surg (Breast and Thyroid) (8 decks)

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