Breast conditions and cancer Flashcards

1
Q

describe the incidence and mortality of breast cancer over time

A

incidence is increasing as mortality is decreasing

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2
Q

what % of breast cancer patients are asymptomatic

A

50

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3
Q

common symptoms of breast cancer

A
lump in breast 
bleeding or non physiological discharge from nipple 
pain in breast 
altered shape/contour or skin change 
lumpy breast
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4
Q

what happens at a triple assessment clinic?

A

clinical exam by hx and exam
radiology by USS or mammogram
core biopsy - cytology is rarely used so core or vacuum core biopsy for histopathology

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5
Q

grading of needle core biopsy?

A
B1 - unsatisfactory/normal 
B2 - benign 
B3 - atypical but probably benign 
B4 - suspicious of malignancy 
B5a - CIS 
B5b - invasive carcinoma
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6
Q

what is the intermediate paradigm of breast cancer

A

breast cancer is a potentially systemic disease and so early detection through screening and local control prevents metastatic spread

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7
Q

treatment for early breast cancer - local

A

radiotherapy

surgery

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8
Q

treatment for early breast cancer - systemic

A

chemotherapy

hormonal - tamoxifen, aromatase inhibitors, GnRH, oophorecotmy

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9
Q

where may later of advanced breast cancer present and management?

A

bone or soft tissue

systemic therapy to improve QOL or symptom control

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10
Q

what is an ANDI

A

alternations in normal development and involution
anything thats not cancer
fibrocystic change, cyst, papilloma

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11
Q

example of a hormonal change leading to breast condition

A

gynaecomastia

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12
Q

example of inflammatory benign breast conditions

A

mastitis

abscess

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13
Q

describe the physiology of lactation

A

babies cries heard in higher centres and removes prolactin inhibition and stimulates oxytocin release
prolactin stimulates milk secretion and oxytocin stimulates smooth muscle contraction and ejection of milk
ejection partly triggered by mechanoreceptors in nipple from suckling

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14
Q

NPI <3?

A

excellent prognosis

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15
Q

NPI<3.4?

A

good prognosis

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16
Q

NPI 3.41-5.4?

A

moderate prognosis

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17
Q

NPI >5.41

A

poor prognosis

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18
Q

methods of breast conservation surgery?

A

wide local excision
image guided local excision
oncoplastic surgery

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19
Q

what is the alternative to breast conserving surgery

A

mastectomy

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20
Q

chemotherapy given as neoadjuvant?

A

FEC and taxane ±herceptin

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21
Q

true/false - mastectomy is more effective than breast conserving surgery + radiotherapy

A

false, they are just as effective

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22
Q

what is WLE used for, what is the margin and where is cut

A

palpable symptomatic cancers
just below skin to pectoral fascia
aim for >1cm

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23
Q

when is image guided local excision used, margin and method?

A

asymptomatic cancers detected on screen
1mm margin
clips, RF wave, magnetic seed

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24
Q

what is oncoplastic breast conservation

A

oncological surgery with additional aim to avoid tissue deformity

25
Q

types of oncoplastic breast conservation surgery

A

therapeutic mastopexy
therapeutic reduction mammoplasty
volume replacement

26
Q

what is a mastectomy and types

A

removal of all breast tissue

standard or skin sparing

27
Q

options for reconstruction following mastectomy

A
immediate/delayed 
external 
implant 
LD pedicle flap 
deep inferior epigastric artery free flap 
inferior/superior gluteal artery free flap 
transverse upper gracilis free flap
profunda artery free flap
28
Q

risks associated with breast reconstruction implant

A
infection 
rippling 
migration 
capsular constriction 
revision surgery 
ALC lymphoma
29
Q

options for lymph node breast cancer treatment

A

USS axilla and biopsy
sentinel node biopsy
axillary clearance
axillary radiotherapy

30
Q

risk of axillary clearance

A

lymphoedema

31
Q

how is lymphoedema avoided in axillary clearance surgery

A

tracer injection to only remove nodes that are stained due to uptake of lymph from breast

32
Q

what intrinsic subtype of breast cancer has the best prognosis

A

luminal like A

33
Q

what intrinsic subtype of breast cancer has the worst prognosis

A

triple negative

34
Q

systemic tx for luminal like A cancer

A

ET alone

ChT if high risk, large tumour or multiple nodes

35
Q

systemic tx for luminal like ABcancer

A

ChT and ET

36
Q

systemic tx for luminal like B and HER2+ve cancer

A

ChT and anti-HER2 and ET

if chemo contraindicated then just anti-HER2 and ET

37
Q

systemic tx for HER2+ve non luminal

A

ChT and anti-HER2

38
Q

systemic tx for triple negative cancer

A

ChT

39
Q

indications for neoadjuvant therapy

A

downsize tumour
enrol pt into trial
locally advanced disease needing rendered operable
large primaries or large to breast

40
Q

for what type of cancers is genomic testing carried out

A

ER+ve sensitive cancers

41
Q

what kind of genomic test is carried out on breast cancers and what does it indicate

A

oncotype dx
risk of recurrence
likelihood of ChT benefit after surgery

42
Q

acute side effects of chemotherapy

A
fatigue 
myelosuppression leading to infection, anaemia, thrombocytopaenia 
N&V
alopecia 
mucositis 
diarrhoea 
constipation 
renal 
neurotoxicity 
infertility
43
Q

late side effects of chemotherapy

A
cardiotoxicity 
infertility 
neruopathy 
renal impairment 
osteoporosis 
carcinogenesis
44
Q

neoadjuvant tx in HER2+ve cancers

A

preop ChT and trastuzumab and pertuzumab

45
Q

what to do drugs if there is clinical response to neoadjuvant tx in HER2+ve cancer

A

if ER-ve then 1 yr dual blockade trastuzumab and pertuzumab or just trastuzumab
other cases 1yr trastuzumab

46
Q

side effects of HER2 targeted drugs

A
congestive HF 
severe diarrhoea 
hand-foot syndrome 
ILD/pneumonitis 
transaminitis
47
Q

neoadjuvant endocrine therapy?

A

ER+ve
pre/perimenopausal - letrozole + gosrelin or tamoxifen ±gosrelin

postmenopausal - letrozole

48
Q

side effects of AI

A
joint pain
osteoporosis 
hot flushes 
fatigue 
sweating 
weight gain 
sexual dysfunction 
loss libido 
mood swings
49
Q

treatment recommendations for ER+ve breast cancer postmenopause

A

low risk - tamoxifen or AI 5yr

high risk - extended adjuvant AI

50
Q

treatment recommendations for ER+ve breast cancer premenopause

A

low risk - tamoxifen 5yr

high risk - ovarian suppression +tam or OS +exmestane

51
Q

who can be given adjuvant bisphosphonates

A

postmenopause and considered risk for tx with adjuvant AI or HER2+ve or ER low/neg
premenopausal with ovarian suppression

52
Q

what is the usual drug for adjuvant bisphosphonate

A

3yr 6monthly zoledronate

53
Q

staging workup for met disease

A

hx and exam
biochem and haematoilogy
chest, abdo, bone imaging
not head unless symptomatic

54
Q

describe action of CDK4/6 inhibitors

A

block CDK4/6 so prevent phosphorylation of Rb so halt cell cycle

55
Q

when are CDK4/6 inhibitors best when given with

A

ET

56
Q

toxicities of CDK4/6 inhibitors

A

neutropaenia
diarrhoea
increased AST/ALT
QTc prolongation

57
Q

early toxicities radiotherapy

A

fatigue
skin reaction
hair loss in radiation field

58
Q

late toxicities radiotherapy

A
breast change 
discomfort 
telangectasia 
lymphoedema 
heart vessel damage 
asymptomatic/symptomatic lung fibrosis