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Cancer Care > Breast Disease > Flashcards

Breast Disease Flashcards

1
Q

What is a carcinoma in situ?

A

This is when the carcinoma is maintained within the basement membrane and is classified as a pre-malignant condition.

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2
Q

What are the two main types of carcinoma in situ, in breast disease?

A

Ductal carcinoma in situ - 20% of all breast cancers

Lobular carcinoma in situ

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3
Q

What are the four different classifications of carcinoma in situ and which presentation is most common?

A

Solid

Micropapillary

Cribriform

Comedo

Nb. Lesions are most commonly mixed

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4
Q

On screening, what will each disease show?

  • DCIS
  • LCIS
A

DCIS will show microcalcifications on mammography, confirmation of diagnosis on biopsy

LCIS doesn’t show calcifications and is usually diagnosed as an incidental finding on the breast.

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5
Q

Which type of DCIS is most likely to form microcalcifications?

A

Comedo will most likely form calcifications.

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6
Q

Which type of DCIS will show focal lesions on mammography?

A

Cribriform and micropapillary

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7
Q

What is the management for DCIS?

A

Localised lesion - A wide local excision

Widespread or multifocal - complete mastectomy

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8
Q

Which type of carcinoma in situ (in breast disease) is more likely to develop invasive cancer?

A

Lobular carcinoma in situ - although they are not as common as DCIS.

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9
Q

What is the management for LCIS?

A

Low grade LCIS - monitor

Bilateral prophylactic mastectomy can be indicated in patients who have the BRCA1/2 genes.

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10
Q

How can invasive breast cancers be classified?

A

1) Invasive ductal carcinoma - 80% of carcinomas
2) Invasive lobular carcinoma - 10% of carcinomas
3) Other subtypes - e.g. medullary and mucinous (aka colloid).

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11
Q

Which patient demographic does invasive lobular carcinoma affect?

A

Older women.

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12
Q

How does age affect the likelihood of someone getting breast cancer?

A

It doubles the likelihood of getting breast cancer every ten years until the menopause

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13
Q

What are some of the risk factors for developing breast cancer?

A
  • Female
  • Older age
  • Nulliparous
  • Early menarche/late menopause
  • First pregnancy after 30 years old
  • Obesity
  • Positive family history
  • Genes - BRCA1/2, PTEN, TP53
  • Geographic variation - more common in developed countries
  • Oral contraceptives/HRT
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14
Q

What are some of the clinical features of invasive breast cancer?

A
  • Nipple changes - redness, retraction, abnormal discharge
  • Skin changes - peau d’orange or Paget’s
  • Lump in breast
  • Lump in axilla
  • Mastalgia
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15
Q

Which tool is used to work out the prognosis of a patient with invasive breast cancer?

A

The Nottingham prognostic index

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16
Q

Which tool is used to grade an invasive breast cancer?

A

The Bloom-Richardson scale

17
Q

Which receptors should be tested for in breast cancer?

A

ER - Oestrogen receptor

PR - Progesterone receptor

HER2 - Human epidermal growth factor 2 receptor

18
Q

Who qualifies for the breast screening programme? How often are they screened?

A

Women aged 50-70 years old, who are screened every 3 years

19
Q

How does Pagets disease present?

A

Roughening, reddening and hardening of the nipple, painful around the area. It is different to eczema as there is also nipple involvement as well as the areola. 97% of cases have underlying breast disease (whether in situ or invasive)

20
Q

How do you diagnose Paget’s disease?

A

A biopsy of the nipple is taken for histological analysis and in some cases the entire nipple is taken.

21
Q

What is the management for Paget’s disease?

A

In all cases the nipple and areola needs to be removed.

Radiotherapy may be necessary if there is an underlying malignancy.

22
Q

Describe breast conserving treatment in breast cancer?

A

The most common type is a wide local excision where the tumour is resected with a 1cm margin.

23
Q

What is a mastectomy?

A

This is removal of all of the breast tissue on the affected side/both sides alongside a significant portion of the overlying skin (dependent on whether a reconstruction will be carried out).

24
Q

When is a mastectomy indicated?

A
  • Recurrent disease
  • High tumour to breast tissue ratio
  • Multifocal disease
  • Patient choice
25
Q

What are the two main types of axillary surgery?

A
  • Sentinel node biopsy - Blue dye injected into peri-areolar skin, sentinel nodes will become blue and are excised and sent for histological analysis
  • Axillary node clearance - All lymph nodes are removed and are sent for histological analysis. Common complications include lymphoedema, paraesthesia and seroma formation.
26
Q

When is medical management used in breast cancer?

A

As adjuvant therapy in a malignant non-metastatic breast cancer following WLE.

In elderly women or those deemed unfit for surgery

27
Q

Tamoxifen

  • Mechanism of action
  • Patient demographic
  • Risks of treatment
A
  • MOA: Oestrogen receptor blockade
  • Patient demographic: pre-menopausal women
  • Risks of treatment: uterine cancer risk increased, menopausal symptoms, increased risk of thromboembolic event
28
Q

Aromatase inhibitors

Examples?

MOA?

Patient demographic?

Risks?

A

Examples: Anastrozole, Letrozole

MOA: Bind to oestrogen receptors to prevent further growth and oestrogen production. Also blocks conversion of androgens to oestrogens in peripheral tissue.

Patient demographic: post-menopausal patients. They are shown to be more effective in these patients even though they are more expensive

29
Q

What is Herceptin?

Clinical indication?

A

Trastuzumab - a monoclonal antibody that targets the activity of the HER2 receptor.

It can be used as an adjuvant therapy or monotherapy in HER2 positive patients who have had at least 2 chemotherapy regimens for metastatic breast cancer.

30
Q

What is a common side effect of Herceptin?

A

Cardiotoxicity - therefore cardiac health has to be carefully monitored whilst patients are taking this medication.

31
Q

What is the procedure called whereby you will remove a tumour on the affected breast (WLE) and carry out a breast reduction on the contralateral side?

A

This is called a therapeutic mammoplasty.

32
Q

Name the three different flap formations that can be carried out in Oncoplastic surgery?

A

Latissimus dorsi flap - a free or pedicle flap. Only a small amount of muscle can be used so this technique is suited to smaller breasts.

Transverse rectus abdominal muscle flap - use of muscle, fat and skin as a free or pedicle flap. This reduces fat on the abdomen but makes muscles weaker.

Deep inferior epigastric perforator flap - a free flap using abdominal skin and tissue. No muscle is used so abdominal strength is maintained.

Cancer Care (3 decks)

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