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Breast Malignancy Flashcards

1
Q

The malignancy is a CARCINOMA if it is _____ in origin

A

Epithelial

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2
Q

The malignany is a SARCOMA if it is _____ in origin

A

Soft tissue

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3
Q

Breast carcinoma - definition

A

Malignant tumour of breast epithelial cells

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4
Q

Where does breast carcinoma arise?

A

In the glandular epithelium of the terminal duct lobular unit

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5
Q

Ductal precursor lesions (intraductal proliferation) - 4

A

Epithelial hyperplasia of usual type
Columnar cell change
Atypical ductal hyperplasia
Ductal carcinoma in situ

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6
Q

Ductal carcinoma in situ - definition

A

Carcinoma which arises in the terminal duct lobular unit which is confined within the basement membrane (i.e. it has features of malignancy but it is not invasive)

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7
Q

Ductal carcinoma in situ - clinical features

A

Often asymptomatic and picked up on breast screening (mammography) as calcifications

May have

  • breast lump
  • blood stained nipple discharge
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8
Q

Which condition is often found in conjunction with paget’s disease of the nipple?

A

DCIS (high grade)

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9
Q

Paget’s disease of the nipple and DCIS

A

Only with high grade DCIS.
High grade DCIS extends along the ducts to reach the epidermis of the nipple. This is still in situ as the basement membrane is still continuous

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10
Q

Paget’s disease of the nipple - clinical features

A

Eczema like changes to the skin of the nipple and the areola.
The addicted skin is often sore and inflamed, it can be itchy or cause a burning sensation

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11
Q

DCIS - imaging investigations

A

Mammography - calcifications

US - lymph nodes

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12
Q

DCIS - diagnostic investigatons

A

Biopsy

  • core needle biopsy
  • vacuum biopsy
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13
Q

DCIS - management

A

Surgery

  • wide local excision
  • if you don’t know where it is (i.e. no lump, can only see it on imaging) then it should be wire guided

Adjuvant radiotherapy
- reduce the risk of recurrence in the future

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14
Q

DCIS - if this is the diagnosis, should you do a sentinel node biopsy?

A

No, because the cancer is in situ and therefore hasn’t spread anywhere else

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15
Q

Lobular precursor lesions

A

Lobular in situ neoplasia

  • atypical lobular hyperplasia
  • lobular carcinoma in situ
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16
Q

What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ?

A

Atypical lobular hyperplasia has less than 50% lobule involvement

Lobular carcinoma in situ has over 50% lobule involvement

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17
Q

Lobular in situ neoplasia - definition

A

Cancer is confined within the basement membrane. It is non invasive as it has not breached the basement membrane

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18
Q

Lobular in situ neoplasia - clinical features

A

Often asymptomatic and detected in breast screening (mammography) as an area of calcification

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19
Q

Lobular in situ neoplasia - incidence increases/decreases after the menopause?

A

Decreases

- as oestrogen levels drop

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20
Q

Lobular in situ neoplasia - investigations

A

Difficult to see on imaging
Mammography - calcifications
US elastography - Stiff

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21
Q

Lobular in situ neoplasia is ER positive/negative?

A

Positive

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22
Q

Lobular in situ neoplasia - diagnosis

A

Core needle biopsy

Vacuum biopsy

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23
Q

Lobular in situ neoplasia - management

A

Vacuum assisted biopsy or

Excisional biopsy

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24
Q

Invasive breast carcinoma - definition

A

Malignant epithelial cells which have breached the basement membrane

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25
What is the most common histologic type of breast cancer?
Ductal carcinoma
26
Incidence of breast cancer is decreasing. True or false?
False | - it is increasing
27
Breast cancer - which age group is it most common in
Middle age -> older women
28
Breast cancer is the most common cause of a breast lump in women over 50. True or false?
True
29
How can breast cancer be asymptomatic?
If it is picked up by breast screening
30
Breast cancer - clinical features
``` Dimpled or depressed breast skin Visible lump on breast Nipple change Bloody discharge - unilateral Breast colour/texture change ```
31
Breast cancer - imaging findings
Calcifications | Spiculate masses
32
Triple assessment - what are the components
Clinical assessment - history and examination Radiology - mammography if over 40 - US if under 40 Pathology - biopsy (usually core needle)
33
Tumour grading - how many grades?
1 (low grade) -> 3 (high grade)
34
Which 3 things are assessed to determine the tumour grade?
``` Tubular differentiation (score 1->3) Nuclear pleomorphism (score 1->3) Mitotic activity (score 1->3) ```
35
Risk factors
``` Female Older age Obesity Early menarche Late menopause Hormones - OCP, HRT Previous breast disease Nulliparity Dense breasts Radiation exposure Alcohol consumption Diet Smoking Genetics (more later) ```
36
What are the 2 main genetic mutations in breast cancer
BRCA 1 | BRCA 2
37
Protective factors
Physical activity | Breast feeding
38
Hormone receptors - what are the 3 hormone receptors?
ER (oestrogen receptor) PgR (progestogen receptor) HER 2 (Human Epithelial growth factor Receptor) 2
39
If a breast cancer is ER +ve, what should be part of the management
Anti-oestrogen therapy (Oestrogen blockade) - oophorectomy - tamoxifen - aromatase inhibitors - GnRH antagonists
40
If a breast cancer is HER 2 +ve then what should be part of the patients management?
Trastuzamab (herceptin) | - MAb which targets HER 2
41
How do you stage a tumour?
TNM T = direct invasion of adjacent structures (T0->T4) N = lymph node spread (N0->N3) M = distant metastasis
42
Which lymph nodes does breast cancer spread to first
Axillary lymph nodes
43
What is a sentinel node?
The first lymph node draining a cancer
44
Which group of lymph nodes are located medially, near the sternum?
Internal mammary nodes
45
What are the 4 most common sites for metastasis?
``` Bones Lung Pleura Liver Brain ```
46
What is the best management option for breast cancer?
Surgery
47
What are the 2 types of surgery for breast cancer?
Breast conserving surgery | Mastectomy
48
Which is preferred surgical option: - mastectomy - breast conserving surgery
Breast conserving surgery
49
When carrying out breast conserving surgery, clear margins of ___ cm are required?
1-2cm
50
Breast conserving surgery is just as effective as mastectomy if there is also administration of ______ in BCS
Adjuvant radiotherapy
51
Breast conserving surgery - definition
Keep the breast tissue and just remove the cancer (wide local excision)
52
How do you manage cancer patients where you can't feel a palpable mass but breast cancer is detected on imaging?
Imaging wire guided local excision
53
If it is a large and advanced breast cancer, what might be useful before surgery?
Neo-adjuvant treatment
54
Mastectomy - definition
Removal of the entire breast, including the skin and the axillary lymph nodes
55
In mastectomy, there is preservation/removal of the pectoralis major?
Preservation
56
Immediate or delayed reconstruction after mastectomy; which is the best?
Immediate - better aesthetic outcome - allows you to keep as much of the patients skin as possible to recreate a new breast
57
What are the options following breast mastectomy?
External prosthesis Reconstruction Implant only
58
Which drug is used as neo-adjuvent therapy for breast cancer and what is the purpose of this?
Chemotherapy Purpose: Reduces the amount of surgery required
59
What is adjuvant therapy?
Back up therapy which is administered after the main treatment (surgery) This prevents recurrence
60
Which 2 chemotherapy regimens are usually used for breast cancer?
Anthracycline | Taxane
61
In ER +ve tumours _____ should be given following surgery for ____ duration
Tamoxifen | 10 years
62
Oestrogen blockade - tamoxifen - disadvantages
Avoid pregnancy Can cause endometrial cancer Common to induce endometrial hyperplasia and/or polyps
63
Oestrogen blockade - name 2 aromatase inhibitors
Lrtrozole | Anastrozole
64
Invasive hormone therapy for breast cancer
Oophorectomy
65
Spiculation is a features of High/Low grade invasive/non-invasive carcinoma?
Low grade invasive carcinoma
66
Is vacuum biopsy suitable for removing a cancer?
No - it breaks the tumour up into lots of small sections. - when dealing with cancer, we need to assess size and margins
67
When is sentinel node biopsy required?
When there is diagnosis of invasive cancer
68
if sentinel node biopsy is -ve, what does this mean?
Sentinel node is generally bottom of the ladder so if this is -ve then all the other nodes in the axillary area will also be -ve
69
If you remove all the axillary nodes, what can this result in?
Lymphoedema
70
Post surgery, patients should all get what?
Adjuvant radiotherapy
71
Management of late or advanced disease?
Palliative care | - symptom control
72
Which people are likely to have a relapse ?
Nodal metastases Large tumour High grade
73
Name 4 tumours that metastasise to the breast
Bronchial carcinoma Ovarian serous carcinoma Clear cell carcinoma of the kidney Malignant melanoma
74
What is the most common sarcoma in the breast?
Angiosarcoma
75
Neo adjuvant treatment is given before/after surgery?
Before
76
What is tamoxifen?
Oestrogen blockade | - competitive antagonist of the ER
77
Tamoxifen can cause which type of cancer?
Endometrial cancer
78
What do aromatase inhibitors do?
Drop the oestrogen level to really low
79
HER2 receptor +ve breast cancers should get which treatment?
Herecptin (Trastuzamab)
80
Palliative care for fun gating breast disease of bone mets
Radiotherapy | Bisphosphonates
81
Patients who have been discharged should receive yearly mammograms for how many years?
3 years
82
If the patient develops neutropenia during chemotherapy but has no symptoms, what should be done?
Nothing
83
Recommend to have which contraceptive removed?
Mirena coil
84
Patient who has been treated for breast cancer develops a lump after receiving adjuvant treatment. What is this likely to be?
Fat necrosis
85
HER2 +ve patient with headaches. What could this be?
Brain mets
86
Patient is using ER-blockade (tamoxifen) but is experiencing vaginal dryness. What can be done to help treat this issue?
Vagifem
87
In which quadrant of the breast do breast cancers usually occur?
Upper outer quadrant
88
Everyone who undergoes Breast conserving surgery must have?
Radiotherapy
89
Who should get chemotherapy?
Young patients | patients with axillary lymph node involvement

Reproduction SOH (50 decks)

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