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Reproduction SOH > Breast Malignancy > Flashcards

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
Q

What is the most common histologic type of breast cancer?

A

Ductal carcinoma

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26
Q

Incidence of breast cancer is decreasing. True or false?

A

False

- it is increasing

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27
Q

Breast cancer - which age group is it most common in

A

Middle age -> older women

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28
Q

Breast cancer is the most common cause of a breast lump in women over 50. True or false?

A

True

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29
Q

How can breast cancer be asymptomatic?

A

If it is picked up by breast screening

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30
Q

Breast cancer - clinical features

A 
Dimpled or depressed breast skin
Visible lump on breast 
Nipple change 
Bloody discharge 
- unilateral 
Breast colour/texture change
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31
Q

Breast cancer - imaging findings

A

Calcifications

Spiculate masses

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32
Q

Triple assessment - what are the components

A

Clinical assessment
- history and examination

Radiology

  • mammography if over 40
  • US if under 40

Pathology
- biopsy (usually core needle)

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33
Q

Tumour grading - how many grades?

A

1 (low grade) -> 3 (high grade)

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34
Q

Which 3 things are assessed to determine the tumour grade?

A 
Tubular differentiation (score 1->3) 
Nuclear pleomorphism (score 1->3)
Mitotic activity (score 1->3)
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35
Q

Risk factors

A 
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)
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36
Q

What are the 2 main genetic mutations in breast cancer

A

BRCA 1

BRCA 2

37
Q

Protective factors

A

Physical activity

Breast feeding

38
Q

Hormone receptors - what are the 3 hormone receptors?

A

ER (oestrogen receptor)
PgR (progestogen receptor)
HER 2 (Human Epithelial growth factor Receptor) 2

39
Q

If a breast cancer is ER +ve, what should be part of the management

A

Anti-oestrogen therapy (Oestrogen blockade)

  • oophorectomy
  • tamoxifen
  • aromatase inhibitors
  • GnRH antagonists
40
Q

If a breast cancer is HER 2 +ve then what should be part of the patients management?

A

Trastuzamab (herceptin)

- MAb which targets HER 2

41
Q

How do you stage a tumour?

A

TNM
T = direct invasion of adjacent structures (T0->T4)
N = lymph node spread (N0->N3)
M = distant metastasis

42
Q

Which lymph nodes does breast cancer spread to first

A

Axillary lymph nodes

43
Q

What is a sentinel node?

A

The first lymph node draining a cancer

44
Q

Which group of lymph nodes are located medially, near the sternum?

A

Internal mammary nodes

45
Q

What are the 4 most common sites for metastasis?

A 
Bones 
Lung 
Pleura 
Liver
Brain
46
Q

What is the best management option for breast cancer?

A

Surgery

47
Q

What are the 2 types of surgery for breast cancer?

A

Breast conserving surgery

Mastectomy

48
Q

Which is preferred surgical option:

  • mastectomy
  • breast conserving surgery
A

Breast conserving surgery

49
Q

When carrying out breast conserving surgery, clear margins of ___ cm are required?

A

1-2cm

50
Q

Breast conserving surgery is just as effective as mastectomy if there is also administration of ______ in BCS

A

Adjuvant radiotherapy

51
Q

Breast conserving surgery - definition

A

Keep the breast tissue and just remove the cancer (wide local excision)

52
Q

How do you manage cancer patients where you can’t feel a palpable mass but breast cancer is detected on imaging?

A

Imaging wire guided local excision

53
Q

If it is a large and advanced breast cancer, what might be useful before surgery?

A

Neo-adjuvant treatment

54
Q

Mastectomy - definition

A

Removal of the entire breast, including the skin and the axillary lymph nodes

55
Q

In mastectomy, there is preservation/removal of the pectoralis major?

A

Preservation

56
Q

Immediate or delayed reconstruction after mastectomy; which is the best?

A

Immediate

  • better aesthetic outcome
  • allows you to keep as much of the patients skin as possible to recreate a new breast
57
Q

What are the options following breast mastectomy?

A

External prosthesis
Reconstruction
Implant only

58
Q

Which drug is used as neo-adjuvent therapy for breast cancer and what is the purpose of this?

A

Chemotherapy

Purpose: Reduces the amount of surgery required

59
Q

What is adjuvant therapy?

A

Back up therapy which is administered after the main treatment (surgery)
This prevents recurrence

60
Q

Which 2 chemotherapy regimens are usually used for breast cancer?

A

Anthracycline

Taxane

61
Q

In ER +ve tumours _____ should be given following surgery for ____ duration

A

Tamoxifen

10 years

62
Q

Oestrogen blockade - tamoxifen - disadvantages

A

Avoid pregnancy
Can cause endometrial cancer
Common to induce endometrial hyperplasia and/or polyps

63
Q

Oestrogen blockade - name 2 aromatase inhibitors

A

Lrtrozole

Anastrozole

64
Q

Invasive hormone therapy for breast cancer

A

Oophorectomy

65
Q

Spiculation is a features of High/Low grade invasive/non-invasive carcinoma?

A

Low grade invasive carcinoma

66
Q

Is vacuum biopsy suitable for removing a cancer?

A

No

  • it breaks the tumour up into lots of small sections.
  • when dealing with cancer, we need to assess size and margins
67
Q

When is sentinel node biopsy required?

A

When there is diagnosis of invasive cancer

68
Q

if sentinel node biopsy is -ve, what does this mean?

A

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
Q

If you remove all the axillary nodes, what can this result in?

A

Lymphoedema

70
Q

Post surgery, patients should all get what?

A

Adjuvant radiotherapy

71
Q

Management of late or advanced disease?

A

Palliative care

- symptom control

72
Q

Which people are likely to have a relapse ?

A

Nodal metastases
Large tumour
High grade

73
Q

Name 4 tumours that metastasise to the breast

A

Bronchial carcinoma
Ovarian serous carcinoma
Clear cell carcinoma of the kidney
Malignant melanoma

74
Q

What is the most common sarcoma in the breast?

A

Angiosarcoma

75
Q

Neo adjuvant treatment is given before/after surgery?

A

Before

76
Q

What is tamoxifen?

A

Oestrogen blockade

- competitive antagonist of the ER

77
Q

Tamoxifen can cause which type of cancer?

A

Endometrial cancer

78
Q

What do aromatase inhibitors do?

A

Drop the oestrogen level to really low

79
Q

HER2 receptor +ve breast cancers should get which treatment?

A

Herecptin (Trastuzamab)

80
Q

Palliative care for fun gating breast disease of bone mets

A

Radiotherapy

Bisphosphonates

81
Q

Patients who have been discharged should receive yearly mammograms for how many years?

A

3 years

82
Q

If the patient develops neutropenia during chemotherapy but has no symptoms, what should be done?

A

Nothing

83
Q

Recommend to have which contraceptive removed?

A

Mirena coil

84
Q

Patient who has been treated for breast cancer develops a lump after receiving adjuvant treatment. What is this likely to be?

A

Fat necrosis

85
Q

HER2 +ve patient with headaches. What could this be?

A

Brain mets

86
Q

Patient is using ER-blockade (tamoxifen) but is experiencing vaginal dryness. What can be done to help treat this issue?

A

Vagifem

87
Q

In which quadrant of the breast do breast cancers usually occur?

A

Upper outer quadrant

88
Q

Everyone who undergoes Breast conserving surgery must have?

A

Radiotherapy

89
Q

Who should get chemotherapy?

A

Young patients

patients with axillary lymph node involvement

Reproduction SOH (50 decks)

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