CANCER Flashcards
Risk factors of breast cancer:
- age > 50
- Ashkenazi Jew ethnicity
- prior history of breast cancer/prior breast biopsy
- history of benign breast disease such as (atypical hyperplasia, sclerosing adenoma, papilloma)
- unopposed estrogen ( nulliparity, first pregnancy >30 y/o, menarche<12 y/o, menopause >55 y/o, not breast feeding, HRT >5 yrs)
- radiation exposure
- first degree relative with breast CA
- BRCA 1 or 2 gene
- obesity, smoking, increased EtOH use
What reduces breast cancer risk? (protective factors)
- early pregnancy <30 y/o
- breast feeding
- not using HRT
- reduce weight (<22.9)
- increased activity
- reduced EtOH use
Breast Cancer Screening for HIGH RISK GROUPS
Screening mammograms (or MRI) annually for women ages 30-74 (in FM notes it is age 30-69) if at least one of the following applies to them:
- They are a BRCA1 or BCRA2 carrier
- They are an untested first degree relative of BRCA1 or BRCA 2 carrier
- Have a very strong family history of breast cancer
- Have had prior chest wall radiation (at age <30 and at least 8 years ago)
mammogram risk
- pain
- anxiety
- false positive
- unnecessary biopsy
When to do genetic testing for Breast Cancer?
- Ashkenazi Jewish ethnicity
- male breast CA
- multiple breast CA on same side of family
- BRCA1 or 2 in the family
- bilateral breast CA
- breast + ovarian CA in same female
- breast CA <50 (esp. if <35)
- ovarian CA (! from FM notes)
- Breast cancer that is hormone receptor negative and HER2 negative (a.k.a. triple negative),
age 60 or younger
Breast cancer prevention in HIGH RISK patients
- mastectomy + salpingo-oophorectomy
- chemoprevention (tamoxifen/ raloxefine/ aromatase inhibitors)
- using MRI (picks extra CA than mammo & U/S but mammo is still better for DCIS)
Types of Breast CA
- Infiltrative ductal carcinoma (MOST COMMON)
- Invasive lobular carcinoma (20 % Bilateral)
- DCIS
- LCIS
- Paget’s disease (ductal CA that invaded the nipple w/ eczema)
- Inflammatory CA (MOST AGGRESSIVE) its ductal CA that invades lymphatics resulting in edema, erythema, warm, tender, peu d’orange)
Triple Testing for Breast CA
- complete breast exam
- imaging (U/S, mammo)
- biopsy (FNA, core biopsy, excisional biopsy)
Breast cancer METS locations
- brain (do brain CT)
- lung (do CXR)
- bone (do bone scan)
- liver (do Abdo U/S)
tamoxifen S/E & risks
Common side effects
Common side effects of tamoxifen include:
- Hot flashes - Night sweats - Vaginal discharge - Vaginal dryness - fatty liver
Risks
Rarely, taking tamoxifen may cause:
-Blood clots
-Endometrial cancer or uterine cancer
-Cataracts
-Stroke
Aromatase inhibitors S/E and risks
side effects of aromatase inhibitors include: Hot flashes Vaginal dryness Joint and muscle pain rash Headache Fatigue somnolence
Risks:
Aromatase inhibitors increase the risk of osteoporosis and increase lipids and BP
so do BMD q2yr and lipid q1yr
Risk factors for cervical cancer
- sexual activity at a young age (<20 y/o)
- multiple partners
- having a partner w/ a number of previous intimate contact
- smoking
- weakened immune system
- longterm OCP
- giving birth to multiple children
protective factors for cervical cancer
- routine PAP
- HPV immunization (grade 8 to age 45)
Screening special populations for cervical cancer
- immunocompromised (e.g: HIV, chronic immunosuppressants) (annual screen)
- SLE (annual screen)
- total hysterectomy (if hx of HSIL, AIS, or cancer - annual vault smear for life
- subtotal hysterectomy w/ cervix intact - routine screening
- pregnant - same screen as non pregnant, if ASCUS & LSIL found in pregnancy - do not repeat until after 6 months post partum
HPV testing once funded
- screen age 30 - 65
- q5yearly
- if HPV DNA is positive then do cytology testing; if cytology is negative then repeat HPV testing in 1 year then q5yearly, if cytology is positive then refer to colposcopy
- if 2 or more tests in past 10 yrs are negative then can stop screening at age 65
