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MHD II Test 3 > Clinical Aspects of Breast Disease > Flashcards

Clinical Aspects of Breast Disease Flashcards

1
Q

Risk Factors in Development of Breast Cancer

A 
Age (risk increases as age increases)
Female Gender
Family hx of breast cancer
Genetic predisposition
Prior personal hx of breast cancer
Increased estrogen exposure (early menarche, late menopause, HRT)
Nulliparity (1st preg after 30)
Diet and lifestyle
Radiation exposure before age 40
Prior benign or premalignant breast changes (in situ cancer, atypical ductal hyperplasia (ADH))
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2
Q

Atypical Ductal Hyperplasia

  1. Describe
  2. What is it associated with?
A
  1. hyperplasia within a duct

2. increased risk of breast cancer development in either breast; marker of breast cancer risk

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3
Q

What factors does the Gail Model take into account? (6)

A
  1. age
  2. age at menarche
  3. age at 1st birth/nulliparity
  4. number of 1st degree relatives w/ breast cancer
  5. number of breast biopsies
  6. pathological diagnosis of atypia
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4
Q

Selective Estrogen Receptor Modulators

  1. Two drugs
  2. Approved for what
  3. Mechanism
  4. How effective are they
A
  1. Tamoxifen and Raloxifene
  2. reduce breast cancer risk in women w/ Gail risk >1.66%; Raloxifene only for postmenopausal women
  3. estrogen agonist and antagonist properties based on specific tissue target and hormonal milieu
  4. reduce risk of developing invasive breast ca by 50% when taken daily for 5 years
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5
Q

Side Effects of Tamoxifen (5)

  1. what is a protective effect?
  2. how does raloxifene differ?
A
  1. reduces cholesterol
  2. uterine stimulation, bothersome GYN side effects, uterine cancer
  3. hot flashes/sweats
  4. anti-estrogenic against breast cancer; no agonist activity
  5. increased risk of thromboembolism
  6. maintains bone density
  7. no increased risk of uterine ca or thromboembolism
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6
Q

Aromatase Inhibitors: What might they do?

A

reduce incidence of developing breast cancer

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7
Q

Screening Mammography

  1. What do they do to breast cancer mortality?
  2. Recommendation
A
  1. reduces mortality

2. at least biennial mammography between ages 50-74

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8
Q

What are some adverse side effects of Hormone Replacement Therapy? (4)
5. What was a benefit?

A
  1. increased risk of breast cancer
  2. Coronary-heart disease
  3. stroke
  4. Venous thromboembolism
  5. reduced rate of fractures
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9
Q
  1. What is the benefit of Modified Radical Mastectomy vs Breast Conserving surgery?
  2. What is a sentinel node biopsy?
A
  1. none, likelihood of cure is the same

2. removes lymph nodes that receive drainage from site of neoplasm; less invasive, fewer complications, more accurate

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10
Q
  1. Radiation Therapy: used after what other treatment?

2. What are the goals of adjuvant therapy? (3)

A
  1. breast conserving therapy
  2. reduce burden of clinically undetectable, distant micrometastatic disease
  3. improve relapse-free survival
  4. improve overall survival
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11
Q

Tamoxifen

  1. What cancer types is it used for?
  2. What does it do?
  3. Side effects?
  4. Is raloxifene used for breast cancer treatment?
A
  1. pre and post-menopausal women with ER/PR positive tumors
  2. decreases risk of tumor recurrence by approximately 50%
  3. endomett
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12
Q

Aromatase Inhibitors

  1. Name the drugs
  2. Mechanism
  3. Who are they indicated in?
  4. Side effects (2)
  5. How long are they used?
A
  1. Anastrozole, Letrozole, Exemestane
  2. blocks aromatase enzyme in the final step of estrogen biosynthesis (adipose tissue); blocks conversion of androgens to estrogens
  3. post-menopausal women
  4. arthralgias, bone loss (important)
  5. 5 years
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13
Q

Adjuvant Chemotherapy

  1. What does it reduce? (2)
  2. Optimal duration
  3. Used with what?
  4. What is used if the tumor is HER2+?
A
  1. reduces recurrence rates by 30%, decrease mortality by 20%
  2. 3-6 months
  3. in addition to hormone therapy
  4. trastuzumab
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14
Q

Questions to ask in the Hx of Breast Mass

A 
Location of Mass
How it was first noted
How long has it been there
Presence of discharge
any change in size
whether lump changes w/ menstrual cycle
pts reproductive hx, last menstrual cycle, history of HRT
Family hx of breast cancer
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15
Q

Physical Inspection of Breast Mass (3)

4. What are some characteristics of a malignant mass.

A

Inspection and Palpation
Neck, supraclavicular area, chest wall, both breasts, axillae
Examination supine and erect
4. Single lesion, hard, immovable, irregular borders, size >= 2cm

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16
Q

Workup of Breast Mass

  1. Imaging techniques
  2. Should a mass be dismissed if imaging is negative?
A
  1. mammography, ultrasound

2. no, refer to breast surgeon for biopsy if any doubt

17
Q

BRCA1 and 2

  1. How are they inherited?
  2. Features that indicated increased likelihood of having BRCA mutations (6)
A
  1. autosomal dominant
  2. multiple cases of early onset breast cancer (<50)
  3. Ovarian cancer (w/ family hx of breast or ovarian cancer
  4. breast and ovarian cancer in the same woman
  5. Bilateral breast cancer
  6. Ashkenazi Jewish heritage
  7. Male breast cancer
18
Q

Apart from Breast cancer, this is associated with ____ cancer

  1. BRCA1
  2. BRCA2
A
  1. ovarian cancer (prostate, colon, other cancers)

2. male breast cancer (pancreatic, prostate, laryngeal, other cancers)

19
Q

DDx of a Red Breast (3)

A
  1. Mastitis
  2. Paget’s Disease of the Breast
  3. Inflammatory breast cancer
20
Q
  1. Describe Paget’s Disease of the Breast

2. Describe Inflammatory Breast cancer

A
  1. eczematous patch on nipple, suggests underlying cancer

2. peau d’orange, neoplastic cells block lymphatic drainage

21
Q

Metastatic Breast Cancer

  1. Common sites of metastasis
  2. Median survival
  3. Goals
  4. Should they be enrolled in clinical trials?
A
  1. bone, liver, lung, brain
  2. over 2 years
  3. palliate or delay symptoms, increase survival
  4. yes
22
Q

HER2NEU+ Breast Cancer

  1. prognosis
  2. chemotherapeutic agent
  3. what does (2) do?
  4. Side effect of (2)
  5. T-DM1
A
  1. more aggressive, worse prognosis
  2. Trastuzumab: monoclonal Ab that targets the HER2Neu protien
  3. improves survival in pts w/ metastatic and early stage disease
  4. CHF
  5. chemo linked to trastuzumab, direct delivery of chemo to tumor w/o typical chemo side effects;

MHD II Test 3 (14 decks)

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