Detection and diagnosis of breast cancer Flashcards
1
Q
There are typically ……….. symptoms in early breast cancer
A
No
2
Q
Screening methods are not …………… ………
A
diagnostic tests
3
Q
Methods of early detections (4 of them)
A
- clinical breast exam (CBE)
- breast self exam (BSE)
- mammography
- breast magnetic resonance imaging (MRI)
4
Q
There is broad acceptance of the value of breast examination as a ……………….. modality
A
complimentary
5
Q
For patients that are at high risk such as those with family history, BRCA 1/2 mutations a ………… may be used in conjunction with ……………. to screen for breast cancer
A
breast MRI and Mammography
6
Q
2 major organizations that have given screening guidelines
A
ACS - American cancer society
NCCN - National Comprehensive Cancer Network
7
Q
The most common symptom of breast cancer is
A
a new lump or mass
8
Q
Description of most new lumps or masses
A
painless, hard, irregular edges
9
Q
Breast cancers can also be ……
A
tender, soft, round, and painful
10
Q
Other signs of breast cancer (9 symptoms)
A
- breast or nipple pain
- change in size or shape of the breast
- skin irritation
- dimpling or puckering of the breast skin
- nipple retraction
- nipple discharge (not milk)
- redness, scaliness, thickening of the skin
- peau d’orange (dimpling that looks like orange skin)
- lump or swelling in lymph nodes in the underarm area or collar bone area
11
Q
According to the ACS guidelines patients should start annual breast cancer screening with mammogram and CBE after age
A
40 yrs
12
Q
What is the most common symptom of breast cancer?
A
new lump or mass
13
Q
Medical history should include …..
A
- evaluation of patients complaints or symptoms
- assessment of the patients risk for breast cancer
- info about previous breast problems and diagnostic tests
- information about menstruation status
- family history of breast cancer
14
Q
A physical exam should include
A
- inspection and palpation of the breasts and regional lymph nodes.
15
Q
During physical exam breast should be examined in both the ………… and ………… position
A
seated and reclined
16
Q
During physical breast size and obvious ………. should be noted
A
asymmetry
17
Q
During physical the skin of the breast and nipple should be examined any signs of ……….., …………., and ……….. should be noted
A
retraction, edema, erythema
18
Q
The entire breast should be thoroughly examined by …………..
A
palpation
19
Q
Both the ……….. and …………. lymph nodes should be examined while the patient is upright
A
axillary and supraclavicular
20
Q
If lymph nodes are palpable their ……… and ……… should be noted
A
size and characteristics
21
Q
Imaging techniques for primary breast cancer (3)
A
- Diagnostic mammography
- Ultrasound
- MRI
22
Q
Diagnostic mammography features
A
- standard evaluation in women who have breast symptoms or an abnormal screening mammogram
- contains additional images (cone or spot views)
23
Q
Ultrasound used for
A
- used to distinguish cysts from solid masses
- useful in women with dense breasts
24
Q
MRI features
A
- may be used to guide biopsies
- NOT commonly used in diagnostic workup due to high false positive rate (detect lesions that are not cancers)
- USEFUL when standard imaging is insufficient or in high risk patients
25
Routine chemistry tests may also be used to detect asymptomatic metastases such as (3 of them) The results can then be followed up with additional tests
- alkaline phosphatase
- alanine and aspartate aminotransferase
- gamma-glutamyl transferase
26
Bone scan features
- radioactive tracer via IV bone changes appear as hot spots
- detect cancer that has spread to the bones
- indicated if the patient has abnormal alkaline phosphatase levels
27
Chest x-ray used for
detecting lung metastases
28
Abdominal ultrasound used for
- looking for tumors in the liver or other abdominal organs
| - indicated if patient has elevated gamma glutamyl transferase
29
CT used for
- To look at chest and/or abdomen for signs of metastases such as lungs or liver
- indicated for elevated gamma glutamyl transferase
30
MRI used for
Helpful in looking at brain and spinal cord
31
PET features
- can detect occult lesions throughout the body
- useful for asymptomatic metastases
- not as detailed as CT or MRI
32
Masses found to be solid during imaging tests require ........ evaluation
triple test
33
Triple test evaluation of solid masses includes
1. physical exam
2. radiologic examination
3. needle biopsy (core or fine needle)
34
Limitations of fine needle aspiration
- if insufficient material is obtain diagnosis may be difficult
- it can't rule out invasive carcinoma in ductal carcinoma in situ (DCIS)
- does not capture histologic information
35
Features of core needle biopsy
- more tissue
- allows for histologic examination to determine tumor sub type and marker evaluation
- Is the STANDARD of care for evaluating masses found in the breast
36
Surgical biopsy types (2)
1. excisional biopsy (complete removal of tumor)
| 2. incisional biopsy (partial removal of tumor)
37
Core needle biopsy provides a slender core of tissue about ....... to ........ in length
1-2 cm
38
Fine needle aspiration removes some ......... or ..... that is smeared onto a slide
fluid or cells
39
Sentinel node definition
first node in the axilla to receive lymphatic drainage from the primary breast tumor and the node most likely to contain tumor cells
40
Sentinel node biopsy definition
procedure in which the node is identified, removed, and examined for cancer cells.
41
Sentinel node biopsy is useful for
assessing axillary status (spread to lymph nodes)
42
When cancer cells are in the lymph nodes there is a risk for metastasis to other parts such as ...................
bone, lung, brain, liver
43
Steps in sentinel node biopsy (3 steps)
1. blue dye and/or radioactive tracer is injected near or into primary tumor. Dye or tracer travels through lymphatic channels to sentinel nodes
2. Use gamma detecting probe to detect tracer
3. sentinel nodes are removed
44
The TNM system was developed by
AJCC (American joint committee on cancer)
45
TNM stand for ?
T - primary tumor size in MM
N - regional node involvement
M - absence or presence of distant metastasis
46
Major Designations of Primary Tumor (T)
TX, T0, Tis, T1, T2, T3, T4
47
TX means
primary tumor can't be assessed
48
T0 means
no evidence of primary tumor
49
Tis
carcinoma in situ
50
T1
Tumor equal or less than 20mm in its greatest dimension
51
T2
Tumor greater than 20mm but equal or less than 50mm
52
T3
Tumor is greater than 50mm
53
T4
tumor of any size with direct extension to the chest wall or skin (includes inflammatory carcinoma)
54
Regional node designations
NX, N0, N1, N2, N3
55
NX means
regional nodes cannot be assessed
56
N0 means
no regional node metastasis
57
N1
metastasis to ipsilateral level I, II axillary nodes that are moveable
58
N2
Metastasis to ipsilateral level I, II axillary nodes are clinically fixed or matted or to other structures
59
N3
Metastasis to ipsilateral infra clavicular (level III axillary) nodes or clinically detected ipsilateral internal mammary nodes with supraclavicular nodes
60
Designations of distant metastases (M)
M0 and M1
61
M0
no clinical or radiographic evidence of distant metastases
62
M1
Distant detectable metastases larger than .2mm
63
A patients stage at diagnosis is a very important ........ factor
prognostic
64
5 year survival rate if confined to primary site
98.6%
65
5 year survival rate if spread to regional lymph nodes
84.4.%
66
5 yr survival rate if cancer has metastasized
24.3%
67
5 year survival rate is unstaged
50%
68
If a patients tumor is greater than 35mm in greatest dimension what T classification would the tumor be?
T2
69
A patients tumor is 35mm in greatest dimension, has no detectable regional node metastasis or distant metastasis. What is the stage?
Stage II
70
A patients stage at diagnosis is a very important prognostic factor (T/F)
True
71
A prognostic factor is a measurement that is taken at diagnosis or surgery that is associated with the patients ............
Outcome
72
Generally prognostic factors refer to a patients anticipated outcome at the time of diagnosis with receiving ............. ..........
systemic therapy
73
A predictive factor is a measurement that predicts a tumor's ........ or .......... to a particular treatment
response or lack of response
74
Some factors can have both ................. and ................... value
prognostic and predictive
75
Nodal status - type of factor and significance
Prognostic - higher number of involved nodes is associated with a worse prognosis
76
Tumor size - type of factor and significance
Prognostic - larger size = more chance of recurrence
77
Age of patient - type of factor and significance
Prognostic - Younger women age 35 or less have poorer prognosis than older post menopausal women
78
Histologic grade - type of factor and significance
Prognostic - Higher grades are associated with poor prognosis
79
Histologic subtypes - type of factor and significance
Prognostic - subtypes carry different prognoses
80
Hormone receptor positive - type of factor and significance
Prognostic and Predictive - Tends to grow slower and have a better prognosis, More likely to respond to hormone therapy
81
HER2 positive - type of factor and significance
Prognostic and Predictive - corresponds to POOR prognosis.
- Predicts response to anti-HER2 therapy
- May also predict response to chemotherapy
82
High rate of proliferation - type of factor and significance
Prognostic and Predictive
- associated with poorer prognosis
- may predict response to chemotherapy
83
Histologic grading has been criticized for .........
poor reproducibility
84
Recommended histologic grading system .....
Elston-Ellis modification of Scarff Bloom Richardson grading system
85
In histologic grading the tumor is assessed and graded by its morphologic features which are (3 items)
tubule formation, nuclear pleomorphism, and mitotic count
86
In histologic grading a value of .....-...... is assigned to each of the 3 features which are added together
1 to 3
87
In histologic grading a .......... score is more favorable
lower
88
In histologic grading a score of 3 to 5 is grade ....
Grade 1 favorable
89
In histologic grading a score of 6 to 7 is grade ....
Grade 2 moderately favorable
90
In histologic grading a score of 8 to 9 is grade .....
Grade 3 unfavorable
91
The majority of cases do not fulfill the definition of any other category and are referred to as ..................
ductal carcinoma NOS
92
Some Histologic subtypes of breast cancer exist the one with the worst prognosis is ..........
inflammatory carcinoma
93
The continued expansion of tumors is based on the ability of cancer to .............. and .................
Divide and replicate
94
Higher rates of ................. have been associated with a poorer prognosis and may predict response to chemotherapy
Proliferation
95
Techniques most used to evaluate the rate of cell proliferation (3 of them)
Mitotic index
S phase fraction
Ki-67
96
What is ploidy
measure of the amount of DNA in a cancer cell.
| Test can help with prognosis but don't affect treatment decision
97
ER and PR have both ............. and ................. effects
prognostic and predictive
98
Cancer cells may have neither, one or both ........
ER and PR
99
Nearly ............ of breast cancers have at least one of the hormone receptors
2/3
100
Patients whose tumors express ER and/or PR are called
ER positive PR positive
101
ER positive and PR positive tumors have a ........... prognosis
better
102
Tumors with ER or PR have a ............... response and ............ respond to hormone therapy
Poorer / hormone
103
HER2 gene amplification or protein overexpression is detected in approximately ....% of breast cancer patients
20%
104
HER2 has been associated with higher tumor grade, ER negative tumors, higher levels of proliferation and ....... prognosis
poorer
105
HER2 is a major predictive factor of whether a patients cancer will respond to ..................
anti-HER2 therapy (trastuzumab)
106
HER2 may predict response to .................. chemo
anthracycline based
107
Molecular subtypes - 4 main breast cancer subtypes (list)
| The subtypes carry different prognosis and respond to different types of therapy
1. Luminal A
2. Luminal B
3. HER2 positive
4. Basal-like (also called triple negative)
108
Gene assays developed for the goal of creating accurate prognostic and predictive assessments of a patients cancer based on the genes expressed by their tumors.
2 main types commercially available
OncotypeDX
| MammaPrint
109
Goal of Gene Assay tests is to determine whether or not a patient would benefit from ..................... following surgery
adjuvant chemotherapy
110
Hormone receptor status is what type of factor?
Predictive
111
** HER2 Positive means
Response to anti-HER2 therapy
112
** Hormone receptor positive means
Response to hormone therapy
113
** Medullary breast cancer is associated with
Favorable clinical outcome
114
** Basal like (triple negative) is associated with
No response to hormone or anti-HER2 therapy
