GYN/ONC - Breast Cancer - collins Flashcards
what are possible risk factors for breast cancer
mostly related to increased lifetime exposure to estrogen
early menarche (prior to age 12)
late menopause (after age 55)
older age at first pregnancy (>30) or nulliparity
OCP use
etc.
what are protective factors for breast cancer
lack of ovaries
no prior HRT
early menopause
longer duration of breastfeeding
earlier age at 1st pregnancy
low dose ASA
what is the primary location of breast cancer
upper outer quadrant
what are the histologic types of breast cancer
- noninvasive types: ductal and lobar carcinoma in situ
- invasive types: infiltrating ductal carcinoma, invasive lobular
- paget carcinoma
- inflammatory carcinoma
What is HER2
Human epidermal growth factor receptor 2
what can significantly impact the treatment course and prognosis of BCA
hormone responsiveness
What are the hormone responsiveness receptors
HER2/neu (+ or -)
Estrogen receptor (+ or -)
progesterone receptors (+ or -)
what tumors are more indolent, better progrnosis
ER/PR Positive tumors
What are BRCA mutations associated with
higher likelihood of developing breast cancer
what is a P53 mutation
tumor suppressor gene mutation
what are the indications for BRCA screening
breast cancer in 2+ first degree ralatives
+fh of BCA dx prior to age 50
+fh of ovarian CA
+fh of male breast CA
fist degree relative with bilat BCA
ashkenazi jew ancestery
what are typical symptoms of BCA
70% present with palpable lump - usu. painless, firm/hard, poorly defined margins
pain, asymmetry, nipple discharge, erosion, retraction, itching/enlargement of nipple, Peau d’orange
what are symptoms of Paget carcinoma
starts as nipple itching/burning; superficial erosions/ulceration
often misdiagnosed as bacterial infection/dermatitis
often no discrete breast mass
what are symtpoms of inflammatory carcinoma
rapidly growing, occasionally painful mass
breast enlargement
often misdiagnosed as infection
often no discrete breast mass
what is the gold standard screening test for breast cancer
mammography
what is BIRADs score
Breast imaging reporting and data system: mammography results
when are calcifications more likely to be malignant
<0.5mm, various sizes and shapres and clustered in one area
what are clustered calcifications in the breast called
clustered pleomorphic microcalcifications
who is recommended to get mammogram
women ages 40-74 years old get screened every 2 years
women age 40-49- shared decision making
who gets MRI for BCA workup
negative mammogram but still suspicious
if we want more information on a new BCA dx
breast implants
adjunct to mammogram if high risk
what is a BIRAD score of 0
inconclusive tests, needs further imaging
what is a BIRAD score of 2
known benign lesion
what is a BIRAD score of 5
highly suggestive of malignancy
mgmt: tissue diagnosis
what is BIRAD score of 6
known biopsy proven malignancy
mgmt: sx excision when clinical appropriate
what is the workup if there is concern for advanced disease/metastasis
CXR or chest CT to eval for lung mets
abdominal CT or US to eval for liver mets
+/- PET/PET-CT
+/- bone scan (if symptoms/labs consistent with bone mets)
what are common metastatic sites for BCA
liver, lung, bones, brain
what type of cancers are more likely to have brain mets
Triple negative and HER2+
how is breast cancer staged
0 - 4
0= no spread
1=early stage - small area spread
2= localized (btwn 20-50mm and some lymph nodes)
3 = regional spread (larger than 50mm)
4 = distant spread to other body parts
what are the primary treatment strategies for BCA
surgical resection + axillary lymph node dissection or sentinel node biopsy
radiation (breast and lymph nodes)
what are adjuvant systemic strategies for tx of BCA
started about 4-8 weeks post op
antiestrogen therapies
anti-HER2 therapies
systemic chemo
bisphosponates
BRCA targeted tx
ER/PR receptor tx
what is the first line procedure for stage 1 and 2
lumpectomy - shared decision
what are common side effects of Chemo
N/V
infertility
premature ovarian failure
neutropenia, cardiomyopathy, peripheral neuropathy, leukemia/myelodysplasia, cognitive dysfunction
What are contraindications of lumpectomy
size >4cm
multifocal tumors
fixation to chest wall
skin involvement
what are hormonal treatment for BCA
Tamoxifen : SERM (5-10 year course)
aromatase inhibitors: 5-10 year course - post menopausal women
what is the 5 year survival rate for stage 3 BCA
30-55%
what is the 5 year survival rate for stage 4 BCA
5-10%
what should be avoided with BCA diagnosis
hormone replacement with hx of hormone receptor + cancers
what men are at a higher risk of developing breast cancer
men with prostate cancer
what are male symtpoms of breast cancer
gynecomastia
nipple discharge less commonly seen
what is the treatment for male breast cancer
same except rarely utilize breast conserving therapies
- move directly to mastectomy
tamoxifen widely used for men
