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1. Reproduction > Invasive Breast Cancer > Flashcards

Invasive Breast Cancer Flashcards

1
Q

What is the definition of invasive breast cancer?

A

malignant epithelial cells that have breached the basement membrane

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2
Q

What is the incidence of breast cancer?

A

1 in 8 (most common female cancer)

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3
Q

What is the peak age of breast cancer?

A

50-70

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4
Q

What are risk factors for breast cancer?

A 
older age
early first birth
not breastfeeding
early first period
late menopause
no births 
exogenous oestrogen - HRT + OCP 
BMI >30
unactive lifestyle 
increased alcohol intake 
high fat intake 
smoking
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5
Q

What % lifetime risk does having the BRACA 1 and 2 genes confir?

A

64%

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6
Q

What do you offer when someone has a BRACA1 gene?

A

prophylactic masectomy

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7
Q

What do you do when someone has other gene mutations that encode for breast cancer - BRACA 2, TP53, PTEN, STK11/LKB1, ATM?

A

do MRI follow up

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8
Q

How is the T part of TNM graded?

A 
0 = no tumour
1 = <2cm
2 = 2-5cm
3 = >5cm
4 = extension to skin + chest wall
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9
Q

How is the N part of TNM graded?

A 
1 = mobile mass
2 = fixed nodes
3 = ipsilateral internal mammary nodes
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10
Q

Where do breast cancers metastasise to?

A 
bone
liver
brain
lungs
abdominal viscera 
female gential tract
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11
Q

What is the most common type of breast cancer?

A

ductal 70%

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12
Q

What are breast cancers scored on to determine their grade?

A 
tubular differentiation (1-3)
nuclear pleomorphism (1-3)
mitotic activity (1-3)
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13
Q

What does score 3-5 indicate?

A

grade 1

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14
Q

What does score 6-7 indicate?

A

grade 2

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15
Q

What does score 8-9 indicate?

A

grade 3

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16
Q

What % of breast cancers are oestrogen positive?

A

80%

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17
Q

What does a progesterone positive breast cancer indicate?

A

better survival prognosis

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18
Q

What does HER 2 positive breast cancer indicate?

A

worse prognosis

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19
Q

What do HER 2 positive breast cancers respond to?

A

Trastuzamab

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20
Q

What are the signs of breast cancer?

A 
dimpled or depressed skin
nipple change
bloody discharge
texture change
visible lump
colour change
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21
Q

What does a unilateral bloody nipple discharge indicate?

A

papilloma or DCIS

22
Q

What is the preferred surgical treatment for breast cancer?

A

breast conserving surgery

23
Q

What is breast conserving surgery?

A

wide local excision with/without oncoplastic reconstruction

24
Q

What usually follows breast conserving surgery?

A

radiotherapy

25
Q

What is the process of a masectomy?

A

can remove all or part of the breast

26
Q

What follows a masectomy?

A

breast reconstruction

27
Q

When is a masectomy followed by radiation?

A

if involvement of >/= 3 lymph nodes or if the tumour >/= 5cm or positive surgical margins

28
Q

What is a side effect of chemotherapy?

A

neutropenia

29
Q

What is Tamoxifen used for? For how long?

A

ER +ve cancers

5 years

30
Q

What are the side effects of Tamoxifen?

A

hot flushes and endometrial cancer

31
Q

Name two aromatase inhibitors?

A

letrozole

anastrozole

32
Q

When are Tamoxifen and Trastuzumab contraindicated?

A

breastfeeding

33
Q

What do all women that present with a lump get?

A

Breast triple assessment

  • history + examination
  • mammogram or USS
  • biopsy of mass
34
Q

What is the role of aromatase inhbitors?

A

stop the production of oestrogen

35
Q

When should a mammogram be offered?

A

> 40

36
Q

When should an USS be offered?

A

<40

37
Q

Why can mammograms only be done after the age of 40?

A

breasts are too dense under age of 40

38
Q

Do mammograms have high or low radiation?

A

low

39
Q

What type of breast cancer do mamograms have a specifically high sensitivity for?

A

DCIS

40
Q

Do ultrasounds detect DCIS?

A

no

41
Q

What are the indications for ultrasound?

A 
palpable mass
breast inflammation
breast problems during pregnancy
image guided biopsy
need of imaging <40
42
Q

What role does elastography play in breast cancer imaging?

A

assesses the stiffness of tissue as benign fibroadenomas are soft and invasive carcinomas are stiff

43
Q

What role does MRI play in breast cancer imaging?

A

sizing cancers

can be used in very highly suspicious women when the pathology cannot be found

44
Q

What ages is screening avaliable for?

A

women aged 50-70

45
Q

How often are women called for breast screening?

A

every 3 years

46
Q

How often are you called for breast screening if you have a moderate FH of breast cancer?

A

yearly

47
Q

How often are you called for breast screening if you have a high FH of breast cancer?

A

you get a yearly MRI

48
Q

What is the follow up once breast cancer is cured?

A

3 yearly mammograms

49
Q

What should be done if there are suspicious axillary nodes?

A

ultrasound guided biopsy

50
Q

What happens if there are macrometastasis in the axillary nodes?

A

axillary node clearance

51
Q

What happens if there are no macrometastasis in the axillary nodes?

A

sentinal node biopsy

52
Q

Name some problems with implants?

A

infection, rippling or migration
40% require revisional surgery
old ones have a risk of ACL lymphoma

1. Reproduction (50 decks)

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