Invasive Breast Cancer Flashcards
What is the definition of invasive breast cancer?
malignant epithelial cells that have breached the basement membrane
What is the incidence of breast cancer?
1 in 8 (most common female cancer)
What is the peak age of breast cancer?
50-70
What are risk factors for breast cancer?
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
What % lifetime risk does having the BRACA 1 and 2 genes confir?
64%
What do you offer when someone has a BRACA1 gene?
prophylactic masectomy
What do you do when someone has other gene mutations that encode for breast cancer - BRACA 2, TP53, PTEN, STK11/LKB1, ATM?
do MRI follow up
How is the T part of TNM graded?
0 = no tumour 1 = <2cm 2 = 2-5cm 3 = >5cm 4 = extension to skin + chest wall
How is the N part of TNM graded?
1 = mobile mass 2 = fixed nodes 3 = ipsilateral internal mammary nodes
Where do breast cancers metastasise to?
bone liver brain lungs abdominal viscera female gential tract
What is the most common type of breast cancer?
ductal 70%
What are breast cancers scored on to determine their grade?
tubular differentiation (1-3) nuclear pleomorphism (1-3) mitotic activity (1-3)
What does score 3-5 indicate?
grade 1
What does score 6-7 indicate?
grade 2
What does score 8-9 indicate?
grade 3
What % of breast cancers are oestrogen positive?
80%
What does a progesterone positive breast cancer indicate?
better survival prognosis
What does HER 2 positive breast cancer indicate?
worse prognosis
What do HER 2 positive breast cancers respond to?
Trastuzamab
What are the signs of breast cancer?
dimpled or depressed skin nipple change bloody discharge texture change visible lump colour change
What does a unilateral bloody nipple discharge indicate?
papilloma or DCIS
What is the preferred surgical treatment for breast cancer?
breast conserving surgery
What is breast conserving surgery?
wide local excision with/without oncoplastic reconstruction
What usually follows breast conserving surgery?
radiotherapy
What is the process of a masectomy?
can remove all or part of the breast
What follows a masectomy?
breast reconstruction
When is a masectomy followed by radiation?
if involvement of >/= 3 lymph nodes or if the tumour >/= 5cm or positive surgical margins
What is a side effect of chemotherapy?
neutropenia
What is Tamoxifen used for? For how long?
ER +ve cancers
5 years
What are the side effects of Tamoxifen?
hot flushes and endometrial cancer
Name two aromatase inhibitors?
letrozole
anastrozole
When are Tamoxifen and Trastuzumab contraindicated?
breastfeeding
What do all women that present with a lump get?
Breast triple assessment
- history + examination
- mammogram or USS
- biopsy of mass
What is the role of aromatase inhbitors?
stop the production of oestrogen
When should a mammogram be offered?
> 40
When should an USS be offered?
<40
Why can mammograms only be done after the age of 40?
breasts are too dense under age of 40
Do mammograms have high or low radiation?
low
What type of breast cancer do mamograms have a specifically high sensitivity for?
DCIS
Do ultrasounds detect DCIS?
no
What are the indications for ultrasound?
palpable mass breast inflammation breast problems during pregnancy image guided biopsy need of imaging <40
What role does elastography play in breast cancer imaging?
assesses the stiffness of tissue as benign fibroadenomas are soft and invasive carcinomas are stiff
What role does MRI play in breast cancer imaging?
sizing cancers
can be used in very highly suspicious women when the pathology cannot be found
What ages is screening avaliable for?
women aged 50-70
How often are women called for breast screening?
every 3 years
How often are you called for breast screening if you have a moderate FH of breast cancer?
yearly
How often are you called for breast screening if you have a high FH of breast cancer?
you get a yearly MRI
What is the follow up once breast cancer is cured?
3 yearly mammograms
What should be done if there are suspicious axillary nodes?
ultrasound guided biopsy
What happens if there are macrometastasis in the axillary nodes?
axillary node clearance
What happens if there are no macrometastasis in the axillary nodes?
sentinal node biopsy
Name some problems with implants?
infection, rippling or migration
40% require revisional surgery
old ones have a risk of ACL lymphoma
