L23: Breast Cancer Flashcards
What are the risk factors for breast cancer
Age Geographic location Oestrogen exposure Family history Previous breast cancer- in the other breast Exogenous hormones- OCP and HRT used Long term High MI Ionising radiation Breast density- more glandular tissue ADH (atypical ductal hyperplasia)
What is ADH (atypical ductal hyperplasia)
When you have cells that change i.e atypical in the breast but are not cancerous
What is the nhs breast screening programme for
47-73 year olds
What does NHS Breast screening programmes involve
Digital mammogram that is done every 3 years
What does obesity lead to within the hormonal Profile
Activation of IGF1 and insulin
Increased oestrogen from adipose tissue
Increased leptin which interferes with oestrogen metabolism
If alcohol is excess how does it increase the risk of breast cancer
- effects actaldeyhde which reduces oestrogen metabolism
- cause epigenetics changes via dna methylation
What type of cancer is BRCA1 mostly associated with
Basal like subtype
What is BRCA2 gene most likely associated with
Luminal (ER+) breast cancers
What are the 2 broad histological groups of breast cancers
In-situ
Invasive
What are the in-situ types of breast cancer
Ductal carcinoma in-situ
Lobular carcinoma in-situ
What are the invasive types of breast cancer
Ductal no special type
Lobular
Tubular
Mucinous
What is the difference between in-situ and invasive breast cancer
In-situ is confounded to the cells and does not breach the basement membrane
Invasive: breaches basement membrane to metastasis
What are the cells in in-situ breast cancer like
More mitosis i.e proliferated but basement membrane is fine
What are the cells like in invasive breast cancer
Basement membrane is breached so the Cells are migrating
What are the molecular subtypes of breast cancer
Basal like Luminal a Luminal b HER2 over expressing Claudin low Normal like
How do we find out the molecular subtypes of the breast cancer
When you disect the breast cancer you look for certain markers of oestrogen receptor, progesteorne receptors, HER2
What is basal like breast cancer
BRCA1 positive Triple negative (ER,PR,HER2)
What is luminal A
ER+
HER2-
What is luminal b
Er+
HER2+
What does the diagnosis of breast cancer involve
Triple assessment
- clinical history and examination
- mammograms or MRI
- biopsy: FNA or core biopsy
What are the treatment options for neo-adjuvant therapy
Endocrine e.g aromatase inhibitor
Chemotherapy (anthracycline surgery and taxanes
Herceptin, pertuzumab, lapatinib
What are the surgery treatment options
Wide local excision
Mastectomy- breast removal or skin sparing for implant
Remove axillary lymph nodes
What are the adjuvant therapy treatment options
Endocrine
Chemotherapy
Radiotherapy
Biological agents
How can HER2 be targeted
Herceptin
Pertzumab
