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The Reproductive System > Lecture 9.2: Breast Disease > Flashcards

Lecture 9.2: Breast Disease Flashcards

1
Q

Symptoms of Breast Disease

A

Pain
Lump in Breast
Skin Changes (Excoriation)
Nipple Disorders

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2
Q

What is Fibrocystic Breast (Fibroadenosis)?

A
  • Breast tissue becomes composed of tissue that feels
    lumpy or rope like in texture
  • This called nodular or glandular breast tissue
  • Occurs mostly between 30 and 50
  • Linked to Oestrogen
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3
Q

What is Benign Mammary Dysplasia?

A

A group of conditions marked by changes in breast tissue that are benign

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4
Q

Chronic Mastitis

A
  • Occurs in women who are not breastfeeding
  • In postmenopausal women, breast infections may be
    associated with chronic inflammation of the ducts
    below the nipple
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5
Q

Inflammatory Conditions of the Breast (3)

A
  • Acute Mastitis
  • Mammary Duct Ectasia
  • Fat Necrosis
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6
Q

What is Acute Mastitis/Lactation (Puerperal Mastitis)?

A
  • Usually a bacterial infection and is seen most
    commonly in the postpartum period
  • Bacteria invade the breast through the small erosions
    in the nipple of a lactating woman, and an abscess can
    result
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7
Q

What is Mammary Duct Ectasia?

A

A benign breast condition that occurs when a milk duct in the breast widens and its walls thicken

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8
Q

What is Fat Necrosis?

A

Fat tissue in the breast or other organs is damaged by injury, surgery, or radiation therapy

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9
Q

What is Gynaecomastia?

A

A common condition that causes boys’ and men’s breasts to swell and become larger than normal

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10
Q

Name 3 Benign Tumour-Like Lesions

A
  • Fibroadenoma
  • Intraduct Papilloma
  • Lipoma
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11
Q

Examples of Malignant Neoplasms (4)

A
  • Ductal Adenocarcinoma
  • Lobular Adenocarcinoma
  • Sarcoma
  • Metastasis from other tissues
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12
Q

What can cause Mastitis? (4)

A
  • Infection
  • Congested Milk
  • No Hygiene
  • Baby sucks wrong
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13
Q

What are Intraductal Papillomas?

A

They are benign (noncancerous), wart-like tumours that grow within the milk ducts of the breast

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14
Q

What is Sclerosing Adenosis?

A

It is a benign proliferative condition of the terminal
duct lobular units characterised by an increased number of acini and their glands

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15
Q

What are Fibroadenomas?

A

Benign breast tumours consisting of both glandular and connective tissue: most common in women in their 20s and 30s

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16
Q

What percentage of patients survive breast cancer for 10 or more years after the diagnosis?

A

76%

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17
Q

Most breast cancers are ……, which are tumours that start in the epithelial cells that line organs and tissues

A

carcinomas

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18
Q

Types of Breast Carcinomas and their Percentage Prevalence? (3)

A
  • Invasive ductal carcinoma (50-70%)
  • Ductal carcinoma in situ (20%)
  • Invasive lobar carcinoma (10%)
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19
Q

Pre-Invasive Breast Cancer: DCIS

A
  • Ductal Carcinoma in situ
  • Spreads through ducts and distorts ductal architecture
  • Can progress to invasive cancer
  • Unilateral
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20
Q

Pre-Invasive Breast Cancer: LICS

A
  • Lobular Carcinoma in situ
  • Does not distort ductal architecture
  • Bilateral
  • Risk factor not a precursor
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21
Q

Invasive Breast Cancer: NST

A
  • Ductal Carcinoma No Special Type
  • Develops from DCIS
  • Fibrous response to produce a mass
  • Metastasises via lymphatics and blood
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22
Q

Invasive Breast Cancer: ILC

A
  • Lobular Carcinoma
  • Isolated Tumour Cells (CDH1 mutations)
  • Minimal Fibrous Response
  • Metastasises preferentially via viscera
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23
Q

1 in XYZ women in the UK will develop breast cancer during their lifetime. What is the number XYZ?

A

7

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24
Q

Risk Factors Breast Cancer, Name 5 (15)

A
  • Increased Age
  • Early Menarche (before 11)
  • Having the first pregnancy after age 30
  • Not breastfeeding
  • Never having a full-term pregnancy
  • Late menopause (after 55)
  • Endogenous Hormones
  • Oral Contraceptives
  • Hormone Replacement Therapy (HRT)
  • Breast Density
  • Family History
  • Ionising Radiation
  • Overweight and Obesity
  • Alcohol
  • Smoking
25
Q

Breast Cancer Symptoms (9)

A
  • Lumps
  • Nipple Discharge
  • Dimpling
  • Breast or Nipple Pain
  • Nipple Retraction/Inversion
  • Redness
  • Changes in Skin Texture
  • Lymph Node Changes
  • Swelling (changes in shape/size)
26
Q

How is Breast Cancer diagnosed? (6)

A
  • Screening
  • Mammography
  • Ultrasonography
  • MRI
  • Biopsy
  • Histopathological Analysis
27
Q

What Biomarkers confirm Breast Cancer Diagnosis

A
  • Ki67
  • Oestrogen Receptor
  • Progesterone Receptor
  • HER2
28
Q

Stage 1 Breast Cancer

A
  • Tumour is no more than 2cm in diameter
  • Cancer hasn’t spread to lymph nodes
  • Cancer hasn’t spread outside of breast
29
Q

Stage 2 Breast Cancer

A
  • Tumour is 2-5cm in diameter & cancer may have
    spread to axillary lymph nodes
  • Tumour is 5cm in diameter but not spread to axillary
    lymph nodes
  • Tumour is less than 2cm in diameter but cancer has
    spread to more than 3 axillary lymph nodes
30
Q

Stage 3 Breast Cancer

A
  • Tumour is more than 5cm in diameter & cancer cells
    have spread to axillary lymph nodes, however nodes
    are unconnected
  • Tumour is smaller than 5cm in diameter & cancer cells
    have spread to nearby lymph nodes & nodes are
    growing into each other
  • Tumour is smaller than 5cm in diameter but cancer
    has spread to lymph node above collarbone
31
Q

Stage 4 Breast Cancer

A

Metastatic Breast Cancer

32
Q

Common Metastatic Sites in Breast Cancer

A
  • Axillary Lymph Nodes
  • Mammary Internal Chain Lymph Nodes
  • Lungs
  • Bones
  • Liver
  • Peritoneal Metastasis
33
Q

Breast Cancer Molecular Subtypes (5)

A
  • Luminal A
  • Normal-Like
  • Luminal B
  • HER2-enriched
  • Triple Negative
34
Q

What is the Oncotype DX Test?

A
  • It is a genomic test used for early stage, ER+, HER2-
    breast cancers that analyses the expression of 16
    cancer-related genes
  • These can affect how an early-stage breast cancer is
    likely to behave and respond to treatment
35
Q

How is the Oncotype DX Test a prognostic test?

A

Provides more information about how likely (or unlikely) the breast cancer is to come back

36
Q

How is the Oncotype DX Test a predictive test?

A

Since it predicts the likelihood of benefit from chemotherapy or radiation therapy

37
Q

Breast Cancer Management

A

Slide 33 & 34

38
Q

Breast Cancer Treatments (5)

A
  • Surgery
  • Hormones
  • Targeted Therapy
  • Radiotherapy
  • Chemotherapy
39
Q

Adjuvant & Neoadjuvant Chemotherapy Drugs (5)

A
  • Anthracyclines (doxorubicin)
  • Taxanes (paclitaxel)
  • 5-fluorouracil (5-FU)
  • Cyclophosphamide
  • Carboplatin
40
Q

What strategies are used to treat hormone-sensitive breast cancer? (4)

A
  • Ovarian ablation by surgery (oophorectomy) or by
    radiation
  • Treatment with gonadotropin-releasing hormone
    (GnRH) agonists, aka luteinizing hormone-releasing
    hormone (LHRH) agonists (goserelin and leuprolide)
  • Blocking oestrogen production via Aromatase
    Inhibitors
  • Blocking oestrogen’s effects via selective oestrogen
    receptor modulators (SERMs) such as tamoxifen
41
Q

Examples of Aromatase Inhibitors

A
  • Anastrozole
  • Letrozole
  • Exemestane
42
Q

Aromatase Inhibitors MOA

A

Lower oestrogen levels by stopping an enzyme in fat tissue (called aromatase) from changing other hormones into oestrogen

43
Q

How does Oestrogen cause cancer?

A

Cells from these types of cancer have receptor sites that bind to oestrogen, which promotes their growth and spread

44
Q

Tamoxifen MOA (Hormone Therapy)

A

Tamoxifen is metabolised via CYP2D6 into endoxifen, its primary active metabolite that blocks ER,

45
Q

Are Aromatase inhibitors or Tamoxifen better at reducing risk of breast cancer recurrence in premenopausal and postmenopausal women?

A

Aromatase inhibitors

46
Q

Targeted Therapy: Trastuzumab/Herceptin MOA (3 MOAs)

A

It is a humanised monoclonal antibody against HER2 receptor
1) Binding to HER2 results in inhibition of downstream
pathways including MAPK and PI3K/Akt that lead to
proliferation
2) Binding to HER2 attracts immune cells to tumour site
and promotes ADCC
3) Binding to HER2 results in receptor internalisation
and degradation

47
Q

Targeted Therapy: Pembrolizumab MOA

A
  • A checkpoint inhibitor that targets the PD-1/PD-L1
    pathway
  • Has been approved in combination with
    chemotherapy for patients with metastatic, PD-L1-
    positive triple-negative breast cancer (TNBC)
48
Q

What percentage of Breast Cancers are Familial Breast Cancer?

A

5-10% (vast majority of cancers are sporadic)

49
Q

What causes Familial Breast Cancer?

A

Characterised by mutations in BRCA1 and BRCA2
tumour suppressor genes that lead to loss of function of BRCA1 and BRCA2 proteins

50
Q

The lifetime risk of developing breast cancer in
women inheriting a BRCA1 mutation is …%?

A

55-65%

51
Q

The lifetime risk of developing breast cancer in
women inheriting a BRCA2 mutation is …%?

A

45%

52
Q

What other cancers are linked to BRCA1 and BRCA2 mutations?

A
  • Ovarian Cancers
  • Prostate Cancers
53
Q

Potential for Cancer Biomarkers (6)

A
  • Estimate Risk of Developing Cancer
  • Screening
  • Differential Diagnosis
  • Determine Prognosis of Disease
  • Predict Response to Therapy
  • Monitor for Disease Recurrence
54
Q

BRCA1 and BRCA2 proteins are Caretakers of
Chromosomal Stability, what does this mean?

A

They promote high fidelity homologous recombination repair of double-stranded DNA (DSDNA) breaks

55
Q

Targeted Therapy for Familial Breast Cancer

A
  • PARP (poly(ADP-ribose) polymerase) inhibitors are
    used for the treatment of germline BRCA-mutated,
    HER2-negative breast cancers
  • The most widely used PARP inhibitor is currently
    olaparib (Lynparza)
  • PARP plays a central role in DNA repair including DNA
    damage caused by alkylating agents & chemo-
    therapeutic drugs
56
Q

What is the NHS Breast Screening Programme?

A
  • Invites all women from the age of 50 to 70 for
    screening every 3 years
  • Breast screening uses a test called mammography
    which involves taking x-rays of the breasts
57
Q

Breast Cancer Self Examination

A

Monthly breast self-exams can help to detect changes that may be signs of infection or breast cancer (such as breast lumps or spots that feel different)

58
Q

Breast Cancer Prevention (3)

A
  • Increased Mammography
  • Elective Surgery
  • Chemoprevention

The Reproductive System (19 decks)

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