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Week 4 - female GU/breast > Malignant conditions of the breast > Flashcards

Malignant conditions of the breast Flashcards

1
Q

What are the risk factors of breast cancer?

A
  • Ealier menarche
  • Later menopause
  • Being older at first pregnancy/childbirth
  • Oral contraceptive use
  • HRT
  • Obesity
  • Tallness
  • Denser breast tissue
  • Alcohol
  • Positive family history
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2
Q

What is thought to be protective against breast cancer?

A
  • Exercise

* Breast feeding

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3
Q

What are the symptoms of a possible breast cancer?

A
  • new lump or thickening in the breast or axilla
  • Altered shape, size or feel of the breast
  • Skin changes e.g. puckering, dimpling, peau d’orange, rash, redness, feels different
  • nipple changes: tethering/inversion, discharge, eczema like changes (paget’s)
  • Rare: widespread inflammation, redness, pain in inflammatory cancer
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4
Q

Which investigations should be carried out in suspected breast cancer?

A
  • Clinical examination
  • Imaging: US, X ray mammography, MRI
  • Fine needle aspiration cytology
  • Core biopsy (often guided by imaging)
  • Excisional biopsy (diagnostic, therapeutic, or both)
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5
Q

Breast screening in the UK

A
  • Women between 47 and 73
  • Triennial 2 view mammographic breast
  • Those over 73 can self refer
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6
Q

What are the two views of a mammography?

A
  • Oblique

* Cranio- caudal

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7
Q

Describe an overview of the treatment of breast cancer

A

•Smaller cancers: wide local excision followed by radiotherapy
• Larger cancers: may require a mastectomy to achieve clear margins
may need chemotherapy or endocrine therapy

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8
Q

What is the significance of the axilla in breast cancer

A
  • Staging the axilla is important for the prognosis and treatment
  • clearance of the axilla is usually not necessary if the sentinel node biopsy is negative
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9
Q

What are the cons of axilla clearance in breast cancer

A
  • Limitation of arm movement

* Lymphoedema

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10
Q

What is the significance of ER/PR positive carcinomas

A
  • They overexposes oestrogen receptor (ER) and progesterone receptor (PR)
  • Likely to respond to endocrine treatment e.g. with tamoxifen (in breast an ER antagonist)
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11
Q

What is the cancer risk with tamoxifen?

A

In the endometrium and bone it has significant agonist activity so there is some elevation of endometrial cancer risk

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12
Q

How do aromatase inhibitors work?

A
  • Prevent the oestrogen stimulation of tumour growth
  • Block the conversion of androgens to oestrogen
  • Especially in post menopausal women
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13
Q

Her 2 positive cancers

A
  • Often have a worse prognosis
  • Treatment with monoclonal antibody trastuzumab (herceptin)
  • Adjuvant herceptin reduces the risk of relapse in women with Her 2+ breast cancer and prolongs survival in women with systematised metastatic breast cancer
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14
Q

Which of the breast cancers is a therapeutic challenge

A

Triple negative (ER- PR- Her2-)

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15
Q

What histological principles is breast cancer grading based on?

A
  1. Nuclear polymorphism
  2. The number of mitoses per mm^2
  3. The degree of gland formation by cancer cells
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16
Q

What is the problem with breast cancer screening?

A
  • to save one life 3 women must be treated for breast cancer
  • This means there is an over diagnosis (or over treatment really as all are cancer)
  • The 2 other women treated may have never had any significant morbidity from the cancer
17
Q

In order for something to be classified a carcinoma in situ, what can it not have?

A
  • no extension into the breast stroma
  • No communication with blood vessels or lymphatics
  • No possibility of metastases
18
Q

What are the subtypes of ER- cancers?

A
  • Normal breast like
  • HER 2
  • Basal like
19
Q

Name 2 aromatase inhibitors

A
  • Letrazole

* Anostrazole

20
Q

Explain the Nottingham Prognostic index

A
  • Combines grade, tumour size in cm and stage into a numerical prognostic index
  • The lower the value, the better the cancer survival rates
21
Q

What are the two major divisions of breast cancer?

A
  • Invasive ductal carcinoma

* Invasive lobular carcinoma

22
Q

Where do breast cancer lesions originate?

A

At the level of the terminal duct lobular unit

23
Q

What is the difference between invasive ductal carcinoma and invasive lobular carcinoma?

A

•In ILC: features related to loss of E-cadherin

  • Widespread invasion of malignant cells
  • Whorls around pre-exisiting parenchyma
24
Q

What are the subtypes of ER- cancers?

A
  • Normal breast like
  • HER2
  • Basal like

Week 4 - female GU/breast (7 decks)

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