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NURSING 2005_Breast Cancer_1 Slide PP Flashcards

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1
Q

Front

A

Back

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2
Q

<h1>Page 01</h1>

<br></br>What are mammary glands also known as?

A

Breasts.

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3
Q

<h1>Page 01</h1>

<br></br>What type of glands are mammary glands believed to be?

A

Modified apocrine sweat glands.

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4
Q

<h1>Page 01</h1>

<br></br>What surrounds the series of ducts in mammary glands?

A

Stroma (connective tissue) and fat.

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5
Q

<h1>Page 01</h1>

<br></br>How are the mammary glands arranged?

A

In lobes.

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6
Q

<h1>Page 02</h1>

<br></br>What is the basic functional and histopathological unit of the breast?

A

Terminal ductal-lobular unit (TDLU).

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7
Q

<h1>Page 02</h1>

<br></br>What does TDLU stand for?

A

Terminal ductal-lobular unit.

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8
Q

<h1>Page 02</h1>

<br></br>What does the TDLU consist of?

A

A small segment of terminal duct and a cluster of ductules.

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9
Q

<h1>Page 02</h1>

<br></br>What is the role of ductules in the TDLU?

A

They are the effective secretory units.

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10
Q

<h1>Page 02</h1>

<br></br>What terminates in the nipple?

A

Collecting duct.

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11
Q

<h1>Page 02</h1>

<br></br>What is drained by a collecting duct in each breast lobe?

A

A collecting duct terminates in the nipple.

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12
Q

<h1>Page 03</h1>

<br></br>What does TDLU stand for?

A

Terminal ductal-lobular unit.

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13
Q

<h1>Page 03</h1>

<br></br>What does TDLU consist of?

A

One extralobular duct giving rise to a collection of smaller ductules.

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14
Q

<h1>Page 03</h1>

<br></br>From which cells are most breast cancers thought to arise?

A

Cells of the TDLUs.

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15
Q

<h1>Page 03</h1>

<br></br>What is the significance of TDLUs in breast anatomy?

A

They are the site from which most breast cancers are thought to arise.

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16
Q

<h1>Page 03</h1>

<br></br>What is the histological importance of TDLUs?

A

They are the key structure from which most breast cancers originate.

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17
Q

<h1>Page 04</h1>

<br></br>How many smaller ductules are contained in each TDLU?

A

20 - 200.

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18
Q

<h1>Page 04</h1>

<br></br>What is the source of the smaller ductules in TDLU?

A

Successive branching of the interlobular duct.

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19
Q

<h1>Page 04</h1>

<br></br>What is associated with the smaller ductules in TDLU?

A

Alveoli.

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20
Q

<h1>Page 04</h1>

<br></br>From what process are the smaller ductules and associated alveoli formed?

A

Successive branching of the interlobular duct.

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21
Q

<h1>Page 05</h1>

<br></br>What hormone influences the growth of mammary glands?

A

Oestrogen.

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22
Q

<h1>Page 05</h1>

<br></br>Which hormone is responsible for the deposition of fat in the breast?

A

Oestrogen.

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23
Q

<h1>Page 05</h1>

<br></br>What does progesterone contribute to in breast tissue?

A

Additional growth of lobules and budding of alveoli.

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24
Q

<h1>Page 05</h1>

<br></br>What changes does progesterone cause in breast tissue?

A

Secretory changes.

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25
Q

<h1>Page 06</h1>

<br></br>What are the characteristics of the proliferative phase?

A

Lobules are small, mitoses are infrequent, and specialized stroma is condensed.

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26
Q

<h1>Page 06</h1>

<br></br>What happens during the secretory phase?

A

TDLUs increase in size with looser oedematous stroma, and there is epithelial mitotic activity.

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27
Q

<h1>Page 06</h1>

<br></br>What occurs during the menstrual phase?

A

Some sloughing of epithelium into the TDLU lumen is evident.

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28
Q

<h1>Page 07</h1>

<br></br>What happens to hormone levels during menopause?

A

They decline.

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29
Q

<h1>Page 07</h1>

<br></br>What begins to recede during menopause?

A

Lobules.

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30
Q

<h1>Page 07</h1>

<br></br>What are the predominant components in breast tissue after menopause?

A

Mostly ducts, adipose tissue, and fibrous tissue.

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31
Q

<h1>Page 08</h1>

<br></br>What is mammogenesis?

A

The growth of breasts.

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32
Q

<h1>Page 08</h1>

<br></br>Which hormones are involved in the growth of the ductal system and alveoli in breasts?

A

Oestrogen and progesterone.

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33
Q

<h1>Page 08</h1>

<br></br>What functional change occurs during lactogenesis?

A

Breasts adapt to secrete milk.

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34
Q

<h1>Page 08</h1>

<br></br>What hormone is involved in the differentiation of alveolar epithelial cells and stimulation of milk synthesis?

A

Prolactin.

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35
Q

<h1>Page 08</h1>

<br></br>What is galactopoiesis?

A

The maintenance of lactation.

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36
Q

<h1>Page 08</h1>

<br></br>Which hormones are involved in the maintenance of milk production?

A

Oxytocin and Prolactin.

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37
Q

<h1>Page 08</h1>

<br></br>What hormonal changes occur during galactopoiesis?

A

Decreased oestrogen and progesterone.

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38
Q

<h1>Page 08</h1>

<br></br>What is the influence of hormones during pregnancy on breast tissue?

A

Stimulation of mammogenesis, lactogenesis, and galactopoiesis.

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39
Q

<h1>Page 09</h1>

<br></br>How does pregnancy influence breast tissue?

A

Pregnancy leads to hormonal changes that cause the breast tissue to enlarge and prepare for milk production.

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40
Q

<h1>Page 10</h1>

<br></br>What are the risk factors for breast cancer?

A

Family history, age, genetic mutations, early menstruation, late menopause, dense breast tissue, hormone replacement therapy, alcohol consumption, obesity.

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41
Q

<h1>Page 10</h1>

<br></br>What are the common presentations of breast cancer?

A

Lump in the breast, change in breast size or shape, dimpling of the skin, nipple discharge, redness or pitting of the skin over the breast.

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42
Q

<h1>Page 10</h1>

<br></br>What are the types of breast lesions?

A

Benign and malignant.

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43
Q

<h1>Page 10</h1>

<br></br>What are the characteristics of pre-malignant breast lesions?

A

Cells that are not yet cancerous but have the potential to become cancerous.

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44
Q

<h1>Page 10</h1>

<br></br>What are the methods used for the investigation of breast lesions?

A

Mammography, ultrasound, MRI, biopsy.

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45
Q

<h1>Page 10</h1>

<br></br>What factors affect the prognosis of breast cancer?

A

Stage of cancer, tumor size, lymph node involvement, hormone receptor status, HER2 status.

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46
Q

<h1>Page 10</h1>

<br></br>What are the treatment options for breast cancer?

A

Surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy.

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47
Q

<h1>Page 10</h1>

<br></br>What is the purpose of mammographic screening?

A

To detect breast cancer at an early stage, often before it can be felt.

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48
Q

<h1>Page 11</h1>

<br></br>What is the normal characteristic of cell proliferation?

A

Limited proliferation, regulated differentiation from immature to mature, and a limited life-span.

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49
Q

<h1>Page 11</h1>

<br></br>What causes breast cancer?

A

Abnormal cells that are unresponsive to normal cell control mechanisms.

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50
Q

<h1>Page 11</h1>

<br></br>What is the evasion of the immune system related to in breast cancer?

A

It is related to the causes of breast cancer.

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51
Q

<h1>Page 12</h1>

<br></br>What percentage of breast cancer cases have one or more affected first-degree relative?

A

Approximately 13%.

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52
Q

<h1>Page 12</h1>

<br></br>What is the inheritance pattern of BRCA1, BRCA2, and p53 mutations?

A

Autosomal dominant.

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53
Q

<h1>Page 12</h1>

<br></br>What is the cancer onset pattern in cases with specific germ line mutations?

A

Often at a younger age.

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54
Q

<h1>Page 12</h1>

<br></br>What is the risk associated with familial (hereditary) breast cancer cases?

A

Interaction of multiple low-risk susceptibility genes.

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55
Q

<h1>Page 12</h1>

<br></br>Apart from breast cancer, what other tumors may develop in cases with specific germ line mutations?

A

Other tumors.

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56
Q

<h1>Page 13</h1>

<br></br>What are the risk factors associated with increased lifetime estrogen exposure for breast cancer?

A

Early age of menarche, late age of menopause, nulliparous (no children) or late age of first birth, use of hormone replacement therapy, post-menopausal obesity, and diet rich in saturated fat.

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57
Q

<h1>Page 13</h1>

<br></br>How does breast feeding affect the risk of breast cancer?

A

It appears to be protective as lactation suppresses normal ovarian hormone production.

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58
Q

<h1>Page 14</h1>

<br></br>What are some environmental and dietary influences on breast cancer?

A

Obesity, alcohol consumption, and history of certain breast diseases.

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59
Q

<h1>Page 14</h1>

<br></br>Where is the greater incidence of breast cancer observed?

A

In developed countries.

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60
Q

<h1>Page 14</h1>

<br></br>How does alcohol consumption influence the risk of breast cancer?

A

Even 1 alcoholic drink/day increases the risk.

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61
Q

<h1>Page 14</h1>

<br></br>What is the age group with the highest percentage of breast cancer diagnoses?

A

Over 50 years old (about 70%).

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62
Q

<h1>Page 14</h1>

<br></br>What are some general risk factors for breast cancer?

A

Age, environmental and dietary influences, and history of certain breast diseases.

63
Q

<h1>Page 15</h1>

<br></br>What is happening to the 5-year relative survival rate for breast cancer?

A

It is increasing.

64
Q

<h1>Page 16</h1>

<br></br>What is the relationship between cancer incidence and age?

A

It increases with age.

65
Q

<h1>Page 16</h1>

<br></br>According to AIHW 2018, where can the information about Australian Cancer Incidence and Mortality (ACIM) books be found?

A

AIHW 2018.

66
Q

<h1>Page 17</h1>

<br></br>What is the study of breast pathology concerned with?

A

The examination of breast tissue for the presence of disease or abnormality.

67
Q

<h1>Page 17</h1>

<br></br>What are the common diseases or abnormalities examined in breast pathology?

A

Breast cancer, benign breast conditions, and other breast disorders.

68
Q

<h1>Page 17</h1>

<br></br>What techniques are used in breast pathology examination?

A

Histological examination, immunohistochemistry, and molecular testing.

69
Q

<h1>Page 18</h1>

<br></br>What are some presentations of breast pathology?

A

Lump, discomfort or pain, nipple changes, nipple discharge, change in shape of breast, breast asymmetry, skin tethering, and mammographic screening detected.

70
Q

<h1>Page 19</h1>

<br></br>What is a lesion?

A

A region in an organ or tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumor.

71
Q

<h1>Page 19</h1>

<br></br>What are examples of benign breast lesions?

A

Fibrocystic breast changes, Cysts, Fibroadenoma, Mastitis.

72
Q

<h1>Page 19</h1>

<br></br>What are examples of malignant/pre-malignant breast lesions?

A

Ductal carcinoma in situ/Lobular carcinoma in situ, Invasive ductal carcinoma, Invasive lobular carcinoma, Medullary carcinoma, tubular carcinoma, mucinous carcinoma, invasive papillary carcinoma.

73
Q

<h1>Page 20</h1>

<br></br>What is the most common type of benign breast pathology?

A

Fibrocystic Changes.

74
Q

<h1>Page 20</h1>

<br></br>What percentage of women does fibrocystic changes occur in?

A

30 - 60% (varied literature).

75
Q

<h1>Page 20</h1>

<br></br>At what age range is fibrocystic changes most common in women?

A

30 - 50 years.

76
Q

<h1>Page 20</h1>

<br></br>How do fibrocystic changes present in the breast?

A

As lumps or lumpy areas, with or without pain.

77
Q

<h1>Page 20</h1>

<br></br>How can fibrocystic changes vary with the menstrual cycle?

A

Due to hormonal influence.

78
Q

<h1>Page 20</h1>

<br></br>What are the two types of lumps associated with fibrocystic changes?

A

Fluid-filled ‘cysts’ or solid lumps due to fibrous tissue.

79
Q

<h1>Page 20</h1>

<br></br>What is often accompanied by fibrocystic changes?

A

Hyperplasia.

80
Q

<h1>Page 21</h1>

<br></br>What is the exact etiology of fibrocystic changes in breast lesions?

A

Unknown.

81
Q

<h1>Page 21</h1>

<br></br>What hormonal imbalance is strongly clinically associated with fibrocystic changes?

A

Excess Oestrogen and deficient progesterone.

82
Q

<h1>Page 21</h1>

<br></br>What is the prevalence of fibrocystic lesions in women receiving Oestrogen treatments?

A

Higher.

83
Q

<h1>Page 21</h1>

<br></br>What can fibrocystic disease mimic in terms of features?

A

Clinical, radiographic, gross, and microscopic features of carcinoma.

84
Q

<h1>Page 22</h1>

<br></br>What is the most common age group for fibroadenoma?

A

Younger women.

85
Q

<h1>Page 22</h1>

<br></br>How does fibroadenoma typically present?

A

As a palpable, mobile, firm, non-tender mass.

86
Q

<h1>Page 22</h1>

<br></br>What is the composition of fibroadenoma?

A

Proliferation of epithelial and mesenchymal elements and stroma.

87
Q

<h1>Page 22</h1>

<br></br>Is fibroadenoma hormone responsive? If yes, to which hormone?

A

Yes, it can be responsive to oestrogen.

88
Q

<h1>Page 23</h1>

<br></br>What is the characteristic of pre-malignant lesions regarding the basement membrane?

A

No penetration of the basement membrane.

89
Q

<h1>Page 23</h1>

<br></br>How is uncontrolled proliferation limited in pre-malignant lesions?

A

Limited to ducts and lobules.

90
Q

<h1>Page 23</h1>

<br></br>What are pre-malignant lesions referred to as?

A

Carcinoma in situ.

91
Q

<h1>Page 23</h1>

<br></br>What is the characteristic of malignant lesions regarding the basement membrane?

A

Cells have penetrated through the basement membrane into the stroma.

92
Q

<h1>Page 23</h1>

<br></br>Where do most malignant lesions originate from?

A

Epithelial cells that line the ducts and lobules of the breast.

93
Q

<h1>Page 23</h1>

<br></br>What are malignant lesions referred to as?

A

Invasive Carcinoma.

94
Q

<h1>Page 24</h1>

<br></br>What is carcinoma in situ?

A

A pre-malignant population of cells confined to ducts and/or acini, with no invasion through the basement membrane.

95
Q

<h1>Page 24</h1>

<br></br>What are the two main histological types of carcinoma in situ?

A

Ductal carcinoma in situ (most common) and lobular carcinoma in situ.

96
Q

<h1>Page 24</h1>

<br></br>What is the most common type of carcinoma in situ?

A

Ductal carcinoma in situ.

97
Q

<h1>Page 24</h1>

<br></br>Does carcinoma in situ always cause a lump?

A

May or may not cause a lump.

98
Q

<h1>Page 24</h1>

<br></br>What is often associated with carcinoma in situ and can be seen on a mammogram?

A

Calcification.

99
Q

<h1>Page 25</h1>

<br></br>What is Ductal Carcinoma in situ (DCIS)?

A

It is the proliferation of abnormal epithelial cells contained within the ductal lining and has not infiltrated past the basement membrane into the breast tissue.

100
Q

<h1>Page 25</h1>

<br></br>What is considered as a precursor for Invasive Carcinoma of the breast?

A

Ductal Carcinoma in situ (DCIS).

101
Q

<h1>Page 26</h1>

<br></br>What is Lobular Carcinoma in situ (LCIS)?

A

It is the proliferation of abnormal monomorphic cells that fill and distend the acini within the lobular units (TDLUs).

102
Q

<h1>Page 26</h1>

<br></br>What is the characteristic feature of Lobular Carcinoma in situ (LCIS)?

A

It has not infiltrated beyond the involved lobule.

103
Q

<h1>Page 26</h1>

<br></br>What is the relative risk of invasive carcinoma after a diagnosis of LCIS?

A

Approximately 9 - 10 times that of the general population.

104
Q

<h1>Page 27</h1>

<br></br>What are the common presentations of invasive breast carcinoma?

A

Lump, discomfort, nipple changes or discharge, change in shape of breast, skin tethering, screening detected, late stage untreated mass.

105
Q

<h1>Page 28</h1>

<br></br>What is the most common type of invasive breast carcinoma?

A

Infiltrating Ductal Carcinoma.

106
Q

<h1>Page 28</h1>

<br></br>How does Infiltrating Ductal Carcinoma typically present?

A

As a firm, cohesive mass.

107
Q

<h1>Page 28</h1>

<br></br>What shape do the invasive cells of Infiltrating Ductal Carcinoma form?

A

Irregular, stellate shape.

108
Q

<h1>Page 28</h1>

<br></br>What is the second most common type of invasive breast carcinoma?

A

Infiltrating Lobular Carcinoma.

109
Q

<h1>Page 28</h1>

<br></br>How do Infiltrating Lobular Carcinoma tumors tend to invade?

A

In single file.

110
Q

<h1>Page 28</h1>

<br></br>At what stage are Infiltrating Lobular Carcinoma usually detected?

A

In advanced stages.

111
Q

<h1>Page 29</h1>

<br></br>What are the local areas where invasive breast carcinoma can spread?

A

Skin, nipple, underlying muscle/chest wall, pleura.

112
Q

<h1>Page 29</h1>

<br></br>What are the metastatic sites for invasive breast carcinoma?

A

Axillary lymph nodes, lungs, liver, bone, brain.

113
Q

<h1>Page 30</h1>

<br></br>What are the methods used for the investigation of breast lesions?

A

Clinical history, physical examination, radiology, mammography, ultrasound, MRI with intravenous gadolinium contrast, and biopsy for pathological diagnosis.

114
Q

<h1>Page 30</h1>

<br></br>What is the purpose of MRI with intravenous gadolinium contrast in breast lesion investigation?

A

To provide detailed imaging of the breast tissue.

115
Q

<h1>Page 30</h1>

<br></br>What is the role of biopsy in the investigation of breast lesions?

A

To obtain a pathological diagnosis.

116
Q

<h1>Page 31</h1>

<br></br>What are the factors affecting prognosis in breast cancer?

A

Stage, grade, presence of oestrogen and progesterone receptors, HER2 overexpression.

117
Q

<h1>Page 31</h1>

<br></br>What does the presence of oestrogen and progesterone receptors in tumour cells indicate?

A

It is a factor affecting prognosis in breast cancer.

118
Q

<h1>Page 31</h1>

<br></br>What is HER2 overexpression a factor for?

A

It is a factor affecting prognosis in breast cancer.

119
Q

<h1>Page 32</h1>

<br></br>What is the TNM staging system used for?

A

To classify the progression of malignancy in terms of local spread and metastasis.

120
Q

<h1>Page 32</h1>

<br></br>When did the eighth edition of the TNM staging system become effective?

A

Since January 2018.

121
Q

<h1>Page 32</h1>

<br></br>What is the focus of factors affecting prognosis in breast cancer?

A

Stage.

122
Q

<h1>Page 33</h1>

<br></br>What does the Nottingham Grading System assess?

A

Tubule formation, nuclear pleomorphism, and mitotic activity.

123
Q

<h1>Page 33</h1>

<br></br>How is each characteristic in the Nottingham Grading System scored?

A

From 1 to 3, with 1 being the closest to normal and 3 being the most abnormal.

124
Q

<h1>Page 33</h1>

<br></br>What is the range of the Nottingham Score?

A

Minimum 3, Maximum 9.

125
Q

<h1>Page 33</h1>

<br></br>What are the grades based on the Nottingham Score?

A

Grade 1 (Score 3-5), Grade 2 (Score 6-7), Grade 3 (Score 8-9).

126
Q

<h1>Page 34</h1>

<br></br>What are the different grades of Infiltrative Ductal Carcinoma?

A

Grade 1, Grade 2, Grade 3.

127
Q

<h1>Page 34</h1>

<br></br>How does the grade of Infiltrative Ductal Carcinoma affect prognosis?

A

It is a factor affecting prognosis.

128
Q

<h1>Page 35</h1>

<br></br>What are Hormone Receptor-Positive cells?

A

Malignant cells with abnormally high levels of Oestrogen and/or progesterone receptors in their nuclei.

129
Q

<h1>Page 35</h1>

<br></br>What drives cell proliferation in Hormone Receptor-Positive cells?

A

Hormone receptors.

130
Q

<h1>Page 35</h1>

<br></br>How can Hormone Receptor-Positive cells respond to therapy?

A

They can respond to hormonal therapy, e.g. Tamoxifen.

131
Q

<h1>Page 35</h1>

<br></br>What does Tamoxifen do in relation to Hormone Receptor-Positive cells?

A

It binds to receptors as a competitive inhibitor.

132
Q

<h1>Page 36</h1>

<br></br>What is HER2?

A

A protein that promotes the growth of cancer cells.

133
Q

<h1>Page 36</h1>

<br></br>How is HER2 over-expression associated with prognosis?

A

It is associated with a poorer prognosis.

134
Q

<h1>Page 36</h1>

<br></br>What therapy can HER2 over-expression respond to?

A

Targeted hormonal therapy, e.g. Trastuzumab (Herceptin).

135
Q

<h1>Page 36</h1>

<br></br>What does Trastuzumab (Herceptin) do?

A

It binds to receptors and inhibits growth signals.

136
Q

<h1>Page 37</h1>

<br></br>What are the surgical options for breast-conserving surgery?

A

Axillary lymph node sampling or sentinel node biopsy, lumpectomy, wide local excision, and quadrantectomy.

137
Q

<h1>Page 37</h1>

<br></br>What does a lumpectomy directly remove?

A

The tumor.

138
Q

<h1>Page 37</h1>

<br></br>What is the purpose of wide local excision?

A

To remove the tumor and a rim of healthy tissue.

139
Q

<h1>Page 37</h1>

<br></br>What does a quadrantectomy involve removing?

A

The tumor and approximately a quarter of the breast (tumor and underlying connective tissue).

140
Q

<h1>Page 37</h1>

<br></br>Which surgical option is performed less often?

A

Complete mastectomy.

141
Q

<h1>Page 38</h1>

<br></br>What is often performed in the management of breast cancer for axillary lymph node clearance?

A

Sentinel node biopsy.

142
Q

<h1>Page 38</h1>

<br></br>How is the first axillary lymph node in the line of lymphatic drainage identified and examined?

A

It is biopsied and examined.

143
Q

<h1>Page 38</h1>

<br></br>Under what condition is the first axillary lymph node removed along with the rest of the nodes?

A

Only if it contains metastatic tumour.

144
Q

<h1>Page 39</h1>

<br></br>What is the approach for the management of breast cancer?

A

Tailored to individual patients: One size does NOT fit all.

145
Q

<h1>Page 39</h1>

<br></br>What is the purpose of radiotherapy in breast cancer treatment?

A

To reduce the incidence of local recurrence.

146
Q

<h1>Page 39</h1>

<br></br>When is chemotherapy used in breast cancer treatment?

A

In some cases to reduce the incidence of metastases or to treat metastases.

147
Q

<h1>Page 39</h1>

<br></br>What is the purpose of anti-Oestrogen therapy in breast cancer treatment?

A

May be used where there is evidence of oestrogen receptor over-expression.

148
Q

<h1>Page 39</h1>

<br></br>What is Trastuzumab (Herceptin) used for in breast cancer treatment?

A

It is a monoclonal antibody targeted to the HER2 protein, used where there is evidence of HER2 overexpression.

149
Q

<h1>Page 39</h1>

<br></br>How does Trastuzumab (Herceptin) work in breast cancer treatment?

A

It blocks receptor sites, which blocks initiation of growth signals and may enhance destruction of tumour cells by the immune system.

150
Q

<h1>Page 40</h1>

<br></br>How often should women aged over 50 undergo mammographic screening?

A

Every 1 - 2 years.

151
Q

<h1>Page 40</h1>

<br></br>Under what circumstances can women have mammographic screening earlier?

A

If they have an increased risk.

152
Q

<h1>Page 40</h1>

<br></br>What is the aim of mammographic screening?

A

To detect cancers early and detect in situ lesions.

153
Q

<h1>Page 40</h1>

<br></br>What are some radiological abnormalities that breast abnormalities may show?

A

Increased densities and calcification.

biology (10 decks)

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