Oncology Workshop 3 (Breast Cancer) Flashcards
What are the 4 cancers that be cured by chemotherapy alone?
- Germ Cells
- High grade lymphoma (e.g. Hodgkin’s)
- Acute leukaemia (NOT chronic)
- Choriocarcinoma
Explain carcinoma in situ (stages)
What are the sub-types of breast cancer?
- Two most frequent sub-types are:
- Ductal carcinoma (70-75%)
- Lobular carcinoma (12-15%)
- 18 other subtypes (0.5-5%)
- (Encapsulated papillary carcinoma and papillary carcinoma massive type=DCIS)
What would be included in pathology? (Breast cancer)
- Pathology should include;
- Presence/absence of DCIS
- Grade •
- IHC (immuno-histo chemistry) of ER (Oestrogen) (i.e. Allred score) and PR (progesterone)
- •Invasive cancer
- HER2 expression or HER2 gene amplification for ambiguous scores (2+)
Explain the Alfred score (Breast cancer)
- Proportion score (cells are ER+ve)
- 0 No cells
- 1 ≤ 1% of cells
- 2 10% of cells
- 3 11–33% of cells
- 4 34–66% of cells
- 5 67–100% of cells
- •Intensity score
- 0 Negative
- 1 Weak
- 2 Intermediate
- 3 Strong
-
Allred score (this bit important)
- 0–1 No effect
- 2–3 Small (20%) chance of benefit
- 4–6 Moderate (50%) chance of benefit
- 7–8 Good (75%) chance of benefit
•How is HER2 expression interpreted?
- HER2 positive by IHC (3+)
- >10% of the cells harbour a complete membrane staining
- If ambiguous, (2+)
- FISH if the number of HER2 gene copies is ≥6
- Or the HER2/chromosome 17 (CEP17) ratio is ≥2 and HER2 copies ≥4
How does HER2 cause cell cancer to grow?
Stimulation of the cell cycle
In breast cancer where do we get pathology from?
- Biopsy
- Surgery (surgery better as get more tissue → representative of more cancer cells)
What is TIL scoring and how does it work? & where used
- Tumour-infiltrating lymphocyte (TIL) scoring is a predictor for pathological complete response to chemotherapy
- Any other treatments used in oncology where TIL might be important?
- Chemotherapy
- Immunotherapy
- TILs not used for treatment decisions (as it’s biased and there isn’t enough prospective evidence)
What is BRCA?
- BReast CAncer gene
- Gene 1 and Gene 2 ••
- •BRCA 1 Chromosome 17
- BRCA 2 Chromosome 13
- BRCA 1
- ~15-45% lifetime risk of ovarian cancer
- ~85% lifetime risk of breast cancer (do an oophorectomy → usually at 40 years old (usually due to comes on older and people want to have kids) and mastectomy)
- BRCA 2
- ~10-20% lifetime risk of ovarian cancer (do an oophorectomy → usually at 50 years old and mastectomy)
- ~85% lifetime risk of breast cancer
- The idea of BRCA was thought of in 1940s
- British researcher Sir David Smithers (Royal Free Cancer Hospital)
- Published a paper on 450 breast cancer patients demonstrating that breast cancer can run in families
- 1980s genes were the focus of cancer research
- Race was on to discover the inherited breast cancer gene called….
- BReast CAncer gene 1
What cancers are associated with BRCA?
- Most common
- Breast cancer
- Ovarian cancer
- Less common
- Pancreas
- Prostate
- ?Melanoma
Why are bilateral mastectomy recurrence reduced to 90-95%
Because not all breast tissue can be removed
Is there any survival benefit of having prophylactic bilateral mastectomy?
No survival benefit as breast cancers can be treated well at an early point
BUT does help reduce the risk of cancer
When to test for BRCA?
- Germline BRCA 1 & 2 testing for;
- What’s germline testing mean?
- Strong family history of breast, ovarian, pancreatic and/or prostate
- Breast cancer before 50
- TNBC (triple negative breast cancer) before 60
- Personal history of ovarian cancer, second breast cancer or male•
What does BRCA gene do?
- BRCA is tumour suppressor gene
- It repairs double stranded DNA breaks by homologous recombination repair (HR)
- Platinum chemotherapies cause double stranded DNA breaks
- So if you have a mutated (damaged) BRCA gene…..
- BRCAs are super sensitive to platinum
Explain aromatase inhibitors
