PBL Week 1 Wrap up Flashcards
what is fibroadenoma
tumour made up of fibrous tissue, tumour of gland tissue
may be related to reproductive hormones
occur more often in reproductive years, bigger during pregnancy or with use of hormone therapy, may shrink after menopause
what are the types of fibroadenoma
juvenile
giant
complex
phyllodes
juvenile fibroadenomas
most common type found in girls and adolescents between ages 10 and 18
can grow large, most shrink over time, some disappear
giant fibroadenomas
can grow larger than 2 inches
may need to be removed as can press on breast tissue
complex fibroadenomas
contain overgrowth of cells (hyperplasia) due to changes in cell proliferation
pathologist makes diagnosis after reviewing the tissue from a biopsy
phyllodes tumour
usually benign
some can become malignant
normally recommend removal
most common type of cancer in females
breast cancer
when do you get invited for mammograms and how frequently
women age 50-53
every three years
what is the mortality rate that breast cancer accounts for out of all cancer deaths in females
15%
how many breast cancer cases are presented in GP clinics
80%
what are the three stages of triple assessment
clinical examination
mammography and/or ultrasound imaging
core biopsy and/or fine needle aspiration cytology
whoo do fibroadenomas usually our in
younger menopausal women
what occurs in stage one breast cancer
less than 2cm
hasn’t spread
what occurs in stage 2 breast caner
less than 2cm
lymph nodes metastasis
greater than or equal to 2cm
stage 3 breast cancer
any size but has spread to axillary lymph nodes
stage 4 breast cancer
spread to other organs of the body such as lungs, skin, liver, bones or brain
what percentage of breast cancer patients survive more than 10 years
75% but dependent on the stage
what is the percentage rate of survival of 5 years in stage 4 metastatic breast cancer
20%
what are the 4 types of breast cancer
HR-/HER2- (triple negative)
HR-/HER2+ (least common)
HR+/HER2+ (triple positive)
HR+/HER2- (most common)
what do all breast cancer cases firstly subdivide into
HR- or HR+
HR- is ER- and PR-
HR+ is ER+ or PR+
HR means hormone
ER means oestrogen
PR means progesterone
+ is high level
- is normal level
triple negative breast cancer
13% of all cases
most difficult to treat
HR-/HER2-
least common type of breast cancer
HR-/HER2+
5% of all cases
triple positive breast cancer
HR+/HER2+
10% of all cases
most common type of breast cancer
HE+/HER2-
73% of all cases
most difficult breast cancer to treat
triple negative
70% of these patients have BRCA mutations
what is the most common hereditary gene mutation in breast cancer
mutation in the BRCA gene
BRCA 1 and BRCA 2 account for 60% of mutation caused cancer
what percentage of the female population have a higher predisposition to breast cancer
10-15%
hormonal risk factors for breast cancer
early menarche
late menopause
greater age of first full-term pregnancy
oral contraceptives
hormone replacement therapy
non-hormonal risk factors for breast cancer
alcohol
obesity
age
risk factors for breast cancer associated with a high socioeconomic background
greater age at first full-term pregnancy
oral contraceptives
hormone replacement therapy
breast cancer in more deprived areas
14% fewer cases
may be due to a lower uptake of breast cancer screening
what is a benign tumour
doesn’t invade and destroy the tissue in which it originates or spread to distant sites in the body
non-cancerous
what is a malignant tumour
invades and destroys tissue in which it originates and has the potential to spread to other sites in the body via the bloodstream and lymphatic system
presentation of a fibroadenoma
painless usually small hard lump in the breast
two categories for breast cancer
invasive
non-invasive
non-invasive breast cancers
DCIS (ductal cancer in situ)- cancer cells developed in the ducts but haven’t spread beyond
LCIS (lobular cancer in situ)- abnormal cells have developed in the lobules
invasive breast cancers
invasive breast cancer- cancer cells grown through the duct lining into the surrounding breast tissue (medullary, papillary, tubular, mucinous)
invasive lobular breast cancer- cancer cells started to grow in the lobules and have spread to the surrounding tissues
inflammatory breast cancer- within the lymph vessels in the skin of the breast, inflamed and painful
pagets disease- develops in the nipple or areola
angiosarcoma- start in blood or lymphatic vessels within the breast ,primary and secondar y
what genes are associated with developing breast cancer
BRCA1
BRCA2
HER2
proto-oncogene
membrane tyrosine kinase
TP53
CHEK2
BRCA1
tumour suppressor involved in double strand breaks of DNA and transcription coupled repair
women with mutation have 55-65% risk breast cancer and 40% ovarian
BRCA2
involved in double strand break repair and have 40% increased risk of breast cancer
HER2
human epidermal growth factor receptor 2
HER2 gene amplification leads to HER2 protein over expression
TP53
tumour suppressor gene
if p53 is faulty it fails to stop cell division
TP53 can be inherited or spontaneous , also binds to apoptosis regulator PTEN
CHEK2
encodes for checkpoint tyrosine kinase which acts as a tumour suppressor
types of DNA mutations
point mutation
addition
deletion
inversion
duplication
what are the potential breast cancer treatments
surgery- first treatment
chemotherapy
radiotherapy
hormone therapy
targeted therapy
breast cancer surgery
breast-conserving: only remove the tumour
mastectomy- remove whole breast and the nipple
chemotherapy
using anticancer (cytotoxic) medicine to destroy cancer cells
can stop oestrogen production, can encourage breast cancer growth
Neo-adjuvant: chemo done before surgery, often used to shrink a large tumour
side effects: loss of appetite, feeling sick, tiredness, hair loss, sore mouth, infections
radiotherapy
doses of radiation to destroy cancer cells
last 3-5 weeks
side effects: extreme tiredness, irritation and darkening of skin on the breast
hormone therapy
lowers level of oestrogen and progesterone in the body, stimulate breast cancer growth or stop effects
breast cancer cells
breast cancer ells have receptors where oestrogen and progesterone attach to help them grow
tamoxifen is most common hormone therapy, can be used in pre and post menopausal women, blocks oestrogen receptors on cancer cells in breast
targeted therapies
change the way cells work and help to stop cancer from growing and spreading
can be given via a drip in the vein, pill or as an injection under the skin
side effects: shivering, diarrhoea, sickness, headache, cough, skin rash
treatment for fibroadenoma
only treated if fast growing, large or causing symptoms
1. surgical excision: cutting out using knife
2. freezing it: thin wand shaped device is inserted, freezes lump, ultrasound used to guide wand to Lump
why are breast cancer assessments less accurate in younger patients
as patients get older the breast shrinks
density reduces
abnormalities are easier to differentiate from normal breast tissue
what occurs in a clinical assessment
take the history:
-symptoms
-risk factors
examination:
-observe breast and axilla for symmetry, colour and masses
-feel each quadrant of breast and axillary tail
-is the mass fixed or mobile
symptoms of breast cancer q
breast lump
skin
nipple change
discharge
pain
duration
patterns
types of imaging used in breast cancer
mammography
breast ultrasound
MRI
staging axillary ultrasound
mammography
low dose X-rays
used in ages 40+ due to glandular tissue density
look for lesions, asymmetry, skin thickening, lymph nodes
breast ultrasound
sound waves
measures size of cancer
can guide needle biopsies
more curate than mammography in younger patients
MRI
detects subtle morphological changes but poorly differentiates between benign and malignant lesions
staging axillary ultrasound
looks for enlarged lymph nodes with increased thickness
methods for pathology for breast cancer
biopsy
fine needle aspiration cytology
vacuum assisted biopsy/ mammotome
biopsy
3-5,1.6mm diameter cylinders of tissue removed and tested
fine needle aspiration cytology FNAC
reserved for very small/superficial lesions that would be difficult to biopsy otherwise
vacuum assisted biopsy VAB/ mammotome
larger biopsy
probe used to collect tissue samples through small 1/4 inch incisions
non-urgent GP referral
longer than 2 weeks
urgent GP referral
within 2 weeks
very urgent GP referrals
within 48 hours
what is a multidisciplinary team
team of healthcare professionals who meet to discuss a patient
support available for breast cancer patients
national hereditary breast cancer helpline
screening programmes
public health “be clear on cancer”
coping with bereavement of breast cancer
live chat forum
mental health guides
talk to family and friends
living healthy lifestyle
