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Breast Cancer > Red Book Early Stage > Flashcards

Red Book Early Stage Flashcards

1
Q

What mutations are involved in breast cancer?

A
  1. Ataxia-telangiextasia
  2. BRCA1: 60-80% risk
  3. BRCA2: 50-60% risk
  4. Cowden
  5. Li-Fraumeni
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2
Q

What’s the most common location for breast cancer?

A

UOQ

Greatest volume of glandular elements

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3
Q

What are the common location for breast cancer

A

UOQ > Central > UIQ > LOQ > LIQ

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4
Q

What’re the anatomical margins of the breast?

A
  1. Overlaying pec major
  2. 2nd to 6th rib
  3. Sternum to anterior axillary fold
  4. Axillary tail of spencer extends into low axilla
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5
Q

What’re the location of IM nodes?

A

Along IM vessels
First three intercostal spaces
2-3 cm lateral to midline
2-3 cm deep

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6
Q

What % of tumors drain to IMN?

A

Medial: 30%
Lateral: 15%

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7
Q

What % of breast cancers are triple negative?

A

15%, and most commonly associated w/ BRCA mutations

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8
Q

What’re the common histologic types?

A 
IDC: 80%
ILC: 5-10% (less visible on mammo, more on MRI)
Tubular
Medullary
Mucinous
Colloid
Papillary
Cribriform
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9
Q

What’s extensive intraductal component (EIC)?

A

> 25% DCIS within invasive cancer

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10
Q

Which pt’s do we use Oncotype DX for?

A

LN -ve
ER +ve
Receiving tamoxifen

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11
Q

What does Oncotype DX tell us?

A

Benefit from chemotherapy in addition to hormonal therapy

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12
Q

What’re the Oncotype DX scores?

A

<18: Low risk
18-30: Intermediate risk
>30: High risk

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13
Q

What’re the rates of distant recurrence for different Oncotype DX groups?

A

Low: ~7%
Intermediate: ~14%
High: ~30%

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14
Q

What’re the 4 main intrinsic (molecular) subtypes of breast cancer?

A 
Luminal A
Luminal B
Triple -ve
HER2 enriched
Normal-like
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15
Q

What defines Luminal A subtypes of breast cancer? What does Luminal A signify?

A

Hormone Receptor + (ER+ and/or PR+)
HER2-
Low Ki-67

Slow growing w/ the best prognosis

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16
Q

What defines Luminal B subtypes of breast cancer? What does Luminal B signify?

A

Hormone Receptor + (ER+ and/or PR+)
+/- HER2+
High Ki-67

Grow faster than Luminal A w/ worse prognosis

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17
Q

What defines HER2 enriched subtypes of breast cancer? What does HER2 enriched signify?

A

Hormone receptor -
HER2 +

Grow faster than luminal cancers w/ worse prognosis

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18
Q

What’s the SN/SP of mammogram?

A

> 90%

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19
Q

What’re the USPS recs for mammograms

A

40-49: No routine screening
50-72: Yearly mammograms
High-risk women: 10 yrs before dx of relative
No evidence for benefit/harm of clinical exam
Recommend against teaching self-exam

20
Q

How’re breast cancers detected?

A

Mammogram 90%

Self-exam 10% (usually painless. Rarely (~5%) painful)

21
Q

If a mass changes w/ menstrual cycles, what’s the likelihood of it being cancerous?

A

Low

22
Q

What % of women have b/l cancers?

A

1-3%

23
Q

What’s the risk of developing contralateral breast cancer after primary dx?

A

0.75% per year

24
Q

What’s multifocal breast cancer?

A

2 or more foci in the same quadrant

25
Q

What’s multi-centric breast cancer?

A

2 or more foci in di quadrants
OR
2 foci > 5 cm apart

NOT eligible for breast conservation

26
Q

What’s BI-RADS?

A

Classification System

0: Incomplete. 1 % risk
1: -ve. <1% risk
2: Benign. <1% risk
3: Probably benign: <2% risk
4a: Low suspicion for malignancy. 2-10% risk > Bx
4b: Mod suspicion for malignany. 10-50% risk > Bx
4c: High suspicion for malignancy. 50-95% risk > Bx
5: Highly suggestive of malignancy. >95% risk > Bx
6: Bx proven malignancy

27
Q

For which stages ca we skip systemic imaging for breast cancer pts?

A

Stage I-II w/o suspicious sx

28
Q

What’re some suspicious sx/findings in a low stage breast cancer pt that would warrant systemic imaging?

A

Elevated LFTs

Elevated alk phos

29
Q

What’re some suspicious findings on mammography?

A

Calcifications

Spiculated lesions

30
Q

How does spot compression distinguish between benign vs. malignant lesions on mammography?

A

Benign (dense breast tissue) spreads out w/ compression.

31
Q

Why do we do US w/ mammography?

A

Distinguish solid from cystic lesions, and evaluate nonpalpable masses identified on mammogram

32
Q

What’re the different types of bx?

A

Core: Preferred
FNA: Cannot distinguish invasive cancer vs DCIS, or hormone/receptor status
Punch bx: For Paget’s disease/inflammatory breast cancer

33
Q

What’re some poor prognostic factors associated w/ breast cancer?

A 
LN +ve
Young age
ER/PR -ve
HER +ve (in the absence of HER2 directed tx)
High Grade
LVSI +
Basal-like subtype
34
Q

What’s the T staging for breast cancer?

A

Tis: Carcinoma in situ

T1mic: <0.1 cm
T1a: 0.1-0.5 cm
T1b: 0.5-1 cm
T1c: 1-2 cm

T2: 2-5 cm

T3: > 5 cm

T4a: Extension into the chest wall (not pec major)
T4b: Extension into the skin
T4c: T4a + T4b
T4d: Inflammatory breast cancer

35
Q

What’s the cN staging for breast cancer?

A

N0: No palpable LNs

N1: Mobile ipsilateral I/II Ax. LNs

N2a: Fixed/matted ipsilateral Ax LNs
N2b: Ipsilateral IM LNs w/o Ax LNs

N3a: Ipsilateral infraclavicular LNs
N3b: IM + Ax LNs
N3c: Ipsilateral Supraclav LNs

36
Q

What’re the pN staging for breast cancer?

A

N0 (i-) -ve by IHC
N0 (i+) +ve by IHC
N0 (mol-) -ve by PCR
N0 (mol+) +ve by PCR

N1 (mi) >0.2 mm and/or >200 cells, but <2mm
N1 (a) 1-3 Ax LNs
N1 (b) IM +ve by pathology, -ve be exam
N1 (c) pN1a + pN1b

N2 (a) 4-9 axillary LNs
N2 (b) IM +ve pathologically and clinically, but -ve Ax LNs

N3 (a) >10 Ax LNs + or infraclav +
N3 (b) Pathologically and clinically +ve IM + +Ax LNs
N3 (c) Ipsilateral Supraclav LNs +ve

37
Q

What’s the M staging for breast cancer?

A

M0 (i+) Circulating tumor cells in BM

M1 Distant Mets

38
Q

What’s the treatment paradigm for low-risk breast caner?

A

MRM

BCT: Lumpectomy + RT

CHT: If desired, done either neoadjuvantly or adjuvantly

Endocrine: For hormone-receptor +ve cancers. Done after all other tx.

39
Q

Therapies to prevent BCa or reduce risk of recurrence?

A

Tamoxifen: ER antagonist in Breast, ER agonist in endometrium. Reduces risk by 50%

Raloxifene: ER antagonist in breast and endometrium. Less thromboembolic effects than tamoxifen.

Vitamin D + Ca: May reduce risk in premenopausal women

Ppx mastectomy: Reduces risk by 90% in predisposed populations

No conclusive evidence from special dietary changes

40
Q

What are the different types of mastectomies?

A

RM: Removes pec major + Level I/II/III LNs

MRM: Removal of Level I/II LNs +/- Pec minor. Preserves Pec major and Level III LNs

TM: Removal of breast tissue only

Skin-sparing M: Removal of breast + scar skin

Nipple-sparing M: Preservation of nipple-areolar complex

41
Q

How many LNs are removed in ALND vs SLNBx?

A

Complete ALND: 20-22 LNs
Level I and II LND: ~15 LNs
SLNBx: Cariable

42
Q

Which women typically receive CHT for early-stage breast cancer?

A 
LN+
ER-
HER2+
Young Age (unclear benefit in > 70 yrs)
Multiple adverse features
High Oncotype DX
43
Q

Timing of CHT?

A

Typically, post-op

Neoadjuvant equivalent to adjuvant, but neo may allow for a less extensive surgery

44
Q

Which CHT has an OS benefit for HER2+ pt’s? How much is the benefit?

A

Trastuzumab

OS benefit 1 yr

45
Q

What’s the benefit of dose-dense (q2 wks) instead of standard regimens?

A

OS advantage for high-risk pt’s

46
Q

Which pts benefit from hormone therapy?

A

All hormone-receptor +ve pts w/o contraindications

47
Q

What’re the common hormone therapies? When are they used? What do they do?

A

All are typically given for 5 yrs

Tamoxifen: Decrease recurrence by 1/3 at 10 yrs, 1/2 subsequently. Carries risk of thromboembolic events (1%) and endometrial cancer.

Anastrozole: Prevents conversion of androgens to estrogen in peripheral tissue. Ineffective in premenopausal women. Less risk of thromboembolic events and endometrial cancer.

Breast Cancer (9 decks)

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