Session 3- Breast Cancer Flashcards
what does the NHS breast screening programme involve?
women ages 50-70(now 47-73) invited once every 3 years to have a mammogram (X-ray) of their breasts to aim to pick up small breast cancers early to reduce needing much chemo/mastectomy
what are the disadvantages from the breast cancer screening programme?
may pick up breast cancers that would never have caused symptoms/ be life threatening
may increase risk of cancer by x-ray exposure to the breast
false positives:
may cause unnecessary distress/worry
may cause you to have extra unnecessary tests
false negatives
may miss a cancer, which could grow and harm the patient but they think they’re ok as they have had the screening
if someone younger than 50 wants to have a mammogram, what problems may this cause?
if they are pre-menopausal, breast is denser so can’t x-ray it like a normal mammogram.
can have ultrasound instead
what is the most common type of breast cancer?
invasive ductal carcinoma - starts in the lining of the ducts and spreads to surrounding breast tissue
what does ER positive breast cancer mean?
the breast cancer cells proliferation is being controlled by oestrogen.
There is an oestrogen receptor inside the cell, which when oestrogen enters and binds to it, it increases cell proliferation and therefore the growth of the cancer.
This indicates better prognosis as it should be responsive to hormonal therapies like tamoxifen. (which inhibits the oestrogen from binding to its receptors)
what does HER2 overexpression mean
the breast cancer cells are overexpressing the surface receptor human epidermal growth receptor.
this receptor is an indicator of worse prognosis as they increase the rate at which cells are dividing at.
however, it can be targeted by the monoclonal antibody trastuzumab aka herceptin
what type of breast disease are benign?
fibroadenoma - benign growoth of collagenous mesenchyme of one breast lobule
breast cyst - benign fluid filled lump
breast abscess - infection of one of the ducts, normally associated with lactation
ductal ecstasia - duct gets blocks, contents stagnate
fat necrosis - fibrosis and calcification after injury to breast tissue
what would you expect a benign breast lump to feel like?
regular borders smooth mobile painful or painless solid or cystic consistency
what would you expect a malignant lump to feel like?
irregular border
craggy/gritty/hard/firm consistency
immobile/tethered/fixed position
normally painless unless there is inflammatory breast cancer
overlying skin changes, blood nipple discharge, nipple inversion/retraction, skin dimpling.
what should all breast lumps undergo?
‘triple assessment’
clinical examination
imaging (mammography/US)
histology/cytology (biopsy, normally by US guided needle)
what should you do first during the breast examination?
feel the normal breast first!
what are the 5 different treatment options for breast cancers? and say a little bit about them
Surgery - can have whole breast removed (mastectomy) or breast conservation where only the tumour is removed. Sentinel node biopsy (first node cancer will spread to) and possibly axillary node removal if has spread.
Radiotherapy - used to kill of any cancer cells not removed by the surgery. to increase survival and reduce reoccurence.
Chemotherapy - same as above
Hormone therapy - if progesterone/oestrogen receptor positive cancers, aim to reduce action of oestrogen causing the cancer to proliferate. Use tamoxifen to block ER. and Aromatase inhibitors to reduce synthesis of oestrogen in post-menopausal women, and ovarian ablation in the young.
Biological therapies - Tanstuzumab/herceptin can be used to prevent the HER2 receptors (if positive) from causing the cancer to grow more rapidly.
what genetic elements are involved in breast cancer?
BRCA1 (chromosome 17)
BRCA2 (chromosome 13) massively increase likelihood of getting breast cancer (and also small increase in ovarian)
TP53 (chromosome 17) most with the mutation will get breast cancer by 50.
PTEN gene- Cowden’s syndrome, increase risk of breast, uterine and thyroid cancers
what is on the 2 week wait guidelines for breast cancer referrals?
aged 30 +, with unexplained breast lump
OR
ages 50+ with one or more of the following in one nipple: retraction, discharge, or other changes of concern
