Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 CBLs > Surgery: Breast Cancer > Flashcards

Surgery: Breast Cancer Flashcards

1
Q

Risk factors for breast cancer

A
  • age → >50 female (rare under 35)
  • family history → first degree relatives

genetics → BRCA/Li-Fraumeni (5% of breast ca)

  • oestrogen exposure: 1st pregnancy >30yrs, OCP/HRT, late menopause, early menarche, obesity
  • Alcohol
  • Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What’s the risk of developing cancer with BRCA1 and BRCA2 genes?

A

80-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can breast cancer present?

(symptoms or picked up where)

A
  • Through screening programme i.e. asymptomatic
  • Lump –hard, irregular, tethered
  • Change in shape
  • Ulceration
  • Skin changes e.g. Peau d’orange
  • Inflammatory breast cancer
  • Nipple changes e.g. Paget’s disease, discharge, inversion
  • Metastatic cancer – axillary lumps, incidental on scans
  • Incidental: Picked up on imaging for something else
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of malignant breast cancer (names)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Breast cancer staging

(TN)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What histological types of breast cancer have better prognosis?

A
  • Tubular
  • mucinous
  • medullary
  • adenoid cystic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s the most common type of non-invasive breast cancer?

A

Ductal Cell Carcinoma

20% of all breast cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens in Ductal Carcinoma in-situ?

A

Malignant cells have not penetrated the epithelial basement membrane → so have not yet extended out of the breast duct system

  • 20-30% of patients who do not receive the treatment will develop invasive disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigations for Ductal Carcinoma in situ

A
  • often detected during screening → appears as microcalcifications on mammography
  • biopsy → to confirm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of Ductal Cell Carcinoma In Situ (DCIS)

A
  • Any detected localised DCIS should be treated with complete wide excision, ensuring the surrounding tissue of all margins have no residual disease
  • Cases of widespread or multifocal DCIS normally requires complete mastectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Possible modes of management (general types of treatment) for breast cancer

A
  • Surgery
  • Radiotherapy
  • Chemotherapy and targeted therapy
  • Endocrine therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who does Breast Cancer MDT consist of?

A
  • all patients diagnosed with breast cancer should be discussed within the multidisciplinary team (MDT) meeting
  • includes breast surgeons, radiologists, oncologists, pathologists, and breast cancer specialist nurses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When us ‘curative’ approach used and when is ‘palliative’ approach used?

A
  • curative → either no lymph node involved or only axillary node is involved
  • palliative → symptoms relief when distant metastases are present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name (2) surgical options with a curative approach in breast cancer

A
  • mastectomy
  • breast-conserving surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When are they used (criteria):

  • mastectomy
  • breast-conserving surgery
A
  • Breast-conserving → suitable for smaller tumours (<5cm) or if patient prefers minimal surgery, suitable for patients with localised disease with no evidence of metastases
  • Mastectomy → suitable for large (<5 cm), central or multifocal tumours, recurrance of the cancer, patient choice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens during breast-conserving surgery?

A

Wide Local Excision (WLE) → lump is removed with a wide margin and followed by radiotherapy

*typically ensuring a 1cm margin of macroscopically normal tissue is taken along with the malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What happens during a mastectomy?

A
  • removes all the tissue of the affected breast, along with a significant portion of the overlying skin (the muscles of the chest wall left intact)
  • the amount of skin that is excised is often dependent on whether a reconstruction is planned.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the aim of axillary surgery?

A
  • most commonly performed alongside WLE and mastectomies
  • to assess nodal status and remove any nodal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is sentinel lymph node biopsy?

How is it performed?

A

Sentinel node biopsy:

  • involves removing first lymph nodes into which the tumour drains
  • The nodes are identified by injecting a blue dye with associated radioisotope into the peri-areolar skin → radioactivity detection and / or visual assessment (as the nodes become blue) can then identify → the sentinel nodes can then be removed and sent for histological analysis
20
Q

The possible outcomes of sentinel nodes biopsy (2)

A
  • negative → rest of the lymphatic trunk is probably free of metastases *
  • positive → all nodes are removed from the axilla

*false-negative ratio is about 5%

21
Q

What happens in axillary node clearance?

Complications

A

Axillary node clearance:

  • involves removing all nodes in the axilla, ensuring to not damage any associated important structures within the axilla, which are then sent for histological analysis
  • Common complications from this operation include paraesthesia, seroma formation, and lymphedema in the upper limb.
22
Q

Who medical treatment for breast cancer is offered to?

A
  • in non-metastatic malignant cancer, after primary surgery→ as therapy adjuvant
  • in the elderly or people not fit for the surgery
23
Q

What’s the importance of Oestrogen Receptor (ER) expression?

A

A tumour that expresses ER is dependant on oestrogen → susceptible to hormonal therapies

  • status is determined histologically
  • ER positive tumours (common) have better prognosis
24
Q

Tamoxifen

  • used in what group of patients
  • MoA
A

Tamoxifen

  • used typically in pre-menopausal patients
  • acts through blockade of oestrogen receptors, therefore also has a role in prophylaxis against breast cancer
25
Q

Side effects of Tamoxifen

A

Tamoxifen increases the risk of:

  • thromboembolism during and after surgery or periods of immobility
  • uterine carcinoma (due to its pro-oestrogenic effect on the uterus)
26
Q

Aromatase inhibitors

  • names (3)
  • group of patients used on
A

Aromatase inhibitors

  • advised for post-menopausal patients
  • as adjuvant therapy
  • however are more expensive than Tamoxifen (but superior to Tamoxifen in these groups of patients)
27
Q

MoA of Aromatase inhibitors (2)

A
  • binding to oestrogen receptors to inhibit further malignant growth and preventing further oestrogen production
  • also blocking the conversion of androgens to oestrogen in peripheral tissues
28
Q

What group of patients is immunotherapy used in?

A

In patients whose cancers express specific growth factor receptors.

29
Q

What is HER-2

What is the treatment

A

Human epidermal growth factor receptor (HER-2)

  • positive malignancies for HER-2 treated with Herceptin (Trastuzumab)*

*is a monoclonal antibody that targets its activity → immunotherapy

*It can be used either as adjuvant therapy or as a monotherapy in patients who have received at least two chemotherapy regimens for metastatic breast cancer

30
Q

Common side effect of Herceptin treatment

A

cardiotoxicity → hence cardiac function must be monitored before and during treatment

31
Q

What is oncoplastic management? (in general)

A
  • oncoplastic surgery → a new approach for either extending techniques to allow breast-conserving surgery or to reconstruct the breast following mastectomy
  • there are several surgical reconstructive techniques in the oncoplastic treatment of breast malignancy, broadly divided into mammoplasty and flap formation
32
Q

Paget’s Disease

  • what’s that
  • what to do
A
  • it is a skin manifestation (patch of eczema around the nipple)
  • suggestive of underlying malignancy (1% of cancers may present like that)
  • underlying malignancy may be palpable (not always)
  • need to perform mammography/ultrasound and nipple biopsy (punch biopsy)
33
Q

How to differentiate Paget’s Disease of the Nipple from Eczema of the Nippe?

A

Paget’s disease differs from eczema of the nipple in that it:

  • involves the nipple primarily and only later spreads to the areolar (the opposite occurs in eczema)
34
Q

What timescale of nipple retraction do we worry about?

A

If it’s short onset e.g. less than 3 months

35
Q

Family history of what cancers do we consider as relevant to tisk of breast cancer (4)?

A
  • breast
  • ovarian
  • prostate
  • pancreas
36
Q

What does score 1 mean and what does sore 5 mean?

A

1 - not cancer; benign disease e.g. fibroadenoma

2

3

4

5 - definitely cancer

37
Q

What age do we consider mammogram and at what age do we do USS?

A
  • mammogram → age 40 or more
  • USS → less than 40
38
Q

What does C1 (cytology result mean)?

What does B1 (biopsy) mean?

A

C1 = inadequate sample to perform scoring !

B1 = normal

39
Q

What do we do for a persistent and/or bloody discharge?

A

Surgical excision of the duct

40
Q

How do we manage (at GP setting) a patient presenting with abscess or mastitis? When do we refer?

A
  • History + examination
  • Give antibiotics
  • See in 2 weeks → if the infection still there → refer for triple assessment*

* this is to role out inflammatory cancer

41
Q

What’s the difference between staging and grading?

A

Staging → how much tumour is there in an axilla, breast, body (e.g. metastases)

Grading → change in tissue e.g. hyperplasia, metaplasia (how different is a lump from normal tissue)

*the higher grade, the more different

42
Q

Breast screening programme in the UK

A
  • to include women aged 47-73 years
  • mammogram every 3 years
  • after the age of 70 years women may still have mammograms but are ‘encouraged to make their own appointments’
43
Q

When does a patient who had one 1st or 2nd-degree relative with breast cancer must be referred?

A

If the person has only one first-degree or second-degree relative diagnosed with breast cancer they do NOT need to be referred unless any of the following are present in the family history:

  • age of diagnosis < 40 years
  • bilateral breast cancer
  • male breast cancer
  • ovarian cancer
  • Jewish ancestry
  • sarcoma in a relative younger than age 45 years
  • glioma or childhood adrenal cortical carcinomas
  • complicated patterns of multiple cancers at a young age
  • paternal history of breast cancer (two or more relatives on the father’s side of the family)
44
Q

How to differentiate fibrocystic change from fibroadenoma?

A
  • Fibrocystic change → no definitive lump
  • Fibroadenoma → definitive lump
45
Q

What does it mean ‘triple-negative breast cancer’ and what group of patients it tends to occur in?

A
  • Cancer that is: oestrogen, Herceptin and progesterone negative
  • Tends to occur in BRACA mutations

*use chemotherapy as systemic treatment

Y4 CBLs (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions