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Reproduction Pathology > Treatment of Breast Disease > Flashcards

Treatment of Breast Disease Flashcards

1
Q

Pathological types of breast cancer

A

In situ carcinoma

Invasive carcinoma

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2
Q

Types of in situ carcinoma

A

Ductal carcinoma in situ

Lobular carcinoma in situ

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3
Q

Types of invasive carcinoma

A 
Ductal 
Lobular
Tubular
Cribriform 
medullary
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4
Q

Two ways to be diagnosed with breast cancer

A
  1. Present with a symptom

2. NHS breast screening programme

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5
Q

5 principles of management for a patient with breast cancer

A 
Establish the diagnosis
Assess the severity ("staging")
Treat the underlying cause
General measures
Specific measures
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6
Q

Risks for breast cancer

A 
Age
Geographical variation 
Age at menarche and menopause
Age at first pregnancy 
FH
Previous benign breast disease 
Cancer in the other breast 
Radiation 
Lifestyle (obesity, alcohol)
Oral contraception 
HRT
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7
Q

Symptoms of breast cancer

A

Lump/thickening in breast - often painless
Discharge or bleeding
Change in size or contours of the breast
Change in colour or appearance of the areola
Redness or pitting of skin over the breast, like orange skin

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8
Q

Investigations of breast cancer

A

clinical exam
mammography
USS
FNA cytology

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9
Q

Definition of sensitivity

A

The ability of a test to detect if it is there

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10
Q

Investigations of staging of breast cancer

A 
Hb FBC, U and Es, LFTs
CXR
Isotope bone scan (if spread to lymph nodes)
Others as clinically indicated
No reliable tumour markers
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11
Q

Staging of breast cancer (TNM)

A 
T (tumour)
- T1 = 0-2cm
- T2 = 2-5cm 
- T3 = >5cm
- T4 = fixed to skin or muscle 
N (nodes)
- NO = none 
- N1 = nodes in axilla 
- N2 = large of fixed nodes in axilla 
M (metastases)
- M0 = none
- M1 = metastases
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12
Q

Two main types of surgical procedure of the breast

A

Breast conservation surgery

Masectomy

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13
Q

Types of breast conservation surgery

A

Wide local excision
Quadrantectomy
Segmentectomy

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14
Q

Tumour size clinically indicated for breast conservation surgery

A

< 4cm

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15
Q

What does it mean if the sentinel lymph node biopsy is negative?

A

Rest of the nodes in the lymphatic basin are negative, as there are no “skip” metastases

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16
Q

What is the first node to which a breast cancer tumour would spread to?

A

Sentinel lymph node

17
Q

Treatment to the axilla if the sentinel lymph node contains tumour

A

Remove all of them surgically (clearance) OR

Radiotherapy to all nodes in the axilla

18
Q

Complications of treatment to the axilla

A

Lymphedema
Sensory disturbance (intercostobrachial nerve)
Decreased ROM of shoulder joint
Nerve damage (long thoracic, thoracodorsal, brachial plexus)
Vascular damage
Radiation induced sarcoma

19
Q

After the breast is treated, what must be carried out?

A

Eradication of micrometastatic disease

20
Q

What factors are associated with increased risk of disease recurrence in breast cancer?

A 
Lymph node involvement 
Tumour grade
Tumour size
Absence of oestrogen receptors 
Presence of Her2 receptors
Lymphovascular invasion of tumour (even if nodes not involved)
21
Q

Treatment of micrometastases in breast cancer

A

Hormone therapy
- oestrogen receptors (only given if hormone receptors present)
- zoladex, tamoxifen, aromatase inhibitors
Chemotherapy
Targeted therapies
- anti-her2 therapy - transtuzumab

22
Q

In the treatment for micrometastases for breast cancer, when does chemotherapy have the best effects?

A

< 50 year olds

23
Q

When is anti-Her2 therapy given in the treatment for micrometastases?

A

Patients with overexpression of Her2 and chemotherapy

24
Q

What do oestrogen receptors do in the treatment of micrometastases?

A

Blocks stimulation of cell growth by oestrogen

25
Q

What types of hormone therapies are given in the treatment of micrometastases of breast cancer?

A 
Premenopausal = tamoxifen for 5 years
Postmenopausal = tamoxifen for 5 years if excellent prognosis 
Others = get aromatase inhibitor e.g. anastrole for 5 - 10 years
26
Q

Follow up after having treatment for breast cancer

A

Clinical exam 6 monthly for 3-5 years
Discharge after 3-5 years, or even sooner
mammogram at yearly intervals for 10 years

27
Q

Look in the breast clinic for …..

A 
Breast pain (cyclical or non-cyclical) 
Benign lumps
- fibroadenoma
- cysts
- fibrocystic change
- fat necrosis
Nipple symptoms
- discharge
- bleeding
- eczema ( pagents) 
Gynaecomastia
28
Q

What drug is used in breast cancer in ER +ve women who are pre or peri menopausal?

A

Tamoxifen

29
Q

What drug is used in breast cancer in ER +ve women who are post menopausal?

A

Aromatase inhibitors

Reproduction Pathology (28 decks)

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