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Yr 3 - Reproduction > Treatment of Breast Disease > Flashcards

Treatment of Breast Disease Flashcards

1
Q

How common is breast cancer?

A

1 in 8 women

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2
Q

What are the risk factors for breast cancer?

A 
Age
PMH
BRCA 1 + 2 
Early menarche and late menopause
Late or no pregnancy
HRT
Alcohol (>14units/week)
Weight
Post-radiotherapy (Hodgkins's disease)
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3
Q

How does breast cancer present?

A 
Asymptomatic
Lump
Breast pain
Nipple discharge (bloody)
Nipple changes 
Change in size/shape
Lymphoedema
Dimpling of breast skin
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4
Q

What nipple changes are seen in breast cancer?

A

Dryness - Paget’s disease

Retraction

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5
Q

What lymphoedema is suggestive of breast cancer?

A

Swelling of the arm

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6
Q

What radiological exams are used for breast cancer?

A

Bilateral mammograms/USS

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7
Q

What cytological exams are used for breast cancer?

A

FNAC

Core biopsy

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8
Q

Which is the most sensitive form of breast imaging?

A

Mammography

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9
Q

Breast imaging sensitivity is reduced in which women?

A

Young women (increased glandular tissue)

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10
Q

What is the most sensitive test for breast lumps?

A

FNAC

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11
Q

What are the different types of breast cancer?

A

Invasive

Non-invasive

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12
Q

What are the different types of invasive breast cancer?

A

80% Ductal carcinoma
10% lobular carcinoma
10% others

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13
Q

What are the other types of invasive breast cancer?

A 
Mucinous
Tubular
Papillary
Medullary
Sarcoma
Lymphoma
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14
Q

What are the types of non-invasive breast cancer?

A

Ductal Carcinoma In situ

Lobular carcinoma in situ

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15
Q

How is breast cancer staged?

A

FBC, U+E, LFT, CA2+/PO2-

Chest x-ray

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16
Q

What do abnormal LFTs suggest in breast cancer?

A

Advanced disease

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17
Q

How would a palpable tumour <2cm be staged?

A

T1

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18
Q

How would a palpable tumour 2-5cm be staged?

A

T2

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19
Q

How would a palpable tumour >5cm be staged?

A

T3

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20
Q

How would a tumour invading skin be staged?

A

T4a

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21
Q

How would a tumour invading chest wall be staged?

A

T4b

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22
Q

How would a tumour invading skin and chest wall be staged?

A

T4c

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23
Q

How is inflammatory breast cancer staged?

A

T4d

24
Q

How are breast tumours N-staged?

A

N0 - No regional nodes palpable
N1 - Regional nodes palpable (mobile)
N2 - Regional nodes palpable (fixed)

25
Q

How is breast cancer managed?

A

SURGERY
Radiotherapy
Chemotherapy
Hormonal Therapy

26
Q

What surgeries are given for breast tumours?

A

Breast conservation surgery

Mastectomy

27
Q

What is the treatment for tumours <4cm?

A

Breast conservation + radiotherapy

28
Q

What factors are taken into consideration for patients with breast tumours?

A

Breast/tumour size ratio

Patient’s wishes

29
Q

What is the use of axilla surgery in breast cancer?

A

Prognostic information/staging

Regional control of disease

30
Q

When are sentinel lymph node biopsies performed?

A

When preoperative axillary USS are normal/benign

31
Q

What treatment is required if the SLN biopsy is negative?

A

None

32
Q

What treatment is required if the SLN biopsy is positive?

A

Surgical clearance

Radiotherapy to the axillary nodes

33
Q

What complications are associated with axillary treatment?

A 
Lymphoedema
Sensory disturbance
Decreased shoulder ROM
Nerve damage
Vascular damage
Radiation-induced sarcoma
34
Q

Sensory disturbance due to axillary treatment is associated with injury to which nerve?

A

Intercostobrachial nn.

35
Q

Nerve damage due to axillary treatment is associated with injury to which nerve?

A

Long thoracic
Thoracodorsal
Brachial plexus

36
Q

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

A 
Lymph node involvement
Tumour grade
Tumour size
Steroid receptor status
HER2 status (+ve)
Lymphovascular invasion
37
Q

What is the local adjuvant therapy for breast cancer?

A

Radiotherapy

38
Q

What is the systemic adjuvant therapy for breast cancer?

A

Hormone therapy
Chemotherapy
Targeted therapy

39
Q

Which breast cancer patients receive radiotherapy?

A

All patients after wide local excision (adjuvant)

After mastectomy if local involvement

40
Q

What complications are associated with adjuvant breast radiotherapy?

A 
Skin reactions - telangiectasis
Radiation pneumonitis
Cutaneous radionecrosis
Osteonecrosis
Angiosarcoma
41
Q

What drugs are used in hormone therapy for breast cancer?

A

Tamoxifen
Aromatase Inhibitors
(Arimidex, Letrozole)

42
Q

Which types of breast cancer hormone therapy be used for?

A

Estrogen receptor positive (ER+) breast cancer

43
Q

Which dose of Tamoxifen is used for breast cancer hormone therapy?

A

20mg daily

5-10 years

44
Q

How does Tamoxifen work?

A

Directly blocks ER receptor

45
Q

Tamoxifen is most effective in which groups?

A

All age groups

Post chemotherapy

46
Q

Tamoxifen increases the risk of what?

A

Thromboembolic events

47
Q

What Aromatase Inhibitors are used for breast cancer? (and what dose)

A

Arimidex (1mg)
Letrozole (2.5mg)
Both once daily 5 years

48
Q

Aromatase Inhibitors are indicated in which breast cancer patients?

A

Estrogen Receptor Positive

POSTmenopausal women

49
Q

Aromatase inhibitors increase the risk of what?

A

Osteoporosis

50
Q

What is the role of Zoladex?

A

Hormone therapy for breast cancer

Inhibits FSH + LH

51
Q

Which women benefit most from chemotherapy?

A

<50y/o

Patients with more adverse prognostic factors

52
Q

What scoring is used to determine whether chemotherapy would be of benefit in breast cancer?

A

Oncotype DX

53
Q

Which Chemotherapy drugs are used in breast cancer?

A

CMF
Antracycline
Taxane

54
Q

Which drugs can be used in women with HER2+ breast cancer?

A

Anti-Her2 therapy

Trastuzumab (Herceptin)

55
Q

What is the follow-up regiment post breast cancer treatment?

A

Patient observation
Clinical examination 1-5 years
Yearly mammograms

Yr 3 - Reproduction (37 decks)

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