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Year 3: Reproduction > Treatment of breast disease > Flashcards

Treatment of breast disease Flashcards

1
Q

breast cancer affects?

A

1 in 8 women

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2
Q

Risk factors for breast cancer? (8)

A
  • increasing age
  • previous breast cancer
  • genetic (5%)
  • Early menarche and late menopause
  • Late or no pregnancy
    HRT
  • Alcohol (>14 units per week)
  • Weight
  • Post Radiotherapy treatment for Hodgkin’s disease
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3
Q

presentation: asymptomatic

A

breast screening - 50-70 years

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4
Q

symptomatic presentation includes? (9)

A
  • Lump
  • Mastalgia (persistent unilateral pain)
  • Nipple discharge (blood-stained)
  • Nipple changes (Paget’s disease, retraction)
  • change in colour of areola
  • redness or pitting of skin- like orange skin
  • Change in the size or shape of the breast
  • Lymphoedema (Swelling of the arm)
  • Dimpling of the breast skin
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5
Q

new patient clinic - radiological?

A

Bilateral mammograms / USS

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6
Q

new patient clinic - CYTO-PATHOLOGICAL?

A
  • FNA- cells only (cytology)

- Core Biopsy- tissue (histo-pathology)

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7
Q

Clinical assessment - history

A

Present Complaint
Previous Breast Problems (prevention cysts or cancers)
Family History of breast or ovarian cancer
Hormonal Status
Drug History - blood thinning?

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8
Q

Clinical assessment - examination

A

BOTH Breasts, Axillae, SCF

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9
Q

most common sign and symptom

A

lump or thickening in breast. Often painless

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10
Q

how can the breast be imaged?

- what is most sensitive

A

mammography, ultrasound or MRI

- mammography

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11
Q

why is sensitivity reduced in younger women to mammography?

A

due to the presence of increased glandular tissue (<35yrs)

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12
Q

what Is FNA?

A

Fine Needle Aspiration

-> Cytology

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13
Q

what is core-biopsy

A

Histo-Pathology
Invasive versus in-situ
ER, PR, HER2 receptor status

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14
Q

most accurate test

A

FNA cytology
Mammography
examination/ultrasound

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15
Q

80 % of breast cancers are

10% can be

A

Ductal Carcinoma - come from the ducts

  • lobular carcinoma- milk producing cells

10% = others

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16
Q

non invasive breast cancers?

A

DCIS - Ductal Carcinoma In Situ

LCIS - Lobular Carcinoma In Situ)

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17
Q

management of cancer (3 steps)

A

1 . Diagnose the disease

  1. Staging of the disease
  2. Definitive treatment
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18
Q

Assessing the severity (“Staging”) (4)

A
  • FBC, U&Es, LFTs, Ca2+/PO2-
  • Chest x ray
  • Others as clinically indicated
  • No reliable tumour markers
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19
Q

T - staging - T0 means?

A

Primary tumour not palpable

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20
Q

what does T1 mean?

A

Clinically palpable tumour -size < 2 cm

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21
Q

T3 means?

A

Tumour size > 5 cm

22
Q

T4a when?

A

skin invasion

23
Q

T4b when?

A

invading chest wall

24
Q

T4c when?

A

invading both

25
Q

T4d when?

A

inflammatory breast cancer - worst kind

26
Q

N - Regional Lymph Nodes staging?

A

N0 - No Regional lymph nodes palpable

N1 - Regional lymph node palpable- mobile

N2 - Regional lymph node palpable- fixed

27
Q

M - Distant Metastasis staging ?

A

Mx - Distant metastasis cannot be assessed

M0 - No distant metastasis

M1 - Distant metastasis

28
Q

Management/ Treatment Neo-Adjuvant means?

A

treatment that has happened before surgery

29
Q

Management/ Treatment -Adjuvant means?

A

treatment after surgery

30
Q

management types?

A

Surgery
+/- Radiotherapy
+/- Chemotherapy
+/- Hormonal Therapy

31
Q

2 main types of breast surgery?

A
  • Breast conservation surgery

- Mastectomy

32
Q

Patients suitable for breast conservation surgery?

A

Tumour size clinically <4cm – IN THE OLD DAYS

  • Breast/Tumour size ratio
  • Suitable for radiotherapy
  • Single tumours – IN THE OLD DAYS
  • Patient’s wish – most important!!
33
Q

what node is first to receive lymphatic drainage?

A

sentinel

34
Q

first node tumour will spread to

A

sentinel

35
Q

is the SLN is negative..

A

clear of tumour)

– no further treatment required

36
Q

If SLN contains tumour ..?

A

either remove them all surgically (clearance= ANC) or give radiotherapy to all the axillary nodes

37
Q

Complications of axillary treatment? (6)

A
  • Lymphoedema (10-17%) - can be mild or severe
  • sensory disturbance (intercostobrachial n.)
  • decrease ROM of the shoulder joint
  • nerve damage (long thoracic, thoracodorsal, brachial plexus)
    vascular damage
  • radiation-induced sarcoma
38
Q

Factors associated with increased risk of disease recurrence?

A
  • Lymph node involvement
  • Tumour grade
  • Tumour size
  • Steroid receptor status (negativity- ER/PR neg)
  • HER2 status (positivity- HER2 pos)
  • LVI- lymphovascular invasion
39
Q

Prevention - local

A

radiotherapy

40
Q

prevention - systemic

A
  • Hormone therapy
  • Chemotherapy
  • Targeted therapies
41
Q

after surgery most patients will get

A

radiotherapy

42
Q

Complications of radiotherapy (4)

A

Skin reaction- Skin telangiectasis
Radiation pneumonitis
Cutaneous Radionecrosis/ Osteonecrosis
Angiosarcoma

43
Q

hormone therapy is only given for?

A

oestrogen positive receptors

44
Q

2 examples of Aromatase Inhibitors

A

Arimidex (1mg) &

Letrozole (2.5mg)

45
Q

drug you can give in hormone therapy?

A

Tamoxifen

46
Q

chemotherapy has best benefit

A

young women under 50

  • more higher risk cancers
  • grade 3, LN pos, ER neg, HER2 pos
47
Q

HER2 positivity and Anti-HER2 therapy- what drug?

A

Trastuzumab (Herceptin®)/Pertuzamab

48
Q

why use HER2 positivity ? (4)

A
  • Monoclonal antibody against HER-2 receptor
  • Given to patients with over-expression of HER2 and chemotherapy
  • 50% decrease risk of recurrence
  • 33% increase in survival at 3 years!
49
Q

Follow up?

A
  • Clinical examination for 1-5 years

- Mammogram of breast(s) at yearly intervals for 3-10 years

50
Q

metastatic spread? Local

A

Chestwall
Skin
Nipple

51
Q

metastatic spread - Distant - give them in order

A

Contralateral Breast

Bone
Lung
Liver
Brain
Bone Marrow

Year 3: Reproduction (40 decks)

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