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Medicine: PBL wrap-ups > Unit 2 Case 1: Breast cancer > Flashcards

Unit 2 Case 1: Breast cancer Flashcards

1
Q

anatomy associated with the case

A

breast and axilla
-learn separately

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2
Q

hormonal risk factors for breast cancer

A

early menarche
late menopause
late first full term pregnancy
exogenous sex hormones
postmenopausal combination hormone therapy

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3
Q

why does early menarche/late menopause increase risk

A

longer exposure to ovarian hormones and oestrogen
cells associated with breast cancer have specific receptor sites that bind to oestrogen, stimulate their growth

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4
Q

why does a late first full term pregnancy increase risk

A

before pregnancy the mammary glands haven’t differentiated to function to produce milk
as cells haven’t differentiated are more likely to develop into cancer cells than differentiated cells

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5
Q

non-hormonal risk factors for breast cancer

A

family history
gender
age
obesity
radiation

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6
Q

how is family a risk factor

A

BRCA1 and BRCA2 genes are hereditary
if a mutated version is inherited then 60-80% risk of breast cancer and 33% ovarian

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7
Q

how is gender/age a risk factor

A

breast cancer more prevalent in women
75% of all female cases the women are over the age of 50

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8
Q

relation of BMI to breast cancer risk

A

obesity grade 2-3 may lead to increased tumour sizes and positive lymph nodes
BMI higher than 35 leads to a stronger risk for oestrogen receptor positive and progesterone receptor positive

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9
Q

how can radiation affect breast cancer risk

A

linear no-threshold model displays that the risk of developing breast cancer is proportional to the dose of radiation

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10
Q

what is a benign tumour

A

doesn’t invade and destroy the tissue in which it originates or spread to distant sites in the body
tumour that isn’t cancerous

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11
Q

what is a malignant tumour

A

tumour that invades and destroys tissue in which it originates and has the potential to spread to other sites in the body via the bloodstream and lymphatic system

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12
Q

what is a fibroadenoma

A

benign neoplasm of the breast
neoplasm- any new or abnormal growth

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13
Q

symptoms of fibroadenoma

A

painless
usually small
hard lump

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14
Q

types of fibroadenomas

A

simple
juvenile
giant
coomplex
myxoid
cellular
hyalinised

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15
Q

risk factors for fibroadenoma

A

age
hormonal levels of oestrogen
family history of cancer
obesity

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16
Q

types of non-invasive breast cancer

A

DCIS- ductal cancer in situ
LCIS-lobular cancer in situ

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17
Q

types of invasive breast cancer

A

invasive
invasive lobular
inflammatory
pages disease
angiosarcoma

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18
Q

other types of breast cancer

A

triple negative
not driven by oestrogen, progesterone or HER2 overexpression

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19
Q

ductal cancer in situ

A

cancer cells have developed in the ducts but haven’t yet spread beyond

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20
Q

lobular cancer in situ

A

abnormal cells have developed in the lobules

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21
Q

invasive breast cancer

A

cancer cells have grown through the duct lining into the surrounding breast tissue

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22
Q

invasive lobular cancer

A

cancer cells have started to grow in the lobules and have spread to the surrounding tissues

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23
Q

inflammatory breast cancer

A

within the lymph vessels in the skin of the breast, inflamed and painful

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24
Q

pagets disease

A

develops in the nipple or areola

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25
Q

angiosarcoma

A

start in the blood or lymphatic vessels within the breast
primary and secondary

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26
Q

types of breast cancer

A

oestrogen receptor positive ER+
progesterone receptor positive PR+
HER2 positive HER2+ve

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27
Q

main genes associated with developing breast cancer

A

BRCA1
BRCA2

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28
Q

BRCA1

A

tumour suppressor
double strand breaks of DNA
transcription coupled repair

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29
Q

BRCA2

A

involved in double stranded break repair

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30
Q

HER2

A

proto-oncogene
HER2 gene amplification leads to HER2 protein over expression
membrane tyrosine kinase, when activated provides the cell with proliferative and anti-apoptosis signals
not hereditary

31
Q

TP53

A

tumour suppressor gene
if p53 is faulty it fails to stop cell division
TP53 mutations can be both hereditary and non-hereditary
binds to apoptosis regulator PTEN

32
Q

CHEK2

A

encodes for a checkpoint tyrosine kinase which acts as a tumour suppressor

33
Q

types of DNA mutations

A

point mutation/substitution
addition
deletion
inversion
duplication

34
Q

somatic mutation

A

occur in non-reproductive cells
not passed onto further generations

35
Q

germline mutations

A

occur in reproductive cells
are hereditary

36
Q

missense mutation

A

change in DNA sequence that results in one amino acid replaced with another amino acid that is different

37
Q

non-sense mutation

A

genetic alteration that causes the premature termination of a protein

38
Q

5 treatments for breast cancer

A

surgery
chemotherapy
radiotherapy
hormone therapy
targeted therapy

39
Q

how to choose the right treatment

A

how cancer was diagnosed
stage
type
health of patient
menopausal or not

40
Q

surgery

A

breast conserving- remove only the tumour
mastectomy- whole breast is removed, including the nipple

41
Q

chemotherapy

A

uses anti-cancer medicine to kill the cancer cells
can also stop oestrogen production, can encourage growth of breast cancers
Neo-adjuvant first to shrink the tumour

42
Q

side effects of chemotherapy

A

loss of appetite
feeling nauseous
fatigue
hair loss

43
Q

radiotherapy

A

uses doses of radiation to kill cancer cells
sessions last for 3-5 weeks, 3 sessions a week

44
Q

side effects of radiotherapy

A

extreme tiredness
irritation
darkening of the skin on the breast

45
Q

hormone therapy

A

lowers the levels of oestrogen and progesterone in the body, stimulates breast cancer growth or stops the effect
breast cancer cells have receptors where oestrogen and progesterone bind to, treatments stop these hormones from attaching

46
Q

example of common hormone therapy drug q

A

tamoxifen
used in both pre and post menopausal and men with breast cancer

47
Q

targeted therapies

A

medicines that change the way cells work and help to stop cancer from growing and spreading
can be given IV, pill or injection

48
Q

side effects of targeted therapies

A

shivering, diarrhoea, vomiting, headache

49
Q

treatment or management of fibroadenoma

A

only if fast growing or large or causing symptoms
surgical excision- cutting out
freezing- thin wand shaped device inserted into the skin to the fibroadenoma and freeze it, ultrasound used to guide the wand towards the lump

50
Q

3 stages of triple assessment

A

clinical assessment
imaging
pathology

51
Q

why does the accuracy of clinical and imaging assessment vary with age

A

assessments less accurate in younger patients
when you age your breast shrinks and the density reduces so abnormalities are easier to differentiate from normal breast tissue

52
Q

clinical assessment stage

A

take history which includes symptoms and risk factors
examine by observing the symmetry, colour and masses, feel each quadrant of the breast and the axillary tail, move to see if a fixed or mobile mass

53
Q

what can be used in the clinical imaging stage

A

mammography
breast ultrasound
MRI
staging axillary ultrasound

54
Q

mammography

A

uses low dose X-rays
in age 40+ due to glandular tissue density
look for lesions, asymmetry, skin thickening and lymph nodes

55
Q

breast ultrasound

A

uses sound waves
measures the size of cancer and can guide needle biopsies
more accurate than mammography in young patients

56
Q

MRI

A

detects subtle morphological changes but poorly differentiates between benign and malignant lesions

57
Q

staging axillary ultrasound

A

look for enlarged lymph nodes with increased thickness

58
Q

pathology, what is included

A

biopsy
fine needle aspiration cytology
vacuum assisted biopsy

59
Q

biopsy

A

remove cylinders of tissue under local anaesthetic

60
Q

fine needle aspiration cytology

A

reserved for small lesions that are difficult to biopsy

61
Q

vacuum assisted biopsy

A

larger biopsy
probe used to collect tissue samples through small 1/4 inch incisions

62
Q

urgent GP referral

A

within 2 weeks

63
Q

very urgent GP referral

A

within 48 hours

64
Q

non-urgent GP referral

A

longer than 2 weeks

65
Q

what is the multidisciplinary team

A

team of healthcare professionals who meet to discuss a patient

66
Q

examples of the MDT on a breast cancer case

A

surgeon
oncologist
radiologist
histopathologist
clinical/oncology nurse specialist
nurse practitioner
MDT patient pathway facilitator
prosthesis fitter
pastoral care team
clinical psychologist
physiotherapist

67
Q

support available for breast cancer patients

A

national hereditary breast cancer helpline

68
Q

support available for breast cancer patients

A

national hereditary breast cancer helpline

69
Q

NHS breast cancer screening program ages

A

screening for women aged 50-70 every 3 years
screening uses mammograms
aged under 50 you may be screened if you have family history

70
Q

how does breast cancer screening work

A

used mammograms in normal age range

MRI’s instead if younger than 50 as breast tissue is more dense

71
Q

public health breast cancer initiatives

A

be clear on cancer
to drive awareness

72
Q

coping with bereavement of breast cancer

A

live chat forums
free mental health audio guides
talking to family and friends
living a healthy lifestyle

73
Q

lifestyle factors that can contribute to increased risk of developing breast cancer

A

being overweight or obese
alcohol

Medicine: PBL wrap-ups (21 decks)

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