Unit 2 Case 1: Breast cancer Flashcards
anatomy associated with the case
breast and axilla
-learn separately
hormonal risk factors for breast cancer
early menarche
late menopause
late first full term pregnancy
exogenous sex hormones
postmenopausal combination hormone therapy
why does early menarche/late menopause increase risk
longer exposure to ovarian hormones and oestrogen
cells associated with breast cancer have specific receptor sites that bind to oestrogen, stimulate their growth
why does a late first full term pregnancy increase risk
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
non-hormonal risk factors for breast cancer
family history
gender
age
obesity
radiation
how is family a risk factor
BRCA1 and BRCA2 genes are hereditary
if a mutated version is inherited then 60-80% risk of breast cancer and 33% ovarian
how is gender/age a risk factor
breast cancer more prevalent in women
75% of all female cases the women are over the age of 50
relation of BMI to breast cancer risk
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
how can radiation affect breast cancer risk
linear no-threshold model displays that the risk of developing breast cancer is proportional to the dose of radiation
what is a benign tumour
doesn’t invade and destroy the tissue in which it originates or spread to distant sites in the body
tumour that isn’t cancerous
what is a malignant tumour
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
what is a fibroadenoma
benign neoplasm of the breast
neoplasm- any new or abnormal growth
symptoms of fibroadenoma
painless
usually small
hard lump
types of fibroadenomas
simple
juvenile
giant
coomplex
myxoid
cellular
hyalinised
risk factors for fibroadenoma
age
hormonal levels of oestrogen
family history of cancer
obesity
types of non-invasive breast cancer
DCIS- ductal cancer in situ
LCIS-lobular cancer in situ
types of invasive breast cancer
invasive
invasive lobular
inflammatory
pages disease
angiosarcoma
other types of breast cancer
triple negative
not driven by oestrogen, progesterone or HER2 overexpression
ductal cancer in situ
cancer cells have developed in the ducts but haven’t yet spread beyond
lobular cancer in situ
abnormal cells have developed in the lobules
invasive breast cancer
cancer cells have grown through the duct lining into the surrounding breast tissue
invasive lobular cancer
cancer cells have started to grow in the lobules and have spread to the surrounding tissues
inflammatory breast cancer
within the lymph vessels in the skin of the breast, inflamed and painful
pagets disease
develops in the nipple or areola
angiosarcoma
start in the blood or lymphatic vessels within the breast
primary and secondary
types of breast cancer
oestrogen receptor positive ER+
progesterone receptor positive PR+
HER2 positive HER2+ve
main genes associated with developing breast cancer
BRCA1
BRCA2
BRCA1
tumour suppressor
double strand breaks of DNA
transcription coupled repair
BRCA2
involved in double stranded break repair
HER2
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
TP53
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
CHEK2
encodes for a checkpoint tyrosine kinase which acts as a tumour suppressor
types of DNA mutations
point mutation/substitution
addition
deletion
inversion
duplication
somatic mutation
occur in non-reproductive cells
not passed onto further generations
germline mutations
occur in reproductive cells
are hereditary
missense mutation
change in DNA sequence that results in one amino acid replaced with another amino acid that is different
non-sense mutation
genetic alteration that causes the premature termination of a protein
5 treatments for breast cancer
surgery
chemotherapy
radiotherapy
hormone therapy
targeted therapy
how to choose the right treatment
how cancer was diagnosed
stage
type
health of patient
menopausal or not
surgery
breast conserving- remove only the tumour
mastectomy- whole breast is removed, including the nipple
chemotherapy
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
side effects of chemotherapy
loss of appetite
feeling nauseous
fatigue
hair loss
radiotherapy
uses doses of radiation to kill cancer cells
sessions last for 3-5 weeks, 3 sessions a week
side effects of radiotherapy
extreme tiredness
irritation
darkening of the skin on the breast
hormone therapy
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
example of common hormone therapy drug q
tamoxifen
used in both pre and post menopausal and men with breast cancer
targeted therapies
medicines that change the way cells work and help to stop cancer from growing and spreading
can be given IV, pill or injection
side effects of targeted therapies
shivering, diarrhoea, vomiting, headache
treatment or management of fibroadenoma
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
3 stages of triple assessment
clinical assessment
imaging
pathology
why does the accuracy of clinical and imaging assessment vary with age
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
clinical assessment stage
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
what can be used in the clinical imaging stage
mammography
breast ultrasound
MRI
staging axillary ultrasound
mammography
uses low dose X-rays
in age 40+ due to glandular tissue density
look for lesions, asymmetry, skin thickening and lymph nodes
breast ultrasound
uses sound waves
measures the size of cancer and can guide needle biopsies
more accurate than mammography in young patients
MRI
detects subtle morphological changes but poorly differentiates between benign and malignant lesions
staging axillary ultrasound
look for enlarged lymph nodes with increased thickness
pathology, what is included
biopsy
fine needle aspiration cytology
vacuum assisted biopsy
biopsy
remove cylinders of tissue under local anaesthetic
fine needle aspiration cytology
reserved for small lesions that are difficult to biopsy
vacuum assisted biopsy
larger biopsy
probe used to collect tissue samples through small 1/4 inch incisions
urgent GP referral
within 2 weeks
very urgent GP referral
within 48 hours
non-urgent GP referral
longer than 2 weeks
what is the multidisciplinary team
team of healthcare professionals who meet to discuss a patient
examples of the MDT on a breast cancer case
surgeon
oncologist
radiologist
histopathologist
clinical/oncology nurse specialist
nurse practitioner
MDT patient pathway facilitator
prosthesis fitter
pastoral care team
clinical psychologist
physiotherapist
support available for breast cancer patients
national hereditary breast cancer helpline
support available for breast cancer patients
national hereditary breast cancer helpline
NHS breast cancer screening program ages
screening for women aged 50-70 every 3 years
screening uses mammograms
aged under 50 you may be screened if you have family history
how does breast cancer screening work
used mammograms in normal age range
MRI’s instead if younger than 50 as breast tissue is more dense
public health breast cancer initiatives
be clear on cancer
to drive awareness
coping with bereavement of breast cancer
live chat forums
free mental health audio guides
talking to family and friends
living a healthy lifestyle
lifestyle factors that can contribute to increased risk of developing breast cancer
being overweight or obese
alcohol
