Unit two Case 1: Breast cancer

Question 1

What are the three components of a triple assessment for breast cancer?

Answer 1

1) Examination/history
2) Imaging
3)Histology

Question 2

What happens during the first stage of a triple assessment for breast cancer?

Answer 2

Examination - the breast and axilla are palpated and checked for visible symptoms such as lumps, rashes or itching.
History - consultation may be used to gain insight into risk factors such as a familiar occurrence of breast, alcohol and diet etc.

Question 3

What happens during the second stage of a triple assessment for breast cancer?

Answer 3

Imaging - often a mammogram or ultrasound is used to look at an image of the tumour, this is often to check if the tumour has a clear boundary.
These exams are less efficient in younger women with denser breast tissue.

Question 4

What happens during the third stage of a triple assessment for breast cancer?

Answer 4

Histology - a sample of the tumour is removed by a biopsy or fine needle aspiration. This is used to identify the degree of abnormality in the cells.

Question 5

What are the different refal pathways from a GP when a patient is suspected of having breast cancer?

Answer 5

Refered by the Supescpet Cancer Referal Pathway.
Three main routes are:
Very urgent - seen within 48 hours
Urgent - seen within two weeks
Non-urgent - seen within four to six weeks.
Referals are to hospitals or local breast cancer clinics where specialist are available.

Question 6

What is the overall survival rate for breast cancer?

Answer 6

75%

Question 7

How do survival rates for different types of breast cancer vary?

Answer 7

Diagnosed at earlier stages have increased survival rates, With the five year survival rate being:
stage 1 = 98%
stage 2= 90%
stage 3= 70%
stage 4=20%
Women aged 60-69 with breast cancer have the highest rate of survival than all other age groups with cancer.

Question 8

What are the different treatment options for fibroadenoma?

Answer 8

1)leave untreated - is not harmful for the patient often shrinks onits own, may be called back in for monitoring or encourage women to perform more regular breast checks.
2) Cyroblation - freezing the tumour allowing it to warm then freezing again to kill the abnormal cells
3)Removed by a biopsy
4)Tamoxifen drug to act as an oestrogen blocker to reduce further growth of the tumour.

Question 9

Explain the purpose of patient concent.

Answer 9

Aligns with the ethical pillar of autonomy.
Concent must be taken for any treatment or producer if a patient is gained to have the mental capacity to give content.
This ensures the patient is at the heart of treatment as they can make decision regarding their own care, this helps to maintain bodily integrity and foster a more positive relationship with the practitioner.
Ensures patients wishes are accepted and they are treated as a Means in itself rather than a means to an end.

Question 10

What section of care often diagnoses a breast cancer case?

Answer 10

80% through a GP
11% through hospital as an in or outpatient
6% through public health screening.

Question 11

What members of the MDT may be involved in a cancer case?

Answer 11

Surgeon, GP, radiologist, clinical oncologist, medical oncologist, Macmillan nurse, pathologists and haematologist (if blood cancer) potential for counsellors, occupational health therapists and dietitians,

Question 12

What is the role of a clinical oncologist?

Answer 12

Specialises in treating cancer with radiotherapy, often combined with other forms of treatment.

Question 13

What is the role of a medical oncologist?

Answer 13

Specialises in treating cancer using drugs often chemotherapy, often combined with other forms of treatment.

Question 14

What is the role of a clinical radiologist?

Answer 14

Uses imaging technology to diagnose and monitor a medical condition.

Question 15

What is the role of a clinical oncologist nurse specialist?

Answer 15

Often follow a patient throughout treatment, help liase with other menerbes of staff, help the patient understand their treatment options, will preform clinical check ups, examinations.
Aid diagnosis, treatments and recovery.

Question 16

What does a pathologist do?

Answer 16

Study cells and tissue

Question 17

What is the deal with the NHS breast cancer screening programme?

Answer 17

Aims to diagnose breast cancer at an early stage hence improve prognosis (over 60% of cases diagnosed through public health screening are early stage)
Mammograms are offered every three years to women between the ages of 50 to 71. Women over the ages of 71 may request a mammogram every three years through the same programme.
A negative test result means you do not currently have cancer but may develop it in the future.
A positive test results means a lump has often been found and requires more clinical observation (may not be cancerous)

Question 18

What does the NHS state are the stages of coping with bereavement?

Answer 18

Recognising that the bereavement is true and accepting that loss.
Feeling the pain of grief.
Moving the energy of grieving into other emotions in order to recover effectivly.

Question 19

What support groups are available to help with bereavement?

Answer 19

Macmillan nurses - online chat and telephone,
The loss foundation - offers online and in-person drop in support groups.
Cruse Bereavment - offers access to a helping of volunteers and live chat with bereavement councillors.

Question 20

What is cyberchondria?

Answer 20

When patients obsessively use the internet to research health conditions or symptoms, to reassure themselves about their health. It often just results in increased anxiety and fear, often believe they have a severe health condition.

Question 21

What are some of the impacts of misinformation from internet research around health?

Answer 21

General public uses unreliable sources of information and without background knowledge they are unable to fact check their results. Leads to wrong impressions around medication, treatment and medical professionals. Can encourage patients to ignore of abuse medical advice.
False news often conflicts with current medical advice.

Question 22

What is an example of the growth of fake medical news?

Answer 22

During COVID-19 antivax social media channels gained 7-8 million followers between Dec 2019 and Oct 2020.

Question 23

What are some of the benefits of online research by patients?

Answer 23

Reliable sources of information can help patients self manage their condition by understanding the severity of their condition hence if a GP appointment is needed, or identify appropriate over the counter medication they could take.
Websites such as change for life encourage healthy lifestyle changes to prevent illhealth.
Specialist services such as cancer research and Macmillan use the internet as a base to share support access and information around health conditions.

Question 24

What are some of the risk factors associated with breast cancer?

Answer 24

Hereditary mutation
Higher economic status (with 14% fewer breast cancer cases in the most deprived areas) - more likely to have a pregnancy later in life, use oral contraceptives or HRT increasing oestrogen levels.
Obesity - (cause of 8%) fat cells increase oestrogen and insulin levels
Age - most likely over the age of fifty
Alcohol consumption -causes 8%, damages DNA increase hormone levels.

Question 25

What statistic links breast cancer and alcohol?

Answer 25

Women who have three alcoholic beverages (one glass of wine) are 15% more likely to develop breast cancer than those who do not.

Question 26

What support does Macmillan offer to cancer patients?

Answer 26

Online chat and telephone numbers for supoprt for friends, family and cancer patients House visits from a Macmillan nurse Can apply for a Macmillan grant to help reduce the costs of living with cancer. Macmillan buddy - consistent once a week communication with

Question 27

What support does cancer research offer to breast cancer patients?

Answer 27

Online forum to post questions and interact with other people with an experience of cancer. Post east to understand information on causes, symptoms and treatments of breast cancer.

Question 28

What support does Breast Cancer Now offer to patients?

Answer 28

Host facebook live meetings and discussions to share the experiences of living with cancer. The Becca app - help people living with and after cancer, inspirational post and tips to adapting to life after cancer diagnosis. Live phone to specialist cancer nurses to ask questions about treatment and diagnosis.

Question 29

Draw and label a sagittal cross section of the breast.

Answer 29

Question 30

What is the function of suspensory ligaments in the breast?

Answer 30

Help the breast to maintain its shape and structure.

Question 31

What differentiates the different stages of breast cancer?

Answer 31

Stage 1 - less than 2cm in width Stage 2 - less than 2cm in width lymph nodes Stage 3 - spread to the axillary lymph nodes and cells may be abnormal in shape, more than 2cm in size Stage 4 - cancer has spread to other parts of the body

Question 32

What are the different types of breast cancer?

Answer 32

Breast cancer is classified based on what hormones and receptors are needed for the tumours to grow. Firstly they are classified as hormone (HR) positive or negative. Distinctions may be made for oestrogen and progesterone Then if the cancer is HER2 positive or negative. If it is positive it means that these hormones / receptors are present and are used as a mechanism for tumour growth.

Question 33

What type of breast cancer is the hardest to treat?

Answer 33

Triple negative. As the cancer cell is not depended on oestrogen. progesterone or HER2 to grow none of these pathways can be targeted to reduce tumour growth.

Question 34

What if fibroadenoma?

Answer 34

A benign fibrous growth often in the conenctive/glandular tissue of the breast. These tumours are often linked to changes in the menstrual cycle, so appear most during pregnancy/menstruation then shrink or disappear after menopause.

Question 35

What are some key points during diagnosis to separate breast cancer from fibroadenoma?

Answer 35

Fibroadenma - younger premenopausal individuals, margin or tumour is more defined.

Question 36

What are the different types of fibroadenomas?

Answer 36

Juvenile fibroadenmas - most common in girls under the age of 18, can grow to a very large size but often shrink. Giant - grow to 5cm, often removed as press on or replace other breast structure. Complex - diagnosed by a biopsy, contain some hyperplasia and changes to cell proliferation. Phyllodes tumour - have more rapid cell growth and risk of developing into breast cancer

Question 37

What types of fibroadenoma are most likley to be treated?

Answer 37

Complex and phyllodes - to decrease cancer risk Giant - to prevent damage to the surrounding structures.

Question 38

What breast abnormalities require further investigation?

Answer 38

A new lump or new area of thickened tissue in the breast A change in the size or shape of one of the breasts. A discharge of fluid from the nipple A lump or swelling in the armpits A change in the look or feel of skin around the breast, such as puckering/dimpling or redness. A change in the appearance of the nipple such as a rash, dry skin, itchiness or sunken nipple.

Question 39

What normal changes occur in the breast due to the menstrual cycle?

Answer 39

Just before a woman's period, it is common for the influx of hormones to cause the breast to grow in size, feel tender, or change in texture. Some women may feel that their breasts are lumpier due to the lactiferus ducts and synuses preparing to potentially produce milk. These are temporary changes.

Question 40

What hereditary genes are associated with breast cancer?

Answer 40

Normal population with unmutated BRCA – 10% of women develop breast cancer BRCA1 – 60% of women with this mutation develop breast cancer BRCA2 – 40% of women with this mutation develop breast cancer Mutated BRCA can no longer repair DNA damage resulting in increased genomic instability HER – If receptor is mutated to be constantly turned it, the cell will continuously receive mitogenic signalling as MAPK ERK pathway is actiavted.

Question 41

How does a DNA mutation affect gene function?

Answer 41

Deletion mutation – inactivates tumour suppressor gene Amplification mutation – turns a protooncogene into an oncogene

Question 42

What is the definition of a malignant and non-malignant tumour?

Answer 42

Malignant tumour is life threatening and can metastasise to other parts of the body. Cells become de-differentiated, and are not surrounded by a dense capsule of tissue A benign tumour is not often life threatening and can not metastasise to other parts of the body, is surrounded by a dense capsule of tissue, and cells remain differentiated.