Week 7 - G - Breast cancer Tx - D.C.I.S - Early invasive breast cancer, locally advanced, metastatic disease

Question 1

What is the commonest cancer in women?

What is the commonest cause of death from cancer in women and how common is breast?

Answer 1

Commonest cancer in women is breast cancer

Commonest cause of death from cancer in women is lung cancer and breast cancer is the 2nd commonest cause of death

Question 2

What are the risk factors for breast cancer in women?

Answer 2

Age
Early menarche, nullparity, first child >30 years of age, not breastfeeding, late menopause - anything which increases oestrogen exposure

Oral contraceptive pill, hormonal replacement therapy

Lifestyle - obese, inactive, alcohol, smoking, childhood radiation
Family history or previous history of breast cancer

BRCA1, BRCA2 or TP 53 mutation (Li Fraumeni)

Question 3

Describe firbocystic change in a breast?

Describe a fibroadenoma in the breast?

Answer 3

Fibrocystic change - lumpiness, thickness and swelling associated with cylcical change for the tenderness and breast pain, Often bilateral
Fibroadenoma - solid, round rubbery lump in breast that is very mobile occuring usually in young woman

Infections: The breast will likely be red, warm, tender and lumpy

Question 4

Does the breast have muscle tissue?

What is the breast screening programme in scotland?

Answer 4

The breast has no skeletal muscle tissue, does have smooth muscle

The breast screening programme takes place in women between the ages of 50-70 tri-annually
Trying to increase the age of the screen curreently from 47-73

Question 5

How is a ductal carcinoma in situ treated?

Answer 5

Surgery (Breast conservation surgery or mastectomy) followed by radiotherpy over 3 weeks

Question 6

In early invasive breast cancer, surgery is usually 1st line in treatment
What will always follow breast conservation surgery?

When is this used when a mastectomy is carried out?

Answer 6

Radiotherapy is given following breast conservation surgery

For mastecotmy, radiotherapy is given if 4 or more nodes involved in the axilla

The tumour is greater than 5cm in size (T3)
There is involved resected margins

Or the tumour extent is T4 disease - fixed to skin,chest wall or peua d’orange

Question 7

Where would the radiation be given after mastectomy if any of the other criteria on the previous card were met?

Answer 7

RADIOTHERAPY FOLLOWING MASTECTOMY
Chest wall radiotherapy

• Tumour size > 5 cm
• 4 or more involved nodes
• Involved resection margins
• T4 disease

Question 8

Adjuvant treatment for early invasive breast cancer
Involes, radiotherapy (discussed), chemo and hormonal therapy

Which oestrogen receptor positive inhibitor is given 1st line in pre and post menopasual?

What is the name for the drug given alongside chemo if HER2 receptor positive?

Answer 8

1st line ER+ve inhibitor premenopausal - tamoxifen
1st line ER-ve inhibitor postmenopasual - aromatase inhibitor - ie letrozole, anastrazole

If HER2 positive - usually trastuazamab (herceptin) is given alongside chemo

Question 9

Locally advanced cancer

What is considered as initial therapy for all inoperable tumours?

Answer 9

This would be consider radiotherapy

Question 10

What are common sites of metastases to the breast?

What is treatment dependent on?

Answer 10

Lung, liver, bone , brain, skin
Treatment dependant on

Site

Symptoms (bisphosphonates, radiotherapy, chemotherapy)

Performance Status

Question 11

What is the order of the 5 most common primary tumour metastases to the bone?

Answer 11

1. Breast
2. Prostate
3. Lung
4. Kidney
5. Thyroid