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Women's Health > Week 8 Breast Malignacies > Flashcards

Week 8 Breast Malignacies Flashcards

1
Q

WHat is the MC cancer in women?

A

Breast Cancer

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2
Q

Breast cancer increases the risk for?

A

endometrial cancer

and vice versa.

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3
Q

The mass in Breast Cancer is most often detected by?

A

patient on self-breast examinatio

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4
Q

The majority of patients with breast cancer are diagnosed as a result of?

A

abnormal mammogra

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5
Q

What are the RF for Breast Cancer?

A

A. Increasing age
B. BRCA1 or BRCA2 gene
C. FH of gynecologic malignancies
D. First-degree relative with breast cancer – esp if premenopausal or bilateral or found in 2+ relatives – 15-20%
E. Personal history of breast cancer
F. Exposure to ionizing radiation, esp before age 30

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6
Q

What are associated factors with Breast Cancer?

A 
Nulliparity
First pregnancy after 30 yo
Early menarche (before 12 yo)
Late menopause (after 50 yo)
Significant alcohol use
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7
Q

What is involved in the prevention Breast Cancer?

A 
Early pregnancy
Prolonged lactation
Chemical or surgical sterilization
Exercise
Low-fat diet
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8
Q

WHat are the types of invasive breast cancer?

A 
Invasive ductal (NOS)
Medullary
Colloid (mucinous)
Tubular
Papillary
Invasive lobular
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9
Q

All invasive lobular, and 2/3 of ductal carcinomas are?

A

estrogen-receptor positive

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10
Q

What is inflammatory breast carcinoma?

A

aggressive form of breast cancer

diffuse/brawny/edema

erysipeloid border

without an
underlying palpable mass

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11
Q

What is Paget Disease?

A

ductal carcinoma

1% of breast cancers

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12
Q

How does Paget Disease present?

A

eczematous lesion

red/scaling/crusty patch on the nipple, areola, and surrounding skin

Does not respond to steroids

Unilateral or bilateral

mass is palpable in about 50% of patients with Paget’s disease

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13
Q

Pregnancy-associated breast cancer is defined as

A

breast cancer that is

  1. diagnosed during pregnancy
  2. in the first postpartum year
  3. anytime during lactation
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14
Q

What is the minimal treatment of choice for Breast cancer in pregnancy?

A

modified radical mastectomy

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15
Q

Most women with breast cancer diagnosed during pregnancy or lactation will be candidates for?

A

systemic chemotherapy

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16
Q

Noninvasive cancers lack the ?

A

ability to spread

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17
Q

What is special about Lobular carcinoma in situ?

A

lacks the ability to spread

associated with development of invasive ductal cancer in 25–30% of cases within 15 years

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18
Q

Ductal carcinoma in situ

A

Age - 50s
Mammogram - Clustered microcalcifications
Diagnosis - Needle or excisional biopsy
Treatment - Surgical excision

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19
Q

Lobular carcinoma in situ

A

Age - 40s
Mammogram - Not seen on mammogram
Diagnosis - Incidentally on biopsy for other condition
Treatment - Local excision

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20
Q

What is critical to managing patients with initial, recurrent, and metastatic disease?

A

the presence or absence of estrogen and/or progesterone receptors in the nucleus of tumor cells

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21
Q

Both estrogen receptors (ERs) and progesterone receptors (PRs) are?

A

nuclear hormone receptors

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22
Q

The responsiveness of breast cancer to hormonal therapy is determined by?

A

tumor expression of the ER and/or PR

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23
Q

ER/PR-negative tumors are unlikely to benefit from?

A

endocrine therapy and would be better treated with systemic chemotherapy

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24
Q

ER-positive tumors are more likely to metastasize to?

A

bone
soft tissue
genital organs

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25
Q

ER-negative tumors are more likely to spread to?

A

liver
lung
brain

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26
Q

Clinical manifestations of Breast cancer?

A 
single
nontender
firm
irregular
immobile

Breast pain is rarely a symptom of breast cancer

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27
Q

In reguards to Breast cancer 45% occur in the _____ outer quadrant; 25% occur _____ the nipple an areola.

A

upper

under

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28
Q

What are Later symptoms of Breast cancer?

A 
skin or nipple retraction
axillary lymphadenopathy
breast enlargement
redness
edema
brawny induration
peau d'orange
pain
fixation of mass to skin or chest wall
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29
Q

What are Late symptoms of Breast cancer?

A

ulceration
supraclavicular lymphadenopathy
edema of arm
bone/lung/liver/brain or other distant metastases

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30
Q

What is the diagnosis of Breast cancer?

A

Clinical breast exam
Monthly self-breast examination
Mammogram imaging modality of choice

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31
Q

What is recommended in patients >20yo in regards to Breast cancer?

A

Monthly self-breast examination 5 days after menses

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32
Q

What is important to note about a mammogram?

A

used to detect early lesions
breast imaging modality of choice
consistently found to decrease mortality

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33
Q

Mammogram Screening Recommendations?

A

A. Yearly starting at 40 years of age and continuing for as long as a woman is in good health
B. 40-49, every 1-2 years, then annually
C. Biennial screening mammography 50 and 74 years
D. Insufficient evidence to assess the additional benefits and harms in women 75 years or older

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34
Q

Clinical Breast Exams (CBE) Recommendations?

A

A. 40 yo annually

C. Insufficient evidence >40 years or older (USPSTF, 2009)

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35
Q

MRI Screening Recommendations?

A

Women at high risk:
A. Known BRCA mutation or untested but have a first-degree relative with a BRCA mutation
B. Greater than 20% lifetime risk based primarily on family history
C. Prior mantle radiation

MRI in addition to mammogram every year

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36
Q

If fine-needle aspiration is negative what should be done?

A

excisional biopsy should be done

37
Q

Biopsy specimen should undergo?

A

histologic
estrogen receptor
progesterone receptor

38
Q

What are findings suggestive of carcinoma?

A

Spiculated mass
Asymmetric local fibrosis
Microcalcifications with a linear, branched pattern

39
Q

What are sensitive, but increased radiation and false-positive results?

A

CT scans

40
Q

What is good for staging and metastatic evaluation, esp bone mets?

A

PET scans

41
Q

What labs are used in diagnosis of Breast cancer?

A 
CBC
Chemistry panel with LFTs
Beta- hCG (reproductive patients)
Estrogen receptor (ER) assay
Oncotype DX test
42
Q

What could be noted in LFTs?

A

elevated alk phos or LFTs for liver mets

hypercalcemia in advanced cases of mets

43
Q

What is special about an Oncotype DX test?

A

is used to help determine need for chemotherapy for women with stage I or hormone receptor-positive cancer.

looks at 21 genes in tumor to determine the likelihood of the cancer recurring or spreading

44
Q

What should occur before treatment begins?

A

staging

45
Q

All oncologic treatment may be classified as?

A

curative or palliative

46
Q

When is Palliative treatment indicated?

A

stage IV disease

previously treated patients who develop distant metastases or unresectable local recurrence

47
Q

When is Curative treatment indicated?

A

stage I
stage IIA
stage IIB cancer

considered with locally advanced disease (IIIB)

48
Q

What are included in medical treatment options?

A

chemotherapy and hormone (anti-estrogen) therapy

49
Q

What are medical treatment options used to control?

A

micrometastases

50
Q

When are medical treatment options indicated?

A

lymph node–positive patients

high-risk lymph node– negative patients

51
Q

What is included in chemotherapy treatment?

A

Polychemotherapy (≥2 agents)

3–6 months or 4–6 cycles

Anthracyclines
taxanes
cyclophosphamide
methotrexate
5-fluorouracil (CMF)
52
Q

When is chemotherapy considered as standard of care for patients?

A

ER-negative tumors who are candidates for adjuvant systemic therapy because of adverse prognostic indicators..

tumor size >1 cm
positive lymph nodes high-grade disease

53
Q

What is included in hormone treatment?

A

Tamoxifen x 5 years

used with estrogen receptor-positive dz and postmenopausal women

54
Q

What are patients at an increased risk for when using tamoxifen?

A

endometrial cancer
DVTs
hot flashes

55
Q

How do Aromatase inhibitors (AI) work?

A

work by blocking the conversion of testosterone to estradiol, and androstenedione to estrogen, both in the adrenal cortex and in peripheral tissue, including breast cancers themselves

56
Q

What are the Aromatase inhibitors (AI)?

A

anastrozole

letrozole

57
Q

What is special to note about Aromatase inhibitors (AI)?

A

as effective or more than tamoxifen in postmenopausal women with early-stage, invasive breast cancer

Increased disease-free survival, time to recurrence, and the incidence of contralateral breast cancer

58
Q

When are Aromatase inhibitors (AI) NOT used and why?

A

premenopausal patients because of paradoxical estrogen feedback on the hypothalamus

59
Q

Aromatase inhibitors (AI) when compared to tamoxifen have an increased risk of?

A

musculoskeletal disorders
osteoporosis
cardiac events

60
Q

Aromatase inhibitors (AI) when compared to tamoxifen have an decreased risk of?

A

endometrial cancer
venous thromboembolic events
hot flashes

61
Q

What surgical option is preferred with early-stage cancer?

A

wide local excision or lumpectomy with sentinel node biopsy

62
Q

What is involved with wide local excision or lumpectomy with sentinel node biopsy?

A

breast-conserving treatment option

used if tumor less than 4 cm and tumor not fixed to underlying tissue

Postoperative radiation

63
Q

What is removed in Simple mastectomy?

A

breast tissue
nipple-areolar complex
skin

no axillary node dissection

64
Q

What is removed in Modified radical mastectomy?

A 
breast tissue 
nipple-areolar complex
skin
pectoralis fascia
axillary lymph nodes
65
Q

What is removed in Radical mastectomy?

A 
breast tissue
nipple-areolar complex
skin
axillary lymph nodes
pectoralis major 
pectoralis minor
66
Q

Goals of close breast cancer follow-up are?

A

detect recurrences

detect second primaries after treatment in the ipsilateral breast

detect new cancers in the contralateral breast

67
Q

What are recommendations for post-treatment in Breast cancer?

A

A. PE every 4 months for first 2 years
then every 6 months until year 5
then annually

B. Mammogram annually for all patients and no less than 6 months after the completion of radiation therapy.

C. patients who received irradiation => yearly CXR

D. Routine labs: for pts on chemo

68
Q

Patients on tamoxifen should have what follow up recommendations?

A

annual pelvic exam

report any irregular vaginal bleeding

69
Q

Patients on AIs should have what follow up recommendations?

A

periodic bone density studies

lipid panels to assess their cardiovascular risk factors

70
Q

_____ is predominant and paramount in predicting outcome.

A

stage

71
Q

Patients with ______ estrogen and progesterone receptor have a more favorable prognosis

A

positive

72
Q

Modified and simple or partial mastectomies have equivalent survival rates when followed by?

A

XRT

73
Q

What histologies are generally believed to have a more favorable prognosis?

A 
colloid (mucinous)
medullary
papillary
adenoid cystic
tubular
74
Q

What is important to note about Stage IV (disseminated disease)?

A

incurable by surgery

goals of care shift from..
cure to palliation
symptom control
improved quality of life

75
Q

What should be reserved for patients in order to control their symptoms and minimize the risk of complications in Stage IV (disseminated disease)?

A

Local therapy

  1. palliative XRT
  2. surgery
76
Q

When is Surgery an option?

A

A. patients with a good performance status
B. minimal organ involvement
C. prolonged disease-free interval
D. slow disease growth
E. if complete resection of the tumor or metastasis is reasonable

77
Q

When is Palliative XRT an option?

A

A. valuable for certain bone or soft tissue metastases to control pain or avoid pathologic fracture
B. isolated bony metastasis
C. chest wall recurrences.

78
Q

Hormonal manipulation is usually more successful in?

A

postmenopausal women

79
Q

For premenopausal woman with advanced breast canceris what is the treatment of choice in HRT?

A

tamoxifen

**Also use GnRH agonists
– suppress FSH and LH

can combine with tamoxifen or AIs

80
Q

For postmenopausal patients, what are the initial therapy of choice in HRT?

A

AIs and tamoxifen

81
Q

What does a favorable response to initial hormonal therapy with tamoxifen is predictive of?

A

future responses to hormonal maneuvers

82
Q

When should cytotoxic drugs be considered for the treatment of metastatic breast cancer?

A

(1) if visceral metastases are present (especially brain or pulmonary lymph node spread)
(2) if hormonal treatment is unsuccessful or the disease has progressed after an initial response to hormonal manipulation
(3) if the tumor is ER and PR negative

83
Q

What are the single most useful agents in the treatment of hormone-refractory metastatic breast cancer?

A

taxanes

84
Q

Combination chemotherapy using multiple agents can be used which?

A

decreased risk of drug resistance

cumulative toxicity is decreased

85
Q

What is the most common site of metastatic disease at initial presentation and at the time of breast cancer recurrence?

A

bone

86
Q

What can bisphosphonate therapy help?

A
  1. diminish pain
  2. decrease the rate of skeletal events
  3. decrease complications related to the bone metastases
87
Q

How is bisphosonate therapy given?

A
  1. Administer with other palliative treatments

2. IV every 3–4 weeks and continued indefinitely

88
Q

Regular dental exams, labs for creatinine and renal function, calcium and vitamin D levels, are recommended due to the risk of?

A

osteonecrosis of the jaw
renal insufficiency
hypocalcemia

Women's Health (8 decks)

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