Breast Cancer Flashcards

1
Q

What is the grading system for breast cancer + how are scores given?

A

Nottingham grading system - scores out of 3 for tubule formation, nuclear pleomorphism, mitotic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the stages of breast cancer?

A

Stage 1 = confined to breast, mobile, small, only in breast tissue or close lymph Stage 2 = confined to breast, mobile, near lymph nodes or ipsilateral axilla Stage 3 = tumour fixed to muscle, ipsilateral lymph, skin involvement Stage 4 = complete fixation of tumour to chest wall, distant mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe stage 1-4 for breast cancer (in terms of TNM)

A

Stage 1 = T1, N0, M0

Stage 2 = T2/3, N0, M0 OR T1, N1, M0

Stage 3 = T(any), N(any), M0

Stage 4 = T(any), N(any), M1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is DCIS?

A

Non invasive ductal carcinoma in situ Premalignant, seen as microcalcification on mammography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the types of breast cancer, how common are they + what % are ER+ + HER2+?

A

Invasive ductal carcinoma (70%)

Lobular (characterised by high incidence of multicentric tumours) 10%

Medullary cancer (5%) - tend to affect younger pts

Mucoid (2%) - tend to affect elderly

60-70% are oestrogen receptor positive

30% express HER2 = aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Epidemiology

A

Most common cancer 1 in 8 females 1 in 870 men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

RF

A

>50 y/o Fam hx Uninterrupted oestrogen = nulliparity, early menarche, late menopause, COCP, HRT Obesity Not breastfeeding Radiation exposure Smoking + alcohol BRCA1+2, P53

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

BRCA1 + 2 gene lifetime risk of breast + ovarian cancer

A

70% are ER negative so poorer prognosis

BRCA1 = 60-80% risk of breast, 30-45% risk of ovarian

BRCA2 = 50-70% risk of breast, 10-20% risk of ovarian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

S+S

A

Lump, change in size + shape of breast, dimpling, inverted nipple, bloody discharge, eczema, peu d’orange, dilated veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Common mets

A

Liver, lungs, lymph nodes, brain, bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a triple assessment?

A

Breast examination Bilateral mammogram US + biopsy - histology/ cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you measure treatment response?

A

Tumour markers Ca15.3, CEA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What staging investigations are used?

A

CXR, bone scan, liver USS, CT/MRI/ PET-CT, LFTs, Ca2+ IHC looking for ER+ and HER2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a sentinel node biopsy?

A

Locates sentinel node: node cancer is draining to first Inject blue dye into tumour day before surgery - look for blue node Removed + analysed - if positive then pts will have axillary clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prognosis (5 year survival) for each stage of breast cancer

A

1 = 95%

2 = 80%

3 = 60%

4 = 25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of early stage breast cancer

A

Surgery - wide local excision/ mastectomy

Radiotherapy - all invasive cancer after WLE

Adjuvant chemo

ER/ PR+ disease (tamoxifen for pre-menopause or aromatase inhibitors for post-menopausal)

If pre-menopausal + ER+ = ovarian ablation/ GnRH analogues

Monoclonal Ab against HER2 +

17
Q

Treatment of stage 3-4 breast cancer

A

Radiotherapy for painful bone lesions

Tamoxifen for ER+ Trastuzumab for HER2+

18
Q

Complications of radiotherapy

A

Radiotherapy side effects = pneumonitis, pericarditis and rib fractures, secondary cancers

19
Q

Effects of hormone therapy

A

Increased risk of osteoporosis, vaginal dryness and irritation from lower estrogen levels.

Some increase risk of blood clots and endometrial cancer

20
Q

Complications of a mastectomy

A

Temp swelling of breast, breast tenderness, scar tissue, infection, lymphodema, phantom breast pain.

21
Q

When is MRI used in diagnosis?

A

If there is a discrepancy between examination, mammogram + US findings If breast density precludes mammogram If histology is lobular

22
Q

When is neoadjuvant chemo used?

A

Initial surgery not possible due to size of tumour

Allows for breast conservation

HER2 +ve or triple negative (ER, PR + HER2 -ve)

23
Q

What tools are used to help decide on adjuvant chemo?

A

Adjuvant online Oncotype DX (genomic test to predict benefit)

24
Q

Trastuzumab use, length of treatment + SE (+ how to monitor SE)

A

Effective when cancer overexpresses HER2

Given for 12 months as adjuvant

Can affect cardiac function - monitor with MUGA scan

25
Q

Endocrine therapy uses

A

Tamoxifen if ER/PR +ve for 5 years for premenopausal

Aromatase inhibitors for postmenopausal women

26
Q

RT use - how long for?

A

All pts following conservative surgery are given RT

Given daily for 3 weeks

For young pts, given an extra week to tumour bed (a boost)

27
Q

How is ovarian ablation used?

A

In premenopausal women, oestrogen production can be stopped by ovarian ablation (either surgially, RT or with LHRH agonists)

28
Q

Best + worst cancer prognosis

A

Best = ER+ PR- HER2-

Worst = triple negagive or ER- PR- HER2+