Breast Cancer Flashcards Preview

Oncology + Palliative > Breast Cancer > Flashcards

Flashcards in Breast Cancer Deck (28):
1

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

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

2

What are the stages of breast cancer?

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

3

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

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 

4

What is DCIS?

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

5

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

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

6

Epidemiology

Most common cancer 1 in 8 females 1 in 870 men

7

RF

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

8

BRCA1 + 2 gene lifetime risk of breast + ovarian cancer

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

9

S+S

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

10

Common mets

Liver, lungs, lymph nodes, brain, bones

11

What is a triple assessment?

Breast examination Bilateral mammogram US + biopsy - histology/ cytology

12

How do you measure treatment response?

Tumour markers Ca15.3, CEA

13

What staging investigations are used?

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

14

What is a sentinel node biopsy?

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

15

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

1 = 95% 

2 = 80% 

3 = 60% 

4 = 25% 

16

Treatment of early stage breast cancer

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

Treatment of stage 3-4 breast cancer

Radiotherapy for painful bone lesions

Tamoxifen for ER+ Trastuzumab for HER2+

18

Complications of radiotherapy

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

19

Effects of hormone therapy

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

Some increase risk of blood clots and endometrial cancer

20

Complications of a mastectomy

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

21

When is MRI used in diagnosis?

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

22

When is neoadjuvant chemo used?

Initial surgery not possible due to size of tumour

Allows for breast conservation

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

23

What tools are used to help decide on adjuvant chemo?

Adjuvant online Oncotype DX (genomic test to predict benefit)

24

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

Effective when cancer overexpresses HER2

Given for 12 months as adjuvant

Can affect cardiac function - monitor with MUGA scan

25

Endocrine therapy uses

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

Aromatase inhibitors for postmenopausal women

26

RT use - how long for? 

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

How is ovarian ablation used?

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

28

Best + worst cancer prognosis

Best = ER+ PR- HER2-

Worst = triple negagive or ER- PR- HER2+