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Flashcards in Cancer care Deck (121)
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1

How is breast cancer classified?

ductal v lobular

in situ v invasive

2

What are the risk factors for breast cancer?

age
BRCA genes - 40% lifetime risk of breast/ovarian cancer
1st degree relative premenopausal relative with breast cancer (e.g. mother)
nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs)
early menarche, late menopause
hormone replacement therapy,, combined oral contraceptive use
past breast cancer
not breast feeding
ionising radiation
p53 gene mutations
obesity

3

Define carcinoma in situ

contained within the basement membrane of the tissue

4

What is the most common type of breast cancer

invasive ductal carcinoma

5

Describe the breast cancer screening programme

women aged 47-73 years f
offered a mammogram every 3 years.

After the age of 70 years women may still have mammograms but are 'encouraged to make their own appointments'.

6

What features make it more likely that a person is at high risk of a familial breast cancer?

Family history of:

age of diagnosis < 40 years
bilateral breast cancer
male breast cancer
ovarian cancer
Jewish ancestry
sarcoma in a relative younger than age 45 years
glioma or childhood adrenal cortical carcinomas
complicated patterns of multiple cancers at a young age
paternal history of breast cancer (two or more relatives on the father's side of the family)

7

What are the common presentations of breast cancer?

lump
erythema - not high temp
nipple retraction
change in shape
dimpling
axillary lymphadenopathy
discharge

8

What is triple assesssment

hospital-based assessment clinic that allows for the early and rapid detection of breast cancer.

referred by their GP if they have signs or symptoms that meet the breast cancer “2 week wait” referral criteria, or if there has been a suspicious finding on their routine breast cancer screening mammography.

clinical
imaging
pathological

9

Describe the clinical aspect of the triple assessment

history - presenting complaint, any potential risk factors, family history and current medications.
examination -

10

Describe the imaging aspect of the triple assessment

Mammography
or
Ultrasound scanning

11

What are the benefits of USS assessment of the breast

more useful in women <35 years and in men, due to the density of the breast tissue in identifying anomalies.

routinely used during core biopsies.

12

How is mammography undertaken?

involves compression views of the breast across two views (oblique and craniocaudal),

13

How is a cancer seen on mammography?

mass lesions
microcalcifications.

14

Describe the pathological aspect of the triple assessment

biopsy!
core or FNA

15

What are the differences between core and FNA biospy

A core biopsy provides full histology wheras fine needle aspiration (FNA) only provides cytology - allowing differentiation between invasive and in-situ carcinoma.

A core biopsy also gives tumour grading and staging,

Core biopsy has higher sensitivity and specificity than FNA for detecting breast cancer.

16

How is the triple assessment graded and used?

Each part is given a score out of five.

P = examination, M = mammography, U = USS, B = biopsy

P1 – Normal
P2 – Benign
P3 – Uncertain/likely benign
P4 – Suspicious of malignancy
P5 – Malignant etc

Aim is to establish whether this is likely a benign lesion or whether the patient should go onto have more definitive biopsy and further intervention.

Cases suspicious for breast cancer are discussed by the MDT to create a suitable treatment plan

17

What are the treatment options for breast cancer?

Surgery
- breast conserving
- mastectomy
- sentinel node biopsy
- axillary clearance

Hormonal
- tamoxifen
- aromatase inhibitors
- immunotherapy

18

Describe breast conserving surgery for breast cancer and who it is suitable for

A Wide Local Excision (WLE) involves excision of the tumour, ensuring a 1cm margin of macroscopically normal tissue is taken along with the malignancy.

This option is only suitable for:
single cancers <4cm in diameter with no metastatic disease
peripheral tumour

19

Describe mastectomy for breast cancer and who it is suitable for

mastectomy removes all the tissue of the affected breast, along with a significant portion of the overlying skin, with the muscles of the chest wall left intact.

Mastectomies are indicated when:
multifocal tumour
central tumour
large lesion in small breast
>4cm
patient choice.

20

Describe sentinel node biopsy for breast cancer and who it is suitable for

A sentinel node biopsy involves removing the nodes responsible for draining the tumour; the nodes are identified by injecting a blue dye with associated radioisotope into the skin overlying the malignancy.

A radioactivity detection or visual assessment (for the nodes which become blue) is then carried out to establish the location of the sentinel nodes. Once identified the nodes are removed and sent for histological analysis.

Performed alongside WLE and mastectomies, in order to assess the sentinel lymph node, as this indicates prognosis of the disease.

21

Describe axillary clearance for breast cancer and who it is suitable for

Axillary node clearance involves removing all nodes in the axilla, being careful not to damage many important structures located in the axilla.

22

What are the complications of axillary clearance for breast cancer?

Common complications from this operation include paresthesia, seroma formation, and lymphedema in the upper limb.

23

Explain the use and mechanism of tamoxifen

used typically if an aromatase inhibitor is not appropriate. and can be used pre-menopausally or peri-menopausally

It acts through blockade of oestrogen receptors at the cell nucleus, preventing the cancer cell proliferation and growth.

However, it is known to increase the risk of thromboembolism during and after surgery or periods of immobility.

24

What are the risks of tamoxifen use?

increased risk VTE, endometrial cancer and menopausal symptoms.

25

Explain the use and mechanism of aromatase inhibitors in breast cancer

Used in post menopausal women

Prevent conversion androgens made in peripheral tissues into oestrogen. Therefore inhibits further malignant growth of the tumour.

NOT for use in pre menopausal women

26

Explain the use and mechanism of immunological therapy in breast cancer

block HER2 receptor - human epidermal growth factor receptor. stops them from receiving growth signals. By blocking the signals, Herceptin can slow or stop the growth of the breast cancer.

given IV or SC and forms part of adjuvant therapy, or can be administered as monotherapy in patients who have received at least two chemotherapy regimens for metastatic breast cancer

27

How many tumours are HER2 postitive?

20-25%

28

What factors determine the prognosis of breast cancer

extent of nodal involvement is best prognostic indicator

NPI = nottingham prognostic indicator.
takes into account size, grade and number of nodes involved.

29

How is breast cancer followed up?

surveillance imaging - yearly mammogram for 5 years

30

What are some differentials for breast cancer?

breast cysts
fibroadenoma and other benign cysts
firbocystic changes
mastitis
breast abscess
gynaecomastia in males