Term
| risk factors for breast cancer |
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Definition
age: higher > 50 years. rare under 35 years
FHx: 1st degree relative
genetics brca1/2
oestrogen exposure: early menarche, late menopause, oestrogen pill, HRT, obesity |
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Term
| which is the most common type of breast cancer? |
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Definition
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Term
what does oestrogen receptor (ER) expression mean?
How is the ER status determined?
are ER tumours common or rare?
what is their prognosis? |
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Definition
this means the tumour is dependent on oestrogen and can be treated using hormone therapies
the ER status is determined histologically.
ER positive tumours are more common and have a better prognosis |
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Term
| explain ductal carcinoma in situ |
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Definition
non invasive cancer
malignant cells have not penetrated the epithelial basement membrane so have not left the breast duct system
usually asymptomatic and can be detected by mammography |
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Term
| Paget's disease of the nipple explain it |
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Definition
skin manifestation of underlying malignancy (eczema around nipple)
usually in situ early on but will become invasive if left untreated
there can be a palpable lump, not always.
mammography and nipple biopsy should be done |
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Term
| explain inflammatory disease of the breast |
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Definition
lymph invasion by highly malignant cancer can cause rapid onset red, hot, swollen breast
tumours are often non resectable and prognosis is often poor |
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Term
| explain ix for breast cancer (triple assessment) |
|
Definition
clinical exam
imaging
biopsy |
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Term
| what are you looking for in a clinical exam when looking for breast cancer? |
|
Definition
skin tethering
nipple changes
asymmetry of breast
painless hard lump irregular lump |
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|
Term
| what type of imaging is involved in triple assessment? |
|
Definition
mammography: uses craniocaudal and oblique views
US: differentiates cysts from solid lesions. |
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|
Term
| which mode of imaging is useful in women < 35 years old? and why? |
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Definition
| USS because it can differentiate between cysts and solid lesions in these women who have more dense breast tissue. |
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|
Term
| what types of biopsies are available in triple assessment? |
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Definition
FNA - distinguishes benign from malignant cells
core biopsy - indicates whether cancer is invasive
open biopsy |
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|
Term
| in mx when is a curative approach used? |
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Definition
when there dis no lymph node involvement or only axillary lymph nodes are involved.
palliative approach when distant mets are present |
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Term
| explain breast conserving surgery. who is it suitable for? |
|
Definition
WLE or lumpectomy
followed by radiotherapy
suitable for tumours <5cm and pts who wish for minimal surgery |
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Term
| if you had a large tumour >5cm or central or multifocal tumours what type of surgery is recommend? |
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Definition
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|
Term
|
Definition
| breast reconstruction using the transverse rectus abdominus muscle |
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Term
| what rxs are involved in palliative breast cancer? |
|
Definition
hormonal therapy
chemotherapy and radiotherapy all play a part
'toilet' mastectomy removes fungating lesions. |
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|
Term
| what is a toilet mastectomy? |
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Definition
| it removes fungating lesions and fractures of long bones may be fixed. |
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|
Term
| name the 2 ways lymph node status can be assessed? |
|
Definition
axiallary lymph node clearance
sentinel lymph node biopsy |
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|
Term
| what is the potential complication of axillary node clearance? |
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Definition
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|
Term
| what hormonal rx are there? |
|
Definition
Tamoxifen - given for 5 years. anti-estrogen
aromatase inhibitors e.g. anastrazole. They block oestrogen synthesis
Trastuzumab (herceptin) - given with chemo. blocks HER2 receptors and slows cell growth
ovarian ablation: LHRH agonists and oopherectomy |
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|
Term
| when is chemotherapy used? |
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Definition
| when women has poor prognostic factors |
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|
Term
special conditions and rx
ductal carcinoma in situ
BRCA
Pagets |
|
Definition
DCIS - WLE with radiotherapy or mastectomy depending on extent
BRCA - annual mammography or prophylactic mastectomy
Pagets - mastectomy and lymph node clearance. |
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|
Term
| how is prognosis measured? |
|
Definition
| nottingham prognistic index. |
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Term
| Ddx of single breast lump |
|
Definition
Cancer - firm, fixed, irregular
fibroadenoma -
breast cyst: fluctuant, mobile |
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|
Term
|
Definition
fibroadenomas
fibrocystic change (cyclical symptoms)
breast cysts |
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|
Term
|
Definition
benign tumour
most common lump in women < 30
hard, mobile, painless lump
if the diagnosis is definite, it does not need excising. |
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|
Term
| what is fibrocystic change |
|
Definition
common presentation that is a variant of normal
it is not pre malignant
due to cyclical proliferation and involution of breast tissue
symptoms change with menstual cycle
in women 25-45 years presenting complaint
cyclical breast pain
multiple/single lumps: triple assessment if solitary lump present
cysts: aspirate
pain relief, oral contraceptives and evening primrose oil may be used in its rx. |
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|
Term
|
Definition
mostly seen in 40-60 year old women where 50% develop one or > .
they are fluctuant
diagnosed with USS
rx with needle aspiration during triple assessment if palpable |
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|
Term
|
Definition
pain due to benign disease uni/bilateral
rx: firm bras, paracetamol, evening primrose oil.
hormone therapies may help with chronic pain |
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|
Term
|
Definition
nipple discharge.
breast duct dilation with periductal inflammation.
nipple retraction, red/tender nipples, green discharge.
there may be a lump that undergoes triple assessment
Abx may be tried.
definitive rx is surgical excision of all major ducts. |
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|
Term
| name 3 types of breast infection |
|
Definition
mastitis
cellulitis
abscess |
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|
Term
| what is fat necrosis in breast disease? |
|
Definition
trauma damages fat cells and causes an immune reaction.
this is followed by fibrosis and painless lump formation.
the lump is aspirated to exclude malignancy, and then it can be excised. |
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|
Term
| what can cause man boobs in older men? |
|
Definition
| chronic liver disease, digoxin, spironolactone, cimetidine or pituitary, testicular and lung tumours |
|
|
Term
|
Definition
fibrocystic breast disease
this include mastalgia and mastodynia
increase of breast size
modularity of breast just before period |
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|
Term
| reasons for getting a mastectomy over WLE |
|
Definition
DCIS > 4cm
patient choice
small breasts and large tumour
multifocal tumour
central tumour |
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|
Term
| reasons for WLE over mastectomy |
|
Definition
peripheral tumour
solitary lesion
small lesions in large breasts
pt choice
DCIS < 4cm |
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|
Term
| what are fibroadenomas also known as? why are they called this? |
|
Definition
| they are known as breast mice lump. this is because they are discrete, non tender and highly mobile |
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|
Term
| Lumpy breasts that may hurt and get worse just before periods. |
|
Definition
| fibroadenosis (fibrocystic disease) |
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|
Term
when does mammary duct ectasia most often occur?
what is plasma cell mastitis? |
|
Definition
around menopause.
there is dilation of large breast ducts with green discharge.
If ruptures may cause local inflammation, sometimes referred to as 'plasma cell mastitis' |
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|
Term
| what breast lump may present in obese women who may have undergone unnoticed trauma? |
|
Definition
fat necrosis. basically an inflammatory reaction response.
the lesion is firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted |
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|
Term
| what are lactating women more prone to? |
|
Definition
|
|
Term
| explain pagets disease of the nipple and how it is diagnosed. how can you differentiate between pagets and normal eczema? |
|
Definition
Paget's is an inflammatory eczema of the nipple. it signifies underlying breast malignancy.
it is diagnosed by punch biopsy, mammography and US of breast
it is different from eczema because it first involves the nipple then later spreads to areolar.
in eczema it starts at areolar then proceeds to nipple
Treatment will depend on the underlying lesion. |
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|
Term
| when is radiotherapy offered to women who have had breast cancer surgery> |
|
Definition
offered to women who have had WLE. it can reduce recurrence by 2/3.
for those with mastectomy, it is offered in T3/T4 tumours or those with 4 or > positive axillary nodes. |
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|
Term
| name 3 important SE of tamoxifen |
|
Definition
endometrial cancer
VTE
menopausal symptoms |
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|
Term
| if a ppt has a history of heart disorders and have HER2 positive cancer, what medication is CI? |
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Definition
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|
Term
the breast screening program is being expanded to include which age groups?
currently it is 50-70 |
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Definition
| It will include 47-73 year old pts. |
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|
Term
| how is the nottingham prognostic index calculated? |
|
Definition
Tumour size x 0.2 + lymph node score + grade score
if 0 nodes then score = 1 and grade = 1
1-3 nodes then score = 2 grade = 2
> 3 nodes then score 3 grade = 3 |
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|
Term
| list the prognosis scored form nottingham prognosis index |
|
Definition
2-2.4 = 93% 5 year survival
2.5 -3.4 = 85%
3.5 - 5.4 = 70%
> 5.4 = 50% |
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|
Term
| what are some less common risk factors for breast cancer> |
|
Definition
not breast feeding
ionising radiation
p53 gene mutations
obesity
previous surgery for benign disease (?more follow-up, scar hides lump) |
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|
Term
| name some benign breast lesions |
|
Definition
fibroadenoma
fat necrosis
epithelia hyperplasia
breast cyst
sclerosing adenosis - causes mammography changes that may mimic cancer
duct papilloma |
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|
Term
| which type of mastitis is strongly associated with smoking? |
|
Definition
periductal mastitis.
it occurs in women younger than ductal ectasia.
features of inflammation, abscess or duct fistula
rx: Abx. abscess need drainage |
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|
Term
| which lesions can be classified as Juvenile, common and giant? |
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Definition
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|
Term
| which benign lesion shows a halo appearance on mammography? |
|
Definition
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Term
| carcinoma and intraductal papilloma may both present with blood nipple discharge. how could you differentiate between the two? |
|
Definition
carcinoma usually in older people
intraductal papilloma in younger people
in carcinoma there may be underlying mass or axillary lymph node
intraductal papilloma: usually no underlying mass |
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|
Term
| when should you refer someone with FHx of breast cancer |
|
Definition
if they have one 1st or 2nd degree relative diagnosed plus any of the following:-
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) |
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|
Term
where do oncogenes come from?
how may this mutation occur? |
|
Definition
they come from proto-oncogenes. there is a gain of function. only mutation in one allele needed i.e Dominant effect
proto oncogenes may become oncogenes in the following ways:-
point mutation
chromosomal translocation
increased protein expression |
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|
Term
which oncogene is involved in CML?
which is involved in burkitts lymphoma?
neuroblastoma?
MEN 2/3
follicular lymphoma |
|
Definition
CML = ABL - it is a cytoplasmic tyrosine kinase.
Burkitts = c-MYC - its a transcription factor
neuroblastoma = n-MYC
MEN 2/3 = RET
follicular lymphoma = BCL-2 - apoptosis regulator |
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|
Term
| in which genes does a loss of fx result in increased risk of cancer? |
|
Definition
tumour suppressor genes e.g P53 BRCA1/2
both alleles must be mutated for this risk to increase. |
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|
Term
| in which genes does a gain of fx result in increased cancer? |
|
Definition
| oncogenes e.g. RAS, RET, HER2, ABL |
|
|
Term
which tumour suppressor genes are implicated in the following cancers
Li-Fraumeni
CRC
breast/ovarian
neurofibromatosis
retinoblastoma
wilms tumour |
|
Definition
Li-Fraumeni - p53
CRC - APC
breast/ovarian - BRCA 1/2
neurofibromatosis - NF1
retinoblastoma -Rb
wilms tumour - WT1 |
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|
Term
| Mechanism of HPV causing cervical cancer |
|
Definition
HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene |
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