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17 Cards in this Set
- Front
- Back
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What is the varying incidence of breast cancer in different age groups? |
20s rare 30s uncommon 30-60s incidence rises in this period Post 60s incidence levels but case numbers fall as its a smaller group |
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What are the risk factors for developing breast cancer? |
Early menarche Late menopause Older age at first pregnancy Use of the oral contraceptive pill (though risk falls to previous 10 years without) Hrt Obesity Family history Alcohol |
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Describe the visible and palpable signs of breast cancer |
New lump or thickening in breast or axilla Altered shape feel or size Skin changes -erythema -skin oedema -puckering Nipple changes -ulceration -discharge -inversion -pigmentation |
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When investigating a possible breast cancer what are the components of the triple approach? |
Clinical exam - inspect, arms behind head, and palpate both breasts, axilla, for lymph nodes Imaging: younger ultrasound, older x ray mammography Biopsy: fine needle aspiration, core biopsy, excision |
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When is breast cancer screening provided? And how is it done? |
Every 3 years, to women between 47 and 73 have a two view x ray mammogram |
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Describe surgical interventions for breast cancer |
1) wide local excision: common, remove whole tumour leaving clear margins of tissue all around 2) mastectomy: may be chosen for peace of mind, may be needed to ensure clear margins around tumour |
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What is sentinel node biopsy? |
Injection of a radioactive dye into the tumour identifies first lymphnode it drains to, this can then be removed and analysed for signs of malignancy. If clear other lymphnodes can be left and side effects of removing them (limitation of arm movements and arm swelling) can be avoided |
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What % of breast cancers over express ER or PR |
80% |
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What is tamoxifen? And how is it used |
It is an oestrogen receptor antagonist. So binds to tumour ER receptors and blocks oestrogen from causing the tumour to develop further. Used in ER + cancers only and for 5 years. Side effect is in slightly raised risk of endometrial cancer |
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What are aromatase inhibitors and how are they used? |
Letrazole anostrazole Inhibitors of aromatase which converts androgens to oestrogens. They're used to prevent oestrogen stimulated development of er + cancers in post menopausal women. Who especially when obese make oestrogen in fat |
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What is the basic management of newly diagnosed breast cancer |
WLE and radiotherapy +- hormonal treatments and chemotherapy |
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What is trastuzumab and how is it used? |
HERCEPTIN, Monoclonal antibody for HER2 receptor which is upregulated in certain cancers |
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what are prognostic and predictive factors? |
prognostic factors are measure how aggressive the tumour is so predict outcome for the patient, eg grade and stage predictive factors are qualities of the tumour which predict how it will respond to certain treatments eg whether it is er+ |
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what is the grading system for breast malignancy based upon and how many grades are there? |
-nuclear pleomorphism -number of mitosis per mm^2 -extent of gland formation 1-3 |
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what is the problem with breast screening |
that like prostate cancer breast malignancies which are sow slowing may not cause symptomatic disease in a persons life time to save one women with breast cancer 3 other women with this better prognosis are investigated and treated. there is a problem of over diagnosis and over treatment |
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how do you calculate the Nottingham prognostic index? |
grade + LN stage + (diameter of tumour in cm/5) |
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what are the different histological types of breast cancer and how frequent are they? |
invasive ductal carcinoma (70%) invasive lobular carcinoma (which has lost e cadherin) (10-15%) less frequent types: -papillary 3% -medullary 3% -tubular, cribiform carcinoma 2% -acinic cell, adenoid, cystic, apocrine, glycogen rich, lipid rich +1%< |
