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18 Cards in this Set
- Front
- Back
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Average age of breast cancer onset?
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~63
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The NCI version of risk assessment is suitable for which pts?
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those w/o strong family hx.
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What are the risk factors for breast cancer? (be able to get the big ones)
- might lifestyle modifications be able to lower risk? |
Age (2/3 postmenopause)
Race Family history Reproductive factors (+ for early menarche, nulli or late parity, late menopause, HRT, postmenopausal obesity, no lactation) Breast disease Radiation to chest Other Yes. |
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BRCA1 and 2 account for __% of familial breast cancers.
- inheritance type? - lifetime risk? - characteristics of the dz when in manifests in these pts? - is aggressive screening proven to help prevent breast cancer? + prophylactic mastectomy? + pro. oophorectomy? - SERMs helpful? Name the most common one, and then the other that is usually used for osteoporosis, but also can help w/ breast cancer. + % of decrease in risk i/ high risk women? + decrease hot flashes, thrombosis, endometrial cancer (tamoxifen), cataracts? |
80%
Autosomal dominant ~60% bilateral dz, premenopausal dz, ovarian cancer (BRCA1), male breast cancer (BRCA2). - no - 90% reduction - 50% reduction - yes, they're helpful. Tamoxifen and Raloxifene... can decrease risk of invasive/non-invasive breast cancer ~50% + No!! INCREASE all of these. |
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Is there a proven value in breast self-exam monthly age 20+? (according to the american cancer society)
Clinical breast examination every 3y? Mammography yearly after 40? |
No.
No. 40-50y reduces mortality 15%, >50y by 20-30% |
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Can US be helpful in screening breast cancer pts?
- how about as an adjunct in examining palpable masses? What % of breast cancers are mammographically occult? Are MRI's useful? |
- no
- yes 15%. thus we still need physical exams. In high risk pts (BRCA1 and 2) |
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What are the types of breast cancer?
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Ductal carcinoma in situ (DCIS)
- noninvasive breast cancer - rarely spreads Invasive breast cancer - risk of spread varies by stage/biology |
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What % of DCIS cases are mammographically detected?
- what % recur (either as DCIS or invasive) if inadequately treated - tx? - histological features? |
80%
- 50% - Surgx (excision or simple mastectomy); Xrt if excised, tamoxifen for some. - solid DCIS, uniform monotonous cell population. |
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Of the invasive cancers, infiltrating ductal is what percent? infiltrating lobular?
- does pure-tubular histology confer a better prognosis? - what about an inflammatory histology? + what is meant by inflammatory? |
Infiltrating ductal 70% most common
Infiltrating lobular 15% - yes - bad prognosis + Induration, peau d’orange skin, erythema, +/- dermal lymphatic invasion |
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Are Phyllodes tumors primary breast cancers?
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No, they are more like sarcomas.
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Tumor stage is based on TNM system. Which stage signifies growth *anywhere* else?
- what do the other stages signify? |
Stage IV (metastatic)
- non-metastatic and curable (breast, axillary lymph node) |
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TNM = ?
- what other things can help with tumor staging/biology? - Does the proportion of pts w/ met's increase w/ tumor size? - does axillary node involvement portend better prognosis? |
tumor size, axillary node involvement, and distant metastases (trumps all else if present).
- Her-2 amplified or not; hormone receptor presence (E/ProGest); histology, tumor grade. - yes - no, worse. |
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What are the most common morbidities of axillary node surgery?
What is a sentinel lymphadenectomy? What are lumpectomies combined w/ as the standard of care? When might mastectomy actually be useful? |
pain, lymphedema or arm.
Removal of first draining lymph node from a tumor If negative, no further surgery If positive, full axillary dissection Xrt --> <10% recur i/ breast. large tumors, many + lymph nodes. |
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What can be used to treat bone mets in the context of breast cancer?
What is Trastuzumab? Lapatinib? Bevacizumab? |
bisphosphonates
- anti Her-2 antibody - anti Her-2 small molecule - anti-VEGF antibody |
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In which tumors are systemic adjuvant tx like chemo, hormone, trastuzumab, etc. considered?
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in all but the smallest stage I tumors.
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Chemo is more effective in which age group? Endocrine tx?
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younger. Same for endocrine therapy.
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With metastatic disease, what are the only tx?
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all are palliative.
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Has screening and the resulting pick-up of earlier, smaller cancers helped survival?
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He thinks so, yes.
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