Aetiology
compare the incidence for ER-positive breast cancer, ER-negative breast cancer, HER2-positive breast cancer
ER-positive increases with age whilst ER-negative + HER2-positive remains fairly constant with age
what are the main 2 genetic mutations associated with breast cancer?
BRCA1 - chromosome 17
BRCA2 - chromosome 13
registered female on GP record
50-70 every 3 years
list 3 types of biologic/targeted therapies given to patients with breast cancer + briefly describe what they are
cancer growth factor inhibitors - inhibits factors such as PDGF, EGF, FGF, HER2
anti-angiogenics - prevents angiogenesis of cancer, inhibiting growth
PARP inhibitors - inhibit poly-ADP ribose polymerase which is a protein involved in damaged DNA repair
what is a protective factor for breast cancer?
breast feeding - lactation suppresses ovulation = reduced oestrogen exposure
which receptors are breast cancers tested for?
oestrogen receptor
progesterone receptor
human epidermal growth factor (HER2)
breast lumps - hard, irregular margins, tethered or fixed, most commonly in the outer quadrant
nipple changes - bleeding, discharge, inversion, deviation
skin changes - dimpling/puckering, ulceration, dryness/roughness, peau d'orange (looks like surface of orange)
list 3 types of hormone therapy given to patients with breast cancer + briefly describe each
SERM - blocks oestrogen receptors in breast, stimulates in bone + uterus
aromatase inhibitors - prevents conversion of testosterone to oestrogen
GnRH agonists - sustained treatment inhibits oestrogen production (pulsatile would increase it)
List some examples of risk cancers for breast cancer
What are the hallmarks of cancer? (8)
self-sufficiency in growth signals (oncogenes)
insensitivity to antigrowth signals (tumour suppressor gene dysfunction)
evasion of apoptosis
limitless replicative potential
sustained angiogenesis
tissue invasion + metastasis
reprogramming of energy metabolism
evasion of immune destruction
when making a diagnosis, what are important features of the breast cancer that would be commented on
TNM stage - size, node infiltration, metastasis
receptor status - ER, PR HER2 (very useful for determining which treatments will work)
types of prophylactic treatment for breast cancer
surgery - bilateral mastectomy, ovary + fallopian tube removal - due to BRCA1+2 mutations
chemoprevention with SERMs
List the 6 main types of breast cancer + say which is the most common
invasive ductal carcinoma (80%)
invasive lobar carcinoma (10-15%)
ductal carcinoma in situ
lobar carcinoma in situ
inflammatory breast cancer
Paget's disease of the nipple
what are the MOLECULAR subtypes of breast cancer + briefly describe each
Luminal A - most common (50-60%), ER+ PR+ HER2-, tends to be less aggressive + lower grade (low Ki-67)
Luminal B - either ER+ OR PR+ and HER2-, tend to be more aggressive + higher grade than luminal A
HER2-enriched - ER- PR- HER2+, tend to be more aggressive + higher grade, diagnosed at late stage
Basal-Like/Triple Negative - ER- PR- HER2-, most aggressive, poorest prognosis, reduced treatment options
What is the triple diagnostic assessment for breast cancer? AND briefly explain what each entails
clinical assessment - clinical history + examination by breast surgeon
imaging - ultrasound (younger women with denser breast tissue/ with smaller breasts), mammogram (older women with less dense breasts, larger breasts - also picks up calcifications missed by ultrasound)
biopsy - fine needle aspiration (collects cells) or cone biopsy (collects core of tissue, higher diagnostic yield)
briefly describe how breast cancer can generally be treated at each stage
stage 0 - lumpectomy/breast conserving surgery (BCT), or simple mastectomy
stage 1 - BCT or simple mastectomy
stage 2 - BCT or mastectomy + HRT/chemotherapy/targeted therapy
stage 3 - mastectomy + axillary dissection + radiotherapy + chemotherapy
stage 4 - surgery is unlikely to be curative, systemic therapy + palliative care