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WEEK 23:
Breast cancer diagnosis and prognosis:
| Question | Answer |
|---|---|
| breast cancer diagnosis involves | NHS breast screening programme (BSP) and triple assessment (physical examination, imaging and biopsy) |
| biopsy meaning | sample cells/tissue |
| symptoms of breast cancer | new lump, area of thickened tissue in breast, change in size or shape, discharge from nipple, lump or swelling in armpit, change in look/feel of skin, rash/crusting/scaly/itchy around nipple etc |
| what is not usually a symptom of breast cancer | breast pain |
| mammogram | xray which detects small changes in breast before symptoms develop given every 3 years for women 50-70yrs |
| radiology options as part of triple assessment | mammogram (xray) and US (ultrasound) of a lesion + US (ultrasound) assessment of axilla |
| pathology options as part of triple assessment | core need biopsy and STVAB (microcalcification) |
| types of breast sampling (3) | cytology (examination of cells in tissue fluids, histopathology (surgical diagnostic excision - removes all or part of abnormality), and core (needle biopsy to collect core of tissue) |
| image guided (US guided) core needle biospy results | gives definitive and timely diagnosis of all potential abnormalities detected during screening |
| B1 need core biopsy (NCB) results | normal |
| B2 need core biopsy (NCB) results | benign |
| B3 need core biopsy (NCB) results | lesion of uncertain malignant potential |
| B4 need core biopsy (NCB) results | suspicious of malignancy |
| B5 need core biopsy (NCB) results | malignant (B5a = in situ, low intermediate and high nuclear grade and B5b = invasive grade 1-3) |
| histopathology process includes | fixed formalin for routine histology (good fixation vital to preserve morpholigcal detail). sample stained with haematoxylin and erosin |
| tumour grade | morphological assessment of biology (degree of differentiation of tumour cells relative to normal tissue of origin, variation in size and shape, and proportion of cells containing mitotic figures) |
| tubule formation in majority of tumour | >75% |
| tubule formation in moderate degree | 10-75% |
| tubule formation in little or none | <10% |
| nuclear pleomorphism | small regular uniform cells with moderate increase in size and variability and marked variation |
| survival difference in patients with high grade and low grade | patients with low grade tumours have a longer survival than those with high grade tumours |
| most powerful prognostic factor in patients with invasive carcinoma of breast | axillary lymph nodal status |
| TNM staging system function | used to describe most types of cancer |
| T in TNM | tumour- describes size of tumour, degree it has locally invaded, and any spread of cancer into nearby tissue |
| N in TNM | nodes- describes spread of cancer to nearby lymph nodes |
| M in TNM | metastasis- describes spread of cancer to other parts of body |
| aONSA | option for detecting sentinel lymph node metastases in people with early invasive breast cancer who have sentinel lymph node biopsy and in whom axillary lymph node dissection will be considered |
| sentinel lymph node biopsy is submitted for histology to asses what | assess for metastasis |
| grade refers to | degree of tumour differentiation |
| stage refers to | extent of spread of tumour |
| NICE recommends | ER, PR, HER2 are assessed on CORE BIOPSY to facilitate planning of patient management |
| ER | expressed in normal breast epithelial cells but increase expression in breast tumour and are associated with negative nodal status and low tumour grade (leads to better survival as slow growing and respond well to hormonal treatment) |
| how is ER tested | via validated immunohistochemistry |
| examples of anti-oestrogens | tamoxigen and fulvestrant |
| hormone treatment/ endocrine therapy for ER in breast cancer (2) | anti-oestrogen and oestrogen deprivation |
| example of oestrogen deprivation | aromatase inhibitors (stop conversion of androgen to oestrogen) |
| how is PR and ER measured | by IHC (immunohistochemistry) |
| ER+ tumours with lower or negative PR expression have what prognosis | worse (as more aggressive and resistant to standard endocrine therapy) |
| HER2 is overexpressed in how many cases of breast cancer | 15% |
| what causes HER2 to be overexpressed | amplification of gene on chromosome 17, associated with positive nodal status and high tumour grade so poor overall survival and disease free survival |
| difference between ER and HER2 | ER has a better survival chance than HER2 because it is associated with negative nodal status and low tumour grade (more respondent to therapy) but HER2 is associated with high nodal status and high tumour grade (less respondent to therapy) |
| HER2 therapies | trastuzumab (MAB), pertuzumab (MAB), ado-tasuzumab emtansine (MAB + cytotoxig agent DM1), and HER2 tyrosine kinase inhibitors (lapantinib etc) |
| physical issues with survivorship of breast cancer | Treatment-related side effects: Menopausal symptoms: Sexual dysfunction: Bone density loss: Increased risk of other cancers |
| emotional issues with survivorship of breast cancer | Fear of recurrence Depression and anxiety Body image concerns Relationship and social challenges bonus: financial issues |
| follow up of treatment to breast cancer | written summary of treatment given to patient and GP, clear instruction on symptoms to watch for, database to ensure surveillance mammography and any switch in endocrine treatment is accurately monitored, and access if patients has concerns/issues |
| patients being treated with primary hormonal therapy should be followed up when | 6 monthly intervals for the first year to ensure clinical response and further follow up should be determined by patient fitness and clinical need |
| annual follow up mammography is for who | for those having breast conserving surgery and at least 2 yearly mammography for at least 5 years after diagnosis or until they reach breast screening age |
| long term follow up | patients are given 3-yearly screening offered by NHSBSP |
Created by:
kablooey
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