22 - Breast Cancer Flashcards
(69 cards)
What is the problem if a patient expresses HER2 genes?
amplification/overexpression generally imparts a poorer prognosis; chemotherapy sensitivity (such as with anthracyclines, this is controversial); endocrine therapy resistance (also controversial)
What increases risk of breast cancer?
- family Hx
- early age of menarche (before 12 yo)
- late age of natural menopause (>55 yo)
- women who don’t have kids before age 30
- diet and alcohol use
- exposure to radiation
-early induced menopause (before 50 yo) decreases risk
What is human breast tissue composed of?
- connective tissue and fat with an elaborate duct system
- abundant blood supply
- not fully developed until first pregnancy
Where does breast cancer most commonly spread to ?
-lung, bones, liver and brain most commonly
What type of surgery requires post operative radiation ?
Breast conserving surgery (lumpectomy)
What is TNM staging?
T = primary tumor (number based on size usually) N = regional lymph node involvement M = metastatic spread
What does stage 4 mean?
it has spread (in breast cancer that means most likely spread to lungs, skin, bones, liver, brain)
Number of lymph nodes affected is ____ related to disease recurrence
directly
What is a tumor grade?
- How aggressive the cancer is
- Look at level of cell differentiation by evaluating amount of tubule formation, nuclear size, and mitotic count
- Grade 1 = well differentiated (more favourable)
- Grade 2 = moderately differentiated
- Grade 3 = poorly differentiated (less favourable)
What is HER2-neu associated with?
increased tumor aggressiveness
What is the treatment for DCIS (ductal carcinoma in situ) ?
Stage 0 cancer
- Surgery (generally do not need axillary lymph node dissection)
- Radiation
- Tamoxifen
- Role of aromatase inhibitors not yet established
What is the Tx for stage 1 breast cancer?
- surgery
- radiation
- adjuvant chemo +/- endocrine therapy +/- biologic therapy
What is Tx for stage 2 and 3 breast cancer?
- surgery
- radiation
- systemic chemotherapy
- management is usually a combined approach of surgery followed by chemotherapy and then radiation to try to reduce the rate of local recurrence
- additionally, many patients will receive 1-2 cycles of neoadjuvant chemo to improve surgical resectability
- hormonal therapy in estrogen receptor positive patients is certainly of value as would be any therapy directed at Her-2ne over expression
If they have bone cancer, most will get a _______ prescribed to them
bisphosphonate
If they have spread to visceral organs (lung, liver), what do we consider for Tx ?
Most oncologists will consider systemic chemotherapy with an anthracycline based regimen or taxane based regimen
What is the Tx for brain or spinal cored metastases ?
usually radiation +/- corticosteroids
If a person has 3 cm invasive ductal cancer will Her2 neu positive, do they need adjuvant therapy ?
yes
What are some possible indications for radiation therapy ?
- breast conserving surgery
- mastectomy with positive margins
- lymph node positive disease
- large tumors
- neo-adjuvant indications
*may be used in metastatic disease to treat metastatic site (bone, brain)
Describe the Tx for early stage (stage 1-3) breast cancer ?
- surgery
- radiation
- chemotherapy
- endocrine therapy
Goals of Tx: long term remission or cure
*patients may receive all of the above or any combination depending on the cancer and patient specific factors
Describe the Tx for metastatic breast cancer (stage 4)
- Typically systemic therapy
- Palliative radiation
- Balance symptom relief with chemotherapy toxicities
- Exposure patient to what they have not been given before
Goals of Tx: Palliation
Most regimens in early breast cancer are combinations of two or more drugs and contain a _______, a ______ or both
an anthracycline, a taxane, or both
Doxorubicin:
______ antibiotic
anthracycline
Doxorubicin:
Lifetime cumulative dose of ?
500-550 mg/m2 - 21 day regimen
700 mg/m2 for weekly regimen
*usually administered in a 50 mg/m2 per dose
Doxorubicin:
Usually the first agent of choice for patients with ____ disease, unless patient has received an anthracycline in the adjuvant setting.
metastatic
