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x REPRO > 5/6 Breast Malignancy > Flashcards

5/6 Breast Malignancy Flashcards

I only made FCs off the notes

1
Q

what hormonal risk factors increase risk of breast cancer?

A

being F

early menarche/late menopause risk (previous lectures say that is due to increased periods of estrogen exposure)

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2
Q

what are important risk factors of breast cancer?

A 
******AGE*****
Family Hx
Prior dx of BCa
Prior bx with atypical hyperplasia or carcinoma in situ
Ionizing radiation
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3
Q

what are indicators of possible breast malignancy? 4

A

new, non-painful hard fixed irregular mass
dimpling
nipple retraction
bloody nipple discharge

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4
Q

T/F A negative mammogram in a person with a breast mass is an indication that person probably doesn’t have BCa

A

FALSE. A negative mammogram cannot be the sole reason the evaluation of a breast mass is concluded

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5
Q

Of the breast malignancies, how many are carcinoma? sarcoma?

A 
carcinoma = 99%
sarcoma = 1%
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6
Q

What are two greatest predictors (prognosis) of 10yr survival of breast cancer?

A

size (+tumor grade)

nodal status

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7
Q

What is the primary “local” therapy in the treatment of non-metastatic invasive BCa?

Who is this most suitable for?

What is a late complications of this therapy?

A

lumpectomy + XRT

suitable for women w/ NEWLY diagnosed BCa with a resectable breast mass W/O evidence of metastatic spread beyond the regional LN

Complications

  • pain/numbness in breast, chest wall, axilla
  • arm swelling/lymphedema (esp if dissection was on the L side)
  • restricted arm mobility
  • infection
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8
Q

Why is XRT impt in the primary local therapy regimen?

A

to reduce the incidence of in-breast recurrence of BCa

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9
Q

What happens if there is local recurrence of breast cancer after the primary local therapy was performed?

A

mastectomy

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10
Q

Lumpectomy is contraindicated in who?

A

women w/

  • really large tumors
  • extensive multifocal disease
  • where radiation is also contraindicated
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11
Q

how is the decision btwn mastectomy and lumpectomy decided on?

A

personal choice

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12
Q

T/F The dx of BCa is a medical emergency and action must be taken immediately

A

False. It is not so time should be taken to evaluate the options to reach a well-reasoned decision

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13
Q

What 3 different kinds of systemic adjuvant therapy? Why is it used? Who is it typically used for?

A

3 categories (more in detail later)

  • endocrine Rx
  • chemotherapy
  • Antibody (targeted) therapy

used to reduce risk of later metastatic or local recurrence

women w/ invasive BCa since their risk of systemic recurrence is high

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14
Q

What is neoadjuvant chemotherapy and when is it typically done?

A

chemoRx or hormonal Rx that is administered BEFORE the surgical removal of the tumor

done when the tumor is very large (or involves skin)

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15
Q

What is the role of endocrine therapy in its use as an adjuvant therapy for BCa?

options for pre- and post-menopausal women?

A

interferes w/ production or function of E in women whose cancer express E or P receptors

pre-menopausal: tamoxifen, ovarian ablation or LHRH agonist

post-menopausal: same as above, or aromatase inhibitors

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16
Q

What is tamoxifen?
Indications?
ADR?
Contraindications?

A

SERM
breast: anti-estrogenic
bone, uterus: estrogenic

Indications: ER+ breast cancer treatment and prevention

ADRs
increase risk of uterine or endometrial cancers, hot flashes, thromboembolic events, decreased bone mineral density in premenopausal women**

Contraindications: hypersensitivity to tamoxifen, warfarin therapy, venous thromboembolic disorders**

17
Q

What is the role of chemotherapy in its use as an adjuvant therapy for BCa? examples?

Complications?

A

prevents cells from dividing by inhibiting various steps that produce metabolites impt for cell division

Cytoxan, Adriamycin, 5FU

18
Q

What is an example of antibody (targeted) therapy in the adjuvant therapy for BCa?
Indications?
ADR?

A

Herceptin “Trastuzumab” - mAb aganist HER2 (cerbB2), a tyrosine kinase receptor, and mediates antibody-dependent cellular toxicity by inhibiting proliferation of cells

indications: HER-2 (+) breast cancer and gastric cancer

ADRs: Cardiotoxicity “HEARTceptin damages the heart”

19
Q

Adjuvant therapy reduces risk of later recurrences of BCa. How does it affect menopause sx?

A

MAKES IT WORSE

20
Q

difference of a prognostic factor vs a predictive factor? example of each?

A

prognostic: molecular + histologic features that influence the final outcome, regardless of treatment. (ex: HER2 status)
predictive: tumor characteristics that predict responsiveness to specific therapies (ex: ER or HER2 status are responsive to tamoxifen and herceptin, respectively)

HER2 status is both a prognostic factor and a predictive factor for Herceptin

21
Q

Women w/ a hx of BCa are at increased risk of what?

As a result of this, they should do this…

What should they not do?

A

contralateral BCa

annual mammography and clinical physical exam

NOTE: in the absence of any signs or sx of metastatic recurrence, periodic CT, bone scans, and blood tests are NOT indicated

22
Q

What always precedes the initiation of systemic therapy?

A

evaluation of the common sites of metastasis (staging)

23
Q

What constitutes a typical staging work-up for breast cancer?

A

bone scan
CT of chest/back/pelvis
labs/LFTs

24
Q

typical staging work-up for breast cancer involves bone scan, CT of chest/back/pelvis, and labs/LFTs. When is an Xray done and why?

A

when the bone scan indicates metastatic involvement of the weight-bearing bones of the legs

Done to evaluate the degree of cortical destruction

25
Q

What should you do if a BCa patient shows more than >50% loss of the cortex in the shaft of the femur due to metastasis?

A

prophylactic XRT +/- surgical stabilization due to a high risk of pathologic fracture

26
Q

T/F metastatic breast cancer is incurable

A

True (with RARE exceptions)

27
Q

Tumor markers for breast cancer?

What are these markers generally used for?

A

CEA
CA27-29
CA15-3

clinical use: follow a response to therapy, esp. when the patient has a metz disease that is difficult to quantify on clinical exam

28
Q

Why is the expression of erbB2 receptor relevant to therapy decisions?

A

erbB2 is aka HER2/neu

b/c these respond to antibody-targeted therapy (trastuzumab or pertuzumab)

29
Q

Why is the expression of ER receptor relevant to therapy decisions?

A

b/c these respond to endocrine therapy (tamoxifen or aromatase inhibitors)

30
Q

Patients w/ metastatic disease to the bone should be treated with…?

What is the purpose of these treatments?

A

bisphosphonate (zoledronic acid) or
inhibitors of RANK-L (denosumab)

reduce the incidence of:

  • bone pain
  • hypercalcemia
  • pathologic fractures
31
Q

MoA of zoledronic acid??

A

bisphosphonate - pyrophosphate analog that bind hydroxyapatite and inhibit osteoclast-mediated bone resorption

32
Q

MoA of denosumab??

A

blocks interaction of RANK ligand with its receptor on osteoclast

33
Q

When do you stop treatment? 4

A
  • complete remission
  • side effects outweigh the benefit
  • tumor progression occurs
  • multi-drug resistance
34
Q

T/F lobular carcinoma in situ (LCIS) is a premalignant lesion (ie destined to progress to invasive lobular cancer)

A

False. it is a marker of increased risk of subsequent invasive cancer of either histology (lobular or ductal)

35
Q

Management of patients with LCIS?

A
  • intensive follow-up (mammogram + clinical breast exam)

- chemoprevention (ie tamoxifen)

36
Q

T/F ductal carcinoma in situ (DCIS) is a premalignant lesion (ie destined to progress to invasive lobular cancer)

A

True. it can undergo malignant progression to an invasive cancer.

37
Q

Management of patients with DCIS?

A

lumpectomy + XRT

38
Q

Why is post-lumectomy XRT a critical part of the management of DCIS, but still remains an evolving issue?

A

because it significantly reduces both invasive + non-invasive tumors but it does NOT affect survival rates….

x REPRO (37 decks)

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