5/6 Breast Malignancy Flashcards
I only made FCs off the notes (38 cards)
what hormonal risk factors increase risk of breast cancer?
being F
early menarche/late menopause risk (previous lectures say that is due to increased periods of estrogen exposure)
what are important risk factors of breast cancer?
******AGE***** Family Hx Prior dx of BCa Prior bx with atypical hyperplasia or carcinoma in situ Ionizing radiation
what are indicators of possible breast malignancy? 4
new, non-painful hard fixed irregular mass
dimpling
nipple retraction
bloody nipple discharge
T/F A negative mammogram in a person with a breast mass is an indication that person probably doesn’t have BCa
FALSE. A negative mammogram cannot be the sole reason the evaluation of a breast mass is concluded
Of the breast malignancies, how many are carcinoma? sarcoma?
carcinoma = 99% sarcoma = 1%
What are two greatest predictors (prognosis) of 10yr survival of breast cancer?
size (+tumor grade)
nodal status
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?
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
Why is XRT impt in the primary local therapy regimen?
to reduce the incidence of in-breast recurrence of BCa
What happens if there is local recurrence of breast cancer after the primary local therapy was performed?
mastectomy
Lumpectomy is contraindicated in who?
women w/
- really large tumors
- extensive multifocal disease
- where radiation is also contraindicated
how is the decision btwn mastectomy and lumpectomy decided on?
personal choice
T/F The dx of BCa is a medical emergency and action must be taken immediately
False. It is not so time should be taken to evaluate the options to reach a well-reasoned decision
What 3 different kinds of systemic adjuvant therapy? Why is it used? Who is it typically used for?
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
What is neoadjuvant chemotherapy and when is it typically done?
chemoRx or hormonal Rx that is administered BEFORE the surgical removal of the tumor
done when the tumor is very large (or involves skin)
What is the role of endocrine therapy in its use as an adjuvant therapy for BCa?
options for pre- and post-menopausal women?
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
What is tamoxifen?
Indications?
ADR?
Contraindications?
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**
What is the role of chemotherapy in its use as an adjuvant therapy for BCa? examples?
Complications?
prevents cells from dividing by inhibiting various steps that produce metabolites impt for cell division
Cytoxan, Adriamycin, 5FU
What is an example of antibody (targeted) therapy in the adjuvant therapy for BCa?
Indications?
ADR?
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”
Adjuvant therapy reduces risk of later recurrences of BCa. How does it affect menopause sx?
MAKES IT WORSE
difference of a prognostic factor vs a predictive factor? example of each?
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
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?
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
What always precedes the initiation of systemic therapy?
evaluation of the common sites of metastasis (staging)
What constitutes a typical staging work-up for breast cancer?
bone scan
CT of chest/back/pelvis
labs/LFTs
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?
when the bone scan indicates metastatic involvement of the weight-bearing bones of the legs
Done to evaluate the degree of cortical destruction
