What are the treatment options for breast cancer in oncology?
Radiotherapy
Chemotherapy
Hormonal therapies e.g tamoxifen, aromatase inhibitors, GnRH agonist
Herceptin
What is offered to breast cancer patients who are not suitable for curative treatment?
Palliative care
What is meant by
a) adjuvant
b) neo-adjuvant treatment?
a) Adjuvant treatments are given alongside curative treatments i.e surgery
b) Neo-adjuvant treatments are given BEFORE curative treatments
Is radiotherapy a neo-adjuvant treatment for breast cancer?
No
Adjuvant - given ALONGSIDE or AFTER curative surgery
What therapies are given as neo-adjuvants in breast cancer?
Chemotherapy
Hormonal therapies
(Herceptin for HER2 positive cancers)
Why are neo-adjuvant therapies given before breast cancer surgery?
To reduce the size of the tumour
To improve cosmesis
What is adjuvant therapy?
Treatments given AFTER curative breast surgery
What is the most commonly given adjuvant therapy for breast cancer?
Radiotherapy
What are four adjuvant therapies given for breast cancer?
Radiotherapy
Chemotherapy
Hormonal therapy (tamoxifen, aromatase inhibitors)
Herceptin
Tamoxifen (an oestrogen receptor blocker) increases a patient’s chances of developing which cancer?
Endometrial cancer
What pathological features increase the risk of a cancer relapsing?
Lymph node invasion
High grade (i.e how well differentiated it is)
High stage (i.e size, local invasion)
What specific chemotherapy drugs are used in breast cancer?
Anthracycline
Taxanes
What are some side effects of chemotherapy?
Hair loss
Fatigue
Nausea and vomiting
Susceptibility to infection
Which receptor does herceptin act on?
HER2 receptor
Out of every 100 people treated with herceptin, how many more survive?
3 out of 100
so an absolute benefit of 3%
How are breast cancer patients followed up surgically?
Surgical review one year following procedure
Then breast screening every 3 years
What are some palliative treatments for breast cancer?
Radio/chemo/hormonal therapy
Bisphosphonates
Why are bisphosphonates given to some palliative breast cancer patients?
1. Drugs affecting oestrogen metabolism e.g tamoxifen can cause osteoporosis
2. Bone destruction in metastatic disease
bisphosphonates reduce bone turnover
The beneficial effects of chemotherapy must be weighed up against the ___ of the patient.
QOL
quality of life
Trastuzumab (Herceptin) is effective for which type of breast cancer?
HER2+ cancers
Transtuzumab can be combined with what to increase its effectiveness?
Chemotherapy
What are the three factors influencing the chance of breast cancer recurrence?
Local invasion (stage)
Degree of differentiation (grade)
Lymph node involvement
What are the chances that a low grade tumour will spread to the bones?
Little to none
Which imaging modalities are used to check the bones of patients complaining of bony pain?
Bone scan
MRI/CT scan
What is a sinister complaint of patients with breast cancer?
Bony pain
What is an important immunological side effect of chemotherapy?
Neutropenia
Neutropenia caused by chemotherapy can cause which complication?
Infection
so admit if patient on chemo has a fever
What is a common side effect of tamoxifen and aromatase inhibitors in women with breast cancer?
Why?
Menopausal symptoms e.g hot flushes, pain on intercourse, vaginal dryness
Reduces oestrogen effects by blocking receptors
Which type of contaception contains oestrogen?
IUS (i.e Merina coil)
there’s more
Why are Merina coils contraindicated in breast cancer?
What’s the problem with this?
Release oestrogen, theoretically increasing the growth of ER positive cancers
Not all breast cancers are ER positive
What is a tumour marker for breast cancer?
CA125
CA125 is for ___, not ___ of breast cancer.
monitoring, not diagnosis
A breast cancer patient complains of a sore jaw.
Which type of drug can cause this?
Bisphosphonates
Jaw osteonecrosis
Fat necrosis is an inflammatory response caused by breast trauma.
What are some traumas which can cause it?
Seatbelt injuries
Dogs jumping up on women (really)
Reconstructive surgery (uncommon cause of breast lump immediately following surgery)
What is an urgent neurological complication of bony metastasis?
Spinal cord compression
Which class of drug influences the circulating levels of tamoxifen?
Antidepressants
common metastasis sites: bones, lungs, liver, brain
HER2 positive cancers PREFERENTIALLY go for the brain
Where does lobular breast cancer preferentially spread to?
Peritoneum
Causing GI symptoms e.g obstruction
What are lifestyle factors which increase your risk of developing breast cancer?
Obesity
Lack of physical activity
Excessive alcohol consumption
Which organs do
a) HER2+ breast cancers
b) lobular breast cancers
commonly invade?
a) Brain
b) GI organs
