What are the treatment options for breast cancer in oncology?
Hormonal therapies e.g tamoxifen, aromatase inhibitors, GnRH agonist
What is offered to breast cancer patients who are not suitable for curative treatment?
What is meant by
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?
Adjuvant - given ALONGSIDE or AFTER curative surgery
What therapies are given as neo-adjuvants in breast cancer?
(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?
What are four adjuvant therapies given for breast cancer?
Hormonal therapy (tamoxifen, aromatase inhibitors)
Tamoxifen (an oestrogen receptor blocker) increases a patient’s chances of developing which 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?
What are some side effects of chemotherapy?
Nausea and vomiting
Susceptibility to infection
Which receptor does herceptin act on?
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?
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.
quality of life
Trastuzumab (Herceptin) is effective for which type of breast cancer?
Transtuzumab can be combined with what to increase its effectiveness?
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?
What is a sinister complaint of patients with breast cancer?
What is an important immunological side effect of chemotherapy?
Neutropenia caused by chemotherapy can cause which complication?
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?
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)
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 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?
Fat necrosis is an inflammatory response caused by breast trauma.
What are some traumas which can cause it?
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?
common metastasis sites: bones, lungs, liver, brain
HER2 positive cancers PREFERENTIALLY go for the brain
Where does lobular breast cancer preferentially spread to?
Causing GI symptoms e.g obstruction
What are lifestyle factors which increase your risk of developing breast cancer?
Lack of physical activity
Excessive alcohol consumption
Which organs do
a) HER2+ breast cancers
b) lobular breast cancers
b) GI organs