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M3 > Onco - BCA Bk Tx > Flashcards

Onco - BCA Bk Tx Flashcards

1
Q

ER (+++)
PR (+++)
Her2 (-)
Low Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

A

A

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2
Q

ER (-)
PR (-)
Her2 (-)
Low Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

A

E

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3
Q

ER (-)
PR (-)
Her2 (-)
High Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

A

D

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4
Q

ER (+++)
PR (+/-)
Her2 (+/-)
High Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

A

B

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5
Q

ER (+/-)
PR (+/-)
Her2 (+++)
Variable

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

A

C

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6
Q

Luminal A

a. Good prognosis, responds well with hormonal therapy
b. poor prognosis, responds well with chemotherapy
c. Poor prognosis, trastuzumab with chemotherapy
d. Associate with BRCA1
e. Associated with lymphocyte infiltration

A

A

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7
Q

Claudin Low

a. Good prognosis, responds well with hormonal therapy
b. poor prognosis, responds well with chemotherapy
c. Poor prognosis, trastuzumab with chemotherapy
d. Associate with BRCA1
e. Associated with lymphocyte infiltration

A

E

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8
Q

Basal

a. Good prognosis, responds well with hormonal therapy
b. poor prognosis, responds well with chemotherapy
c. Poor prognosis, trastuzumab with chemotherapy
d. Associate with BRCA1
e. Associated with lymphocyte infiltration

A

D

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9
Q

Her 2

a. Good prognosis, responds well with hormonal therapy
b. poor prognosis, responds well with chemotherapy
c. Poor prognosis, trastuzumab with chemotherapy
d. Associate with BRCA1
e. Associated with lymphocyte infiltration

A

C

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10
Q

Luminal B

a. Good prognosis, responds well with hormonal therapy
b. poor prognosis, responds well with chemotherapy
c. Poor prognosis, trastuzumab with chemotherapy
d. Associate with BRCA1
e. Associated with lymphocyte infiltration

A

B

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11
Q

Tumors with gene expression profile reminiscent of nonmalignant “normal” breast epithelium. Prognosis similar to luminal B group

A

Normal Breast-like

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12
Q

High grade tumors that express cytokeratins 5/6 and 17 as well as vimentin p63, CD10, alpha smooth muscle actin and EGFR

A

Basal

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13
Q

Treatment of brast cancer depends on whether patient does or does not have evidence of distant mets. Distant mets are detected via…

A

Scintigraphic or radiologic imaging

biopsy

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14
Q

For patients with no evidence of detectable distant metastases the goal of therapy is

a. cure
b. at least substantial survival prolongation
c. both
d. neither

A

C

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15
Q

The following are considered primary therapies for breast CA

a. surgery
b. radiation therapy
c. chemotherapy
d. A and B
e. A, B and C

A

D

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16
Q

ALL treatments for breast cancer are based on this/these factor/s:

a. prognostic
b. predictive
c. both
d. neither

A

C

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17
Q

factors used to determine if a given treatment is likely to work or not

A

Predictive factors

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18
Q

provide indication of how likely a cancer will recur either locally or in distant organs, in the future if a patients is not treated with the respective treatments

A

Prognostic factors

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19
Q

True about prognostic features in breast CA treatment EXCEPT:

a. Prognostic features guide what type of primary treatment should be pursued, but does not contribute in decision making regarding adjuvant systemic treatments
b. Anatomic prognostic features include visual but not physical examination findings of locally advanced breast cancer
c. Histologic tumor grade as well as ER PgR and HER2 influence treatment but are not prognostic
d. AOTA

A

D

a. it help decide on adjuvant systemic treatment
b. Anatomic prognostic features
c. Histologic tumor grade as well as ER PgR and HER2 influence treatment and are also prognostic

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20
Q

Standard treatment of choice for early-stage breast CA

A

Halsted radical mastectomy

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21
Q

procedure in which breast, chest wall muscles, and complete axillary nodal contents were removied

A

Halsted radical mastectomy

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22
Q

t/f less disfiguring modified radical mastectomy in which the chest wall muscles were preserved and only a sampling of axillary lymph nodes were removed is called modified radical mastectomy. Recurrence and survival rates were the same with modified radical mastectomy and Halsted radical mastectomy for early stage breast CA

A

T

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23
Q

T/F
Breast conserving treatments such as lumpectomy, quandrantectomy, or partial mastectomy show equal if not slightly superior results with mastectomy in early stage breast CA, especially if postlumpectomy radiation is done.

A

T

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24
Q

Patient with early stage ER (+), node (-) breast CA, chose lumpectomy. Which is more appropriate adjuvant therapy?

a. radiation
b. endocrine tx
c. chemo

A

B; their risk of in-breast recurrence is quite low with surgery and endocrine therapy

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25
Q

Contraindications to breast-conserving therapy in early stage breast CA (5)

A
  1. large tumor to breast ration
  2. inability to achieve clear margins with adequate cosmesis after extensive surgery
  3. multifocal cancers
  4. extensive 4-quadrant DCIS
  5. inability to receive radiation
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26
Q

Patients unable to receive radiation (3)

A
  1. women with dermal autoimmune disease (e.g. SLE)
  2. prior radiation to the site
  3. lack of available radiation tx facilities
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27
Q

Patient with early stage breast CA, with extensive 4-quadrant DCIS, treatment of choice?

a. radical mastectomy without radiation
b. breast conservation surgery with radiation
c. radiation therapy only
d. NOTA

A

A

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28
Q

Patient with early stage breast CA, with SLE. Treatment of choice?

a. lumpectomy + radiation
b. radical mastectomy without radiation
c. chemotherapy
d. NOTA

A

B
patients not able to receive radiation
1. women with dermal autoimmune disease (e.g. SLE)
2. prior radiation to the site
3. lack of available radiation tx facilities

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29
Q

Patients with high risk of local-regional recurrence benefit from postoperative chest wall and regional nodal radiation in terms of survival. These patients include (3)

A

Tumors >=5cm
4 or more positive axillary lymph nodes
postoperative positive margins

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30
Q

Postmastectomy radiation is not indicated in women with cancers (3)

A

T <2cm
negative lymph nodes
negative margins

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31
Q

Post mastectomy radiation is beneficial in the ff EXCEPT
a. patient with 6cm tumor with SLE
b. patient with 2cm tumor, 5 positive axillary lymph nodes
c. patient with 2cm tumor, negative lymph nodes, positive post op margins
d. patient with 5cm tumor, 4 positive axillary lymph nodes, negative post op margins
E. AOTA

A

A

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32
Q

This can be done and is currently the standard of care for women with localized breast CA and clinically negative axilla.

A

Sentinel lymph node mapping and biopsy

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33
Q

If SLNB is negative,

a. extensive axillary surgery should be done
b. extensive axillary surgery is not required

A

B

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34
Q

SLNB (+)

a. further axillary surgery should be done in all patients
b. axillary surgery is not required in all patients
c. axillary surgery is required for older women and those with ER (+) cancers
d. NOTA
e. AOTA

A

D;axillary surgery may not be required for older women and those with ER (+) cancers

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35
Q

who has worse prognosis

a. adequate surgery and radiation, but patient had recurrence
b. no recurrence
c. local-regional recurrence after mastectomy

A

C

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36
Q

True about local-regional recurrence

a. it is a negative prognositc variable
b. it is a cause of distant metastasis
c. both
d. neither

A

A; it is not a cause of distant metastasis

37
Q

True about adjuvant systemic therapies

a. almost all patients with metastatic breast CA are destined to die with, if not of their cancer
b. It is better to wait until symptomatic documented metastases to occur before treatment to spare patient from toxicity of adjuvant systemic therapies
c. both
d. neither

A

A; it is better to treat right away

38
Q

5 year survival rate for breast CA

stage 0

A

99%

39
Q

5 year survival rate for breast CA

stage I

A

92%

40
Q

5 year survival rate for breast CA

stage IIA

A

82%

41
Q

5 year survival rate for breast CA

stage IIB

A

65%

42
Q

5 year survival rate for breast CA

stage IIIA

A

47%

43
Q

5 year survival rate for breast CA

stage IIIB

A

44%

44
Q

5 year survival rate for breast CA

stage IV

A

14%

45
Q

The ff. needs imaging for distant mets

a. patient with no signs or symptoms of widespread
b. patient with T3 or less tumor
c. fewer than four involved axillary lymph nodes
d. NOTA
e. AOTA

A

D; no imaging necessary

46
Q

The ff does not need adjuvant systemic therapy

a. <1cm tumor
b. negative lymph nodes
c. both
d. neither

A

C; but still at risk for distant metastases therefore might still benefit

47
Q

3 types of adjuvant systemic therapies

A

chemotherapy
endocrine
anti-HER2 therapies

48
Q

patient with positive lymph nodes and/or T4

is adjuvant chemotherapy recommended?

A

Yes

49
Q

<1cm tumor, axillary lymph nodes negative, ER +

adjuvant therapy? if yes, what kind?

A

adjuvant endocrine therapy

50
Q

<1cm tumor, axillary lymph nodes negative, HER2+

adjuvant therapy? if yes, what kind?

A

adjuvant chemo and trastuzumab

51
Q

<1cm tumor, axillary lymph nodes negative, triple negative

adjuvant therapy? if yes, what kind?

A

adjuvant chemo to reduce risk (from 15%, reduced by 1/3)

52
Q

T2-3, node negative, ER (+)

adjuvant therapy? if yes, what kind?

A

it is unclear if this small but real benefit is sufficient to justify adjuvant chemotx

53
Q

Detection of breat cancer cells either in the circulation or bone marrow is associated with an increased relapse rate. However, finding of bone marrow micrometastases only portens a slightly worse prognosis, especially in node negative patients. For these patients, are bone marrow biopsies recommended?

A

No

54
Q

is the use of Ki67 as a proliferation marker. is this recommended?

A

NO

55
Q

The important predictive factors that should be ordered in all breast CA biopsies are

A

ER

HER2

56
Q

ER is most commonly measured by counting the percent of positive cells within the cancer after IHC staining. Endocrine therapy is recommended for any patient with what percent positive cells?

A

> =10%

57
Q

ER is most commonly measured by counting the percent of positive cells within the cancer after IHC staining. patient with 1% positive cells? is endocrine tx recommended?

A

no, 0-1% not recommended

58
Q

ER is most commonly measured by counting the percent of positive cells within the cancer after IHC staining. patient with 1-9% staining, is endocrine therapy recommended?

A

yes, but low threshold for discountinuation

59
Q

IHC staining for HER 2:

value for positive

A

3+

60
Q

IHC staining for HER 2:

value for negative

A

0-1+

61
Q

IHC staining for HER 2:

what does 2+ mean?

A

must do reflex FISH

62
Q

These chemotherapeutic agents have higher activity in patients with triple negative breast CA and in patients with HER2 positive disease

A

platin salts (carbo-, cis-)

63
Q

Duration of trastuzumab tx

A

1 year

64
Q

after trastuzumab, preliminary data support pertuzumab for how long?

A

at least 3 months

65
Q

Endocrine tx adminestered to px with ER + breast CA following completion of chemotx and administered for at least how long?

A

5 years, probably longer

66
Q

True about endocrine tx EXCEPT

a. tamoxifen reduces risk of distant recurrence and death due to invasive breast CA by 40%
b. it is more effective in premenopausal women
c. it is less effective in <40 years old
d. antagonist in breast and brain, agonist in bone, liver, and uterus

A

B. same effectivity in pre and postmenopausal

67
Q

Side effects of tamoxifen EXCEPT

a. hot flashes
b. thrombosis
c. osteopenia
d. NOTA

A

C; reduces osteopenia

68
Q

tamoxifen increases risk for which cancers?

A

liver
uterus
endometrial

69
Q

Medical ovarian ablation can be achieved by GnRH agonist such as

A

goserelin

70
Q

the following still produce small amounts of estrogen EXCEPT

a. women with non functioning ovaries by oophorectomy
b. women with non functioning ovaries by goserelin
c. menopause
d. NOTA

A

D estrigen production by adrenal synthesis of estrogen precursors (testosterone and DHEA convereted to estrone by aromatas activity in peripheral fat, and possible cancer cells)

71
Q

how to reduce circulating estrogen to nearly imperceptible levels in postmenopausal women?

A

use of oral AIs

72
Q

give 3 examples of aromatase inhibitors

A

anastrozole
letrozole
exemestane

73
Q

T/F AIs are equally effective as tamoxifen

A

F; more effective

74
Q

duration recommendation for treatment of AI in postmeopausal women with ER + breast CA with no contraindications?

A

3-5 years

75
Q

what percent of patients cannot tolerate AIs due to musculoskeletal syptoms mimicking OA and arthralgias?

A

15-20%

76
Q

postmenopausal breast CA ER + treated with AI but developed musculoskeletal syptoms mimicking OA and arthralgias. What can be done?

A

shift to tamoxifen assuming no contraindications exist

77
Q

tamoxifen contraindications, most important

A

thrombosis or high risk Cerebrovascular disease

78
Q

True of chemotherapy EXCEPT

a. multiple agent is more effective than single agent
b. sequential single-agent chemo is as effective as simultaneous combination chemotherapy
c. dose escalation above an optimal dose is more effective
d. NOTA
e. AOTA

A

C; it is not more effective

79
Q

optimal number of cycles of chemotherapy

A

4-6, above 6, too toxic

80
Q

True about neoadjuvant treatment EXCEPT

a. it involves administration of adjuvant systemic therapy before definitive surgery and radiation therapy
b. many patients will be “downstagd” by neoadjuvant chemotx
c. overall survival has not been improved using drugs given before, compared to given after surgery
d. NOTA
e. AOTA

A

D; all are true

81
Q

T/F all patients, regardless of response to neoadjuvant chemotx should receive adjuvant endocrine therapy if they have an ER + breast CA and Adjuvant anti-Her 2 if they have HER2 +

A

T

82
Q

Secondary myelodysplasia and leukemia occur in 0.5-1% of patients treated with

a. alkylating agents
b. anthracyclines
c. antimetabolites
d. taxanes

A

C

83
Q

major dose-limiting and life-changing toxicity of taxanes

A

peripheral neuropathy

84
Q

trastuzumab in HER2 positive breast CA is optimally delivered with which chemotherapeutic durg class?

A

taxanes

85
Q

trastuzumab in HER2 positive breast CA is should not be given simultaneously with which chemotherapeutic durg class?

A

anthracyclines; since main toxicity of trastuzumab is cardiac dysfunction that worsens if delivered with doxorubicin

86
Q

single agent paclitaxel plus trastuzumab is adequate regiment for patients with T1 or 2 node negative, good prognosis. T/F

A

T

87
Q

How is trastuzumab given?

A

IV weekly or every 3 weeks, for 12 months

88
Q

At present, routine use of bisphosphonates as adjuvant therapy is recommended. T/F

A

F no consensus but if patient has advancing osteopenia, or confirmed osteoporosis, tey should be treated accordingly

89
Q

Poly-ADP ribose polymerase (PARP) inhibitors are being tested for what type of breast CA patients?

A

BRCA1
BRCA2
triple negative

M3 (66 decks)

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