Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRCR2 > Breast > Flashcards

Breast Flashcards

1
Q

Who gets adjuvant endocrine therapy
how is it divided

A

All ER+ pts, regardless of HER2 status and stage, after adj ChT. improves OS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Indications for adjuvant bisphosphonates in breast cancer

A

Post-MP women with node positive early breast cancer
Post-MP women receiving neo-adjuvant or adjuvant chemotherapy
Pre-MP pts receiving OFS

For up to 5yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Duration of endocrine treatment in post-MP pts

A

High risk (Gr3, Node positive, T3 or ER-) - 10yrs
Med/low risk - 5yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indications for breast conserving surgery (WLE)
And what is the acceptable margin

A

T2 disease or less (<5cm tumour)
Operable multifocal disease in single quadrant

Acceptable margin - 1mm (2mm for DCIS) -> re-excision or mastectomy (or consider RT + boost)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Indications for mastectomy

A

Pt related: Patient choice, Pregnancy

RT CI: scleroderma, pre-existing cardiac/lung disease, reduced shoulder movement
Or previous RT to breast

Site: Multifocal, Central tumour

Tumour: > 5cm, Inflammatory breast cancer, Extensive DCIS

Prophylactic in BRCA carrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Indications for post-operative RT
What is the benefit of post-op breast RT?
What is the dose

A

All breast conserving surgery

N+ pts: Decrease in local recurrence risk 21%; 15yr risk of death reduced by 8%
N- pts: Decrease in local recurrence risk 15%; 15yr risk of death reduced by 3%

26Gy/5# (can consider 28.5Gy/5# over 5wks if frail / co-morbid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When can post-op whole breast RT be avoided?

A

> 70yrs, T1N0 (stage 1A), ER+/PR+, Gr1-2 and pt will take endocrine therapy for 5yrs and have mammograms for 10yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indications for tumour bed boost RT
Dose
Benefit

A

Positive margins and further resection not possible
<50yrs
High risk - G3, DCIS, TNBC

Dose: SIB - 48Gy/15# with 40Gy/15 to whole breast
Or sequential boost of 13.35Gy/5# or 16Gy/8# following 26Gy/5#

Reduction in risk of local recurrence by 4%. no benefit on OS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Indications for chest wall RT after mastectomy
Dose
Benefit

A

Absolute indications: T3, ≥4 LNs (N2), positive margin (<1mm) or skin involvement
Relative indications: High risk T2 or 1-3 LNs only - Gr3 or LVSI; multifocal with largest tumour >2cm (T2)

26Gy/5#

Reduces local recurrence by 20% in high risk groups
8% survival benefit at 10yrs
No benefit for node negative pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the indication for olaparib in breast cancer adjuvant setting

A

Adjuvant monotherapy or ER+ HER2- or triple negative breast cancer, treated with NACT or adjuvant chemotherapy, in those with BRCA1/2 mutations and PS 0-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the indication for abemeciclib in breast cancer adjuvant setting
Benefit

A

Adjuvant treatment of hormone receptor positive, HER-2 negative, node-positive breast cancer at high risk of recurrence, defined as either:
>4 pALN (positive Axillary Lymph Nodes), or
1-3 pALN and one of: tumour size ≥5cm (T3) or grade 3

6% increase in invasive disease free survival at 4yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of DCIS

A

WLE +/- RT (If Van Nuys prognostic index score 7-9)

Adjuvant whole breast RT - 26Gy/5#

Mastectomy & SLNB
Indication: disease in ≥2 quadrants, or if clear margins can’t be obtained with WLE
Total mastectomy with clear margins in DCIS is curative

Endocrine therapy
Offer Tamoxifen to pts who have WLE and decline adjuvant RT
Consider Tamoxifen for patients having WLE alone (i.e. RT not recommended)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the follow up after DCIS

A

annual mammogram for 5yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is SCF RT indicated in breast cancer

A

N2-N3 disease (>4 axillary LNs)
N1 (1-3 axillary nodes), and G3 / LVI+ / T3 disease, age <50, TNBC
≥ypN1 following NACT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is internal mammary nodal RT indicated

A

High risk of recurrence: T4 disease, ≥4 axillary LN (N2-3)
Intermediate risk of recurrence: 1-3 axillary nodes & INNER/CENTRAL quadrant tumour, who have been recommended locoregional RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the indications for Neo-adjuvant chemotherapy?

A

HER2+ and ≥T2 (≥2cm) or node positive
T3-4 disease
Node positive disease
Triple negative breast cancer
Inflammatory breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What Neo-adjuvant regime is given to HER2+ breast cancer ≥T2 or node positive

A

Acc EC x3 followed by docetaxel x4
Or carboplatin/docetaxel x6
With Phesgo (trastuzumab/pertuzumab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is TDM-1 (Kadcyla) indicated
Based on what trial

A

For residual disease, up to 14 cycles, after NACT and HER2-directed treatment and surgery/RT, in HER2+ early breast cancer
Based on Katherine trial - decreased risk of death and 10% improvement in invasive disease free survival

19
Q

When is neratinib indicated

A

For the extended adjuvant treatment of HR+/HER2+ EBC in those who completed adjuvant trastuzumab monotherapy less than one year previously
AND did not receive NACT
OR still had residual invasive disease in the breast or axilla following NA-treatment

Given orally for one year

20
Q

When can a shorter duration of trastuzumab be considered and based on what trial

A

HER2+ EBC, post NACT with pCR
6mth can be considered instead of 12mths for T1-2 disease with no aggressive characteristics
Based on Persephone trial

21
Q

What is the benefit of trastuzumab and based on what trial

A

Hera trial
1yr trastuzumab reduces risk of recurrence by 50% vs observation
8% absolute survival benefit

22
Q

When is Phesgo (trastuzumab/pertuzumab indicated)

A

With neoadjuvant ChT for HER2+ EBC, continued for 6-12mths adjuvantly if initially node positive disease
6mth can be considered instead of 12mths for T1-2 disease with no aggressive characteristics

Given adjuvantly for those found to be node positive (pN+) but who did not receive NACT

Metastatic setting - given until progression?

23
Q

BRCA1
Chr & Inheritance
What cancers are increased in risk and by how much

A

Chr 17 - AD inheritance
Lifetime risk of breast cancer 45-60%, typically TNBC
Ovarian cancer 15%

24
Q

BRCA2
Chr & Inheritance
What cancers are increased in risk and by how much

A

Chr 13 - AD inheritance
Breast cancer lifetime risk 55-85%, usually ER+
Ovarian cancer risk 60%

25
Q

What is the risk of contralateral breast cancer with BRCA mut?
What is the monitoring

A

60% (vs 7% in general population).
Annual MRI from age 30yrs

26
Q

Breast cancer screening criteria
and what is the outcome

A

Between 50-70yrs - every 3yrs
Can request if >70yrs, but not routinely invited
10% are recalled, 1% require biopsy and 0.5% have cancer

27
Q

What is the screening for those with a BRCA mutation

A

Annual MRI age 30-39
Annual mammogram age 40-69
As per population screening >70yrs

28
Q

What is the screening for those with a TP53 mutation

A

Annual MRI age 20-49
Consider MRI age 50-69

29
Q

When is a staging CT abdo/pelvis indicated for breast cancer

A

Any positive nodes
Tumour >5cm (T3)
Aggressive biology
Suspicion of mets

30
Q

What are the axillary lymph nodes

A

Level 1: Lateral to pec minor
Level 2: Deep to pec minor
Level 3: Superior or medial to pec minor

31
Q

What is the CTV for chest wall RT

A

CTV - skin flaps and scar, extending to deep fascia posteriorly, and excluding muscle and rib cage

32
Q

What is the CTV for a tumour bed boost
CTV-PTV margin

A

CTV - clips and tumour bed
PTV margin = CTV +5-10mm

33
Q

What is the dose constraint for breast RT - ipsilateral lung

A

V30Gy <17%
V18Gy <15% for two fields & <30% for 3 fields

34
Q

What is the dose constraint for breast RT - heart

A

V13Gy <10%
V25Gy <5%
Mean dose ≤2Gy

35
Q

What is the dose constraint for breast RT - brachial plexus

A

Max dose <40Gy (as 2.67Gy/#)

36
Q

What is the dose constraint for breast RT - spinal cord

A

Max dose <37Gy (as 2.67Gy/#)

37
Q

What techniques exist to minimise cardiac dose / toxicity

A

DIBH
MLC cardiac shielding
Wide tangent technique

38
Q

What test must be sent in metastatic TNBC, and why

A

PDL1
If >1% - give abraxane and atezolizumab (de novo metastatic disease only)
or Pembrolizumab-ChT if CPS >10
ChT - nab-paclitaxel, paclitaxel, gemcitabine or carbo/gem, if de-novo mBC or progression after >6mths of adjuvant tx

39
Q

What is given in metastatic TNBC for gBRCA-mut

A

PARP inhibitor - tcatinib or olaparib

40
Q

What would a skin biopsy show for inflammatory breast cancer

A

Dermal lymphatic invasion

41
Q

Where do phylloides tumours typically metastasise to
How are they typically treated

A

Lungs
Referral to sarcoma unit
WLE with wide margins, or mastectomy (preferred)
No need for ALND (don’t spread to LNs)

42
Q

What are the molecular subtypes of breast cancer

A

Luminal A - ER+, HER2-
Luminal B - two types
ER+/HER2- and PR- or KI67 high
ER+/HER2+
Non-luminal HER2+ - ER-/HER2+
Triple negative (ER-/PR-/HER2-)

43
Q
A

FRCR2 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions