Breast Cancer Flashcards
(45 cards)
What are some NON-MODIFIABLE risk factors for developing breast cancer?
Female*
Older > 50*
White
Family hx
Genetics
Breast changes found on biopsy
Radiation < 30 yo
High breast density
Late menopause/early menarche
What are some MODIFIABLE risk factors for developing breast cancer?
No pregnancies/first child at older age
Post-menopausal hormone replacement
Postmenopausal obesity
Physical inactivity
EtOH
Where do breast cancers develop within the breast?
Lobular and ductal epithelium = proliferative abnormality
Local (IN-SITU) breast cancer has not penetrated membrane, is contained
May become invasive
Which is more common, ductal or lobular breast carcinoma? Which is more likely to progress from in-situ to invasive?
Ductal is both more common and more likely to become invasive
How do invasive ductal and lobular breast carcinomas differ in presentation and locations for metastasis?
Invasive ductal carcinoma is the signature “lump” in breast, metastasis to bone, liver, lung, brain
Invasive lobular carcinoma is a general thickening of the breast, metastasis to leptomeninges, peritoneum, GI, gonads
What are special other types of breast cancer from ductal or lobular? Do they have better or worse prognoses?
Medullary
Mucinous (colloid)
Tubular
Rarer, have better prognoses
What is the presentation of INFLAMMATORY breast cancer? How does this evolve from normal breast cancer?
Signs: skin redness, edema, warmth, hardening of tissue
Cancer cells migrate to dermal lymphatics
Often rapid progression, thus poor prognosis
Who should be screened for breast cancer? (Average risk people)
All women should have “breast awareness”
Women 25-39 = clinical breast exam q1-3 years
Women ≥ 40 = clinical breast exam and mammogram every year
What is the general clinical presentation of breast cancer?
Asymptomatic, non-mobile lump, usually painless
Occasional breast or nipple pain
Rarely nipple discharge, retraction, dimpling
Advanced: redness warmth, edema
Metastatic - swollen lymph nodes, sx dependent on location of metastasis
What diagnostics should be conducted to confirm breast cancer?
History and physical exam
Bilateral mammogram
Breast ultrasound
Breast biopsy
May consider bloodwork
What FIVE factors affect predicted prognosis of breast cancer?
Tumor size
Lymph node involvement status
Tumor grade (differentiation, like Gleason score)
- Grades 1-3 from normal cell to fully abnormal looking cell
Ki67 index (measures rate of cell division)
Lymphovascular invasion
What are the THREE breast cancer biomarkers?
Hormone receptor markers:
Estrogen Receptor (+) [ER]
Progesterone Receptor (+) [PR]
Predicts how tumor will respond to hormone therapy
HR (+) tumors are slower growing and less deadly
HER2 gene
Control breast tissue growth, division, repair
If overamplified = more rapaidly growing and aggressive
Triple negative cancers (~15%)
- grow quickly but are chemo-sensitive
How is breast cancer staged?
TNM staging
+
Biomarkers *ER, PR, HER2)
Early stage = 0.1.2 [CURE]
Locally invasive = 3 [CURE]
Metastatic = 4
What is the treatment of in-situ lobular breast carcinoma?
Monitoring
What is the treatment of in-situ ductal breast carcinoma?
Lumpectomy + Radiation
Mastectomy
Hormone receptor (+)? = consider endocrine therapy
What are some surgical options for invasive breast cancers?
Lumpectomy + radiation
Mastectomy +/- radiation
& chemo/target/endocrine therapy
Why do we use chemotherapy even after mastectomy or lumpectomy?
Systemic chemo can destroy any lingering cancer cells to prevent relapse (mop up)
What are the two paths for invasive breast cancer treatment? What if they are Hormone (+)? Hormone (-)?
General Path:
1. Surgery -> adjuvant chemo -> +/- RT -> +/- endocrine
2. Neoadjuvant chemo -> surgery -> +/- RT -> +/- endocrine
HR (+):
1. ER/PR(+) AND HER2(+) = chemo + HER2 therapy + endocrine therapy
2. ER.PR(+) BUT HER2(-) = chemo + endocrine therapy
HR(-):
1. ER/PR(-) AND HER2(+) = chemo + HER2 therapy
2. ER/PR(-) AND HER2(-) [triple negative] = chemo only!
What SIZE should a breast cancer tumor be to qualify for chemotherapy?
Since chemo is toxic, limit!
>1 cm = give chemo
0.6 - 1 cm = consider chemo
≤0.5 cm = AVOID
What is the Oncotype DX tool?
Tumor biopsy tests for 26 genes, directs prognosis and relapse risk in HER2 (-) BUT ER/PR(+) cancers.
Score 0-100, higher is worse
Divide into:
Post-menopausal
<26 = endocrine therapy only, no chemo benefit
≥26 = chemo followed by endocrine therapy
Pre-menopausal Node (-)
≤15 = no chemo benefits
16-25 = chemo followed by endocrine OR ovarian suppression + endocrine
≥26 = chemo followed by endocrine therapy
Pre-menopausal Node (+) [N1 score]
<26 = chemo followed by endocrine OR ovarian suppression + endocrine
≥26 = chemo followed by endocrine therapy
What chemo do we use for ER/PR (+/-) & HER2(-) breast cancer?
Dose-dense doxorubicin/cyclophosphamide q2wk x4 doses + (paclitaxel q2wk x 4 doses OR paclitaxel qweek x 12 doses)
OR
Docetaxel/cyclophosphamide q2wk x 4-6 doses
What chemo do we use SPECIFICALLY for ER/PR (-) & HER2(-) breast cancer?
Neoadjuvant:
Pembrolizumab q3wk x 4 doses + paclitaxel/carboplatin qweek x 12 doses
Then Pembrolizumab + doxorubicin/cyclophosphamide q3wk x 4 doses
Adjuvant:
Pembrolizumab q3wk x 9 doses
What chemo do we use for HER2(+) breast cancer?
Docetaxel/carboplatin/trastuzumab +/- pertuzumab q3wk x 6 doses
OR
Paclitaxel + trasutzumab qweek x 12 doses
Only give pertuzumab if: ≥T2 or N1 with high recurrence risk
Post-chemo - continue trastuzumab OR trastuzumab/pertuzumab for 1 year
What drugs are HER2-specific and downregulate HER2 expression?
Trastuzumab, Pertuzumab
