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PHM703 Heme/Onc 1 > Breast Cancer > Flashcards

Breast Cancer Flashcards

(54 cards)

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1
Q

modifiable risk factors

A

nulliparity or older age at first childbirth, menopausal hormone therapy, postmenopausal obesity, physical inactivity, alcohol consumption

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2
Q

non-modifiable risk factors

A

female, old age, family history, personal history, genetics (BRCA1, BRCA2), breast changes, ionizing radiation, breast density, early menarche/late menopause

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3
Q

inflammatory breast cancer

A

-skin edema, redness, warmth, induration of tissue
-cancer cells in dermal lymphatics on biopsy
-very rapid onset
-poor prognosis

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4
Q

screening recommendations

A

-age 25-39: breast exam every 1-3 years
-age >/40: breast exam and mammogram yearly

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5
Q

clinical presentation

A

mass, breast/nipple pain, nipple discharge, skin changes, swollen lymph nodes

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6
Q

diagnosis

A

H&P, imaging, biopsy, bloodwork

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7
Q

BC subtypes

A

-hormone receptor positive: estrogen receptor (ER) or progesterone receptor (PR) positive
-HER2/neu (HER2) positive
-triple negative: ER/PR/HER2 negative

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8
Q

staging (TNM)

A

T: tumor size
N: nodal status
M: metastases to distant site (bone, liver, brain, lung)

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9
Q

early stage breast cancer (ESBC)

A

stage 0, 1, 2

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10
Q

locally advanced breast cancer

A

stage 3

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11
Q

metastatic breast cancer (MBC)

A

stage 4

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12
Q

cure

A

early stage breast caner and locally advanced breast cancer (stages 0-3)

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13
Q

palliative

A

metastatic breast cancer (stage 4)

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14
Q

treatment for non-invasive cancer

A

-lobular carcinoma in situ (LCIS): regular monitoring, no treatment
-ductal carcinoma in situ (DCIS): lumpectomy + radiation, mastectomy (+/- endocrine therapy)

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15
Q

treatment for invasive disease

A

-surgery and radiation (lumpectomy or mastectomy)
-systemic therapy (chemo, targeted therapy, endocrine therapy)

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16
Q

ER/PR+ and HER2+ treatment

A

chemo + HER2 therapy + endocrine therapy

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17
Q

ER/PR+ and HER2- treatment

A

chemo + endocrine therapy

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18
Q

ER/PR- and HER2+ treatment

A

chemo + HER2 therapy

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19
Q

ER/PR- and HER2- treatment

A

chemo

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20
Q

ER/PR+ treatment

A

endorcrine therapy +/- chemo
-premenopausal: tamoxifen
-postmenopausal: aromatase inhibitors

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21
Q

HER2+ and tumor >1cm treatment

A

chemo + HER2-targeted therapy

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22
Q

node positive + treatment

23
Q

triple negative tumor >1cm treatment

24
Q

ER/PR+, HER2-, tumor >0.5cm treatment

25
ER/PR (+/-), HER2- chemo
-doxorubicin/cyclophosphamide (AC) x4d → paclitaxel q2wks x4d -AC x4d → qwk paclitaxel x12d -docetaxel and cyclophosphamide (TC) q3wks x4-6d
26
ER/PR-, HER2- → triple negative chemo
neoadjuvant: pembrolizumab q3wks x4d + qwk paclitaxel/carboplatin x12d → pembrolizumab + doxorubicin/cyclophosphamide q3wks x4d adjuvant: pembrolizumab q3wks x9d
27
HER2+ chemo
-docetaxel/carboplatin/trastuzumab +/- pertuzumab q3wks x6d -paclitaxel + trastuzumab qwk x12d
28
pertuzumab criteria
->/ T2 or >/ N1, HER2+ tumor -high risk of recurrence
29
post chemotherapy pearl
continue trastuzumab or pertuzumab/trastuzumab to complete 1 year
30
common chemo toxicities: myelosuppression
-neutropenic fever (>100.4* with low absolute neutrophil count) medical emergency!! -granlocyte colony stimulating factor (pegfilgrastim/filgrastim)
31
common chemo toxicities: nausea/vomiting
administer prophylactic and rescue antiemetics
32
common chemo toxicities: mucositis
-inflammation of the GI mucosa that develops painful ulcerations and infections -may be unable to eat or drink
33
common chemo toxicities: hair loss
-typically occurs after the first few cycles -regrowth is expected after chemo ends
34
other common chemo toxicities
fatigue, changes in taste/loss of appetite
35
common chemo toxicities: nail/skin changes
-avoid sun exposure -use spf 30 or higher -regularly moisturize skin
36
specific chemo counseling points: taxanes (paclitaxel/docetaxel)
-neuropathy (p>d) -alopecia -hypersensitivity reactions -arthralgias/myalgias -peripheral edema (d)
37
specific chemo counseling points: doxorubicin
-cardiotoxicity (irreversible) -red secretions/urine discoloration -secondary malignancies -vesicant- extravasation
38
specific chemo counseling points: cyclophosphamide
-hemorrhagic cystitis -sterility
39
specific chemo counseling points: HER2 targeted therapy (trastuzumab/pertuzumab)
-cardiotoxicity (reversible) -diarrhea -infusion reactions
40
endocrine therapy (tamoxifen and AI)
-recommended for ER/PR+ tumors -DCIS: adjuvant -stage 1-3: adjuvant -stage 4: palliation
41
tamoxifen
-hepatic metabolism -prodrug -interacts with SSRI/SNRI
42
ovarian suppression (for premenopausal with AI)
-oophorectomy -lutenizing hormone releasing hormone (LHRH) agonists (goserelin or leuprolide)
43
endocrine therapy counseling points: tamoxifen
-menopausal symptoms -menstrual changes -uterine or endometrial cancer -VTE, stroke -avoid pregnancy
44
endocrine therapy counseling points: AI (anastrozole, letrozole, exemestane)
-menopausal symptoms -musculoskeletal symptoms -bone loss -hypercholesterolemia -cardiovascular risk
45
adjuvant therapy for triple negative
capecitabine
46
adjuvant therapy for HER2+
emtansine (neoadjuvant), neratinib (adjuvant)
47
adjuvant therapy for BRCA mutated BC
olaparib
48
adjuvant therapy for ER/PR+, HER2-
abemaciclib (high risk), ribociclib (high risk and stage 2&3)
49
adjuvant therapy for postmenopausal patients
zoledronic acid
50
endocrine therapy for MBC
-palbociclib (HR+, HER2-) --ribociclib -abemaciclib -everolimus (HR+, HER2-) -capivasertib (HR+, HER2- mutated)
51
when to begin chemo in MBC
-failure of multiple endocrine manipulations -visceral crisis -patient is symptomatic -patient decision
52
HER2+ MBC chemo
pertuzumab + trastuzumab + docetaxel or paclitaxel
53
MBC bone metastases
-bisphosphonates (zoledronic acid, pamidronate) -denosumab
54
survivorship issues
-hot flashes (gabapentin) -sexual problems (topical estrogen) -infertility -lymphedema (physical therapy) -osteoporosis -neuropathy -cardiac toxicity (lifetime dose of doxorubicin <450 mg/m^2) -secondary malignancies

PHM703 Heme/Onc 1 (5 decks)

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