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Breast RIA > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

Drug of choice for ER nuclear positive invasive ductal carcinoma?

A

anti oestrogen therapy: tamoxifen

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2
Q

Drug of choice for widespread HER2 positivity in an invasive ductal carcinoma

A

monoclonal anti-HER2 therapy: trastuzumab (Herceptin)

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3
Q

monoclonal anti-HER2 therapy

A

Trastuzumam (Herceptin)

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4
Q

anti oestrogen therapy

A

Tamoxifen

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5
Q

link between oestrogen + breast ca

A

increased exposure to oestrogen puts you at an increased risk of breast cancer

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6
Q

factors resulting in an increased level of oestrogen

A
  • early menarche
  • late menopause
  • nulliparity
  • older age @ first birth
  • use of COCP
  • HRT
  • no breastfeeding
  • reproductive organ surgery
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7
Q

risk of breast Ca by 70 years in women with BRCA 1 or 2

A

45-65%

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8
Q

risk factors for breast cancer (8)

A
  • high oestrogen exposure
  • family history
  • radiotherapy
  • alcohol
  • smoking
  • low physical activity
  • age
  • dense breasts
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9
Q

where do 50% cancers occur?

A

upper outer quadrant of breast

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10
Q

1st + 2nd most common breast cancer?

A

1) invasive ductal carcinoma

2) invasive lobular carcinoma

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11
Q

85% cancers are?

A

INVASIVE DUCTAL CARCINOMA

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12
Q

what percentage of cancers are invasive lobular carcinomas?

A

10-15%

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13
Q

why are invasive lobular carcinomas difficult to detect?

A

cells infiltrate surrounding tissues in a single file pattern therefore the clinical presentation is a thickening rather than a discrete lump

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14
Q

imaging requested prior to surgery for invasive lobular carcinoma

A

MRI

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15
Q

3 factors to consider following pathological assessment of biopsies?

A

1) differentiation (aggressive potential of the cancer)
2) pleomorphism: how abnormal the tumour cells look
3) mitotic activity (how much the tumour cells are dividing)

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16
Q

what hormones can stimulate the growth of breast cancer cells

A

oestrogen + progesterone

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17
Q

what does ER +ve indicate?

A

presence of oestrogen receptors within the cancer

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18
Q

PR + ve means…

A

presence of progesterone receptors

19
Q

HER2 is =

A

Human epidermal growth factor receptor 2

20
Q

HER2 + ve means….

A

cancer cells have a higher than normal level of this protein on their surface… which stimulates them to grow

21
Q

decision making aid used to estimate breast cancer survival

A

PREDICT

22
Q

what does PREDICT take into account?

A
  • age
  • mode of detection
  • tumour size + grade
  • no. positive nodes
  • ER + HER2 status
  • chemo regimen
23
Q

3 indications for mastectomy

A

1) Local focality: 2 or more breast cancers in the same breast
2) local recurrence
3) DCIS or Invasion > 4cm

24
Q

different types of breast reconstruction offered?

A

1) delayed reconstruction using an implant
2) delayed recon - using flap of muscular tissue e.g. lat dorsi
3) immediate recon: implant, flap from muscle or abdomen
4) nipple: tattoo/reconstruction

25
Q

side effects of tamoxifen (4)

A
  • Cataracts
  • DVT
  • Endometrial thickening
  • menopausal symptoms
26
Q

menopausal symptoms

A
  • hot flushes
  • vaginal dryness
  • nausea
  • low libido
27
Q

name the targeted drug therapy for HER2 positive breast cancer

A

monoclonal antibody: Trastuzumab/Herceptin

28
Q

how does Trastuzumab/herceptin work ?

A

Monoclonal antibody that binds to the HER2 protein –> preventing stimulation of cancer cells –> stopping the cells dividing + growing

29
Q

when is Herceptin given?

A

before or after chemotherapy treatment

30
Q

delivery of Herceptin?

A
  • IV infusion
  • subcutaneous injection

3 weekly or weekly
1) if used to treat

31
Q

frequency and duration of Herceptin treatment?

A

3 weekly or some have weekly

a) if using to treat primary breast cancer after surgery = 18 cycles (1 year duration)
b) if having before surgery = 4 to 6 cycles

32
Q

common side effects of herceptin?

A
  • nausea
  • diarrhoea
  • soreness at injection site
  • flu like symptoms
33
Q

less common side effects of Herceptin

A
  • allergic reaction
  • risk of infection (through lowering WCC)
  • heart
34
Q

signs of allergic reaction

A
  • feeling hot
  • itching
  • shivering
  • skin rash
  • facial oedema
35
Q

how does Tamoxifen work

A

hormonal therapy that blocks oestrogen binding to the oestrogen receptors of the cancer therefore reducing the stimulation of the cancer to grow by oestrogen stimulation

36
Q

delivery of tamoxifen

A

tablets or syrup

37
Q

common side effects of tamoxifen

A

menopausal symptoms -

38
Q

advice for menopausal symptoms

A
  • wear clothes made of natural fabrics: cotton
  • dress inlayers that can be easily removed
  • cotton bed sheets
  • room temperature cool/use fan
  • cold drinks
  • avoid caffeine
39
Q

treatment for vaginal effects from tamoxifen

A
  • effects = discharge, bleeding, itching, dryness

- hormonal creams, gels, lubricants

40
Q

components of tamoxifen which may affect your lifestyle

A
  • alcohol
  • some sugars
  • lactose
41
Q

what should be ruled out in a patient with non lactational breast abscess, and mastitis

A

inflammatory breast cancer

42
Q

pathophysiology of inflammatory breast cancer

A

when cancer cells block the lymphatic drainage –> inflamed appearance of breast

43
Q

symptoms of inflammatory breast cancer

A
  • orange peel skin
  • nipple discharge
  • raised marks on skin of breast
  • tender
  • warmth
  • erythematous
44
Q

treatment

A

rapidly due to rapid progression of type of cancer

combination therapy

Breast RIA (8 decks)

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