Breast Cancer: Basic Science and Clinical Management

Question 1

What is the most common malignancy in women in the United States AND the second leading cause of cancer deaths after lung cancer

Answer 1

Breast

Question 2

What hormone causes worsening breast cancer

Answer 2

Estrogen

Question 3

What is the peak age for incidence in breast cancer

Answer 3

60-70

Question 4

What are estrogen-related risks that increase likelihood of breast cancer

Answer 4

early menarche (age 9), nulliparity (never given birth), late menopause

Question 5

What are estrogen-related risks that decrease likelihood of breast cancer

Answer 5

late menarche, pregnancy before age 25, bilateral oophorectomy, early menopause

Question 6

What are modifiable breast cancer risk factors

Answer 6

Diet/obseity,, alcohol consumption, physical activity, exogenous estrogen exposure

Question 7

What are the non-modifiable breast cancer risk factors

Answer 7

Age, gender, family history, genetic factors, endogenous hormones

Question 8

What are the gene most associated with breast and ovarian cancers, what ways would mutations be handled if discovered early

Answer 8

BRACA1 and BRCA2/ proplylactic mastectomy or oophorectomy, chemoprevention with tamoxifen or raloxifene

Question 9

What does BRCA do

Answer 9

Repair DNA damage

Question 10

What are the screening recomendations for clinical breast exam, mammogram, MRI, Breast awareness

Answer 10

Every 1-3 years (25-39) or every year once 40 and older, annually at age 40 and older, women with greater than 20% lifetime risk or BRCA mutations, age25 and older

Question 11

What is the gold standard for breast cancer detection

Answer 11

MMMOGRm

Question 12

What is the most common breast cancer

Answer 12

Invasive ductal carcinoma

Question 13

T/F: If there are a large number of lymph nodes involved there is an increase in risk of recurrence

Answer 13

True

Question 14

What marker is used to predict the tumor cell proliferation

Answer 14

Ki-67

Question 15

What hormone receptors are important for knowing response to breast cancer in patient

Answer 15

estrogen and progesterone receptors

Question 16

What gene is overexpressed 25-35% of the time and may mark how aggressive the tumor is

Answer 16

HER2

Question 17

What is TNM classification

Answer 17

T: tumor size
N: Nodal status
M: Distant metastasis

Question 18

What is the staging classificaion of breast tumor

Answer 18

Stage 1: Tumor confined to the breast
Stage 2:Tumor has spread to movable ipsilateral axillary nodes
Stage 3: Tumor has spread to the superficial structures of the chest wall
Stage 4: Metastasis

Question 19

What are other considerations needed for breast cancer characteristics

Answer 19

Tumor grade: a measurement of how much the cancer cells look like normal cells
Estrogen and progesterone receptor status
HER2 status
Oncotype DX score

Question 20

T/F: All stages of breast cancer have a cure

Answer 20

False: Stage 1 and stage 2 is highly curable while stage 3 does have a cure but STAGE 4 IS NOT CURABLE

Question 21

What part of the estrogen receptor plays a large part in whether a ligand binds, what happens when a ligand binds

Answer 21

Helix 12, alpha helix snaps shut trapping the ligand in place while attracting co activators to aid in transcription

Question 22

What are actions of the coactivators

Answer 22

Binds to the LBD of the receptor when agonsits are bound, histone acetyltrasnferase activity, recruit ubiquittous coactivator for several transcription factors

Question 23

What do corepressors do, how are they recurited

Answer 23

Histone deacetylase activity, antiestrogen binds to prevent transcriptional activation

Question 24

T/F: Estrogen receptor Alpha deals with breast cancer

Answer 24

True

Question 25

What are the other ways estrogen receptor can signal

Answer 25

Indirect tethering to other transcription factors. membrane-initiatied or non-genomic signaling (phosphorylation cascades), ligand-independent (initiated through growth factor receptor)

Question 26

What are the three types of endocrine therapy that target estrogen or the receptor

Answer 26

SERM: blocks the ER in the breast and prevents signaling, SERD: removes the ER by degredation, Aromatase inhibitors: blocks the synthesis of estrogen

Question 27

What the SERM used in breast cancer, how

Answer 27

Tamoxifen: all stages but principally used to treat premenopausal patients Raloxifene: breast cancer prevention Tormifene: treatment of metastatic breast cancer

Question 28

T/F: All of the SERMs have different efficacy

Answer 28

False: Toremifene and Raloxifene do not have improved efficacy over tamoxifen

Question 29

What are the adverse effects of tamoxifen

Answer 29

Hot flahses, increased bone density, endometriosis (endometrial cancer)

Question 30

What are the aromatase inhibitors, when are they used

Answer 30

Arimidex, femara, aromasin/ for women who have gone through menopause

Question 31

What do aromatase inhibitors do

Answer 31

Block convervsion of testosterone to estrogen through inhibition of aromatase

Question 32

What is the mutation that is associated with aromaste inhibitor therapy, what happens

Answer 32

ESR1, result in decreased sensitivity to ER antagonists including tamoxifen and fulvestrant abd stimulation of the receptor when no estrogen is present

Question 33

What is the on SERD approved

Answer 33

Fulvesterant