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PHAM02 > breast cancer JH > Flashcards

breast cancer JH Flashcards

1
Q

genetics and breast cancer

A

FHx strongest RF

first degree relative 2-3x higher risk

BRCA1 and BRCA2 major risk genes associated with BC

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2
Q

personal Hx RF of BC

A

age
previous BC
high breast density
previous exposure to radiation (chest)
inc exposure to oestrogen
- early menarche, late menopause
- combined oral contraceptives/HRT
- nulliparous
- never breast fed
higher social/economic status
white ethnicity

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3
Q

lifestyle RF with BC

A

lower incidence in those who exercise regularly

higher incidence in obese patients

inc risk when acohol consumed regularly (even small quantities)

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4
Q

screening for BC

A

mammogram

x-ray of the breast tissue to detect presence of cancer that is too small to see/feel

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5
Q

How is diagnosis of BC made?

A

self examination or screening

usually facilitated using TRIPLE ASSESSMENT:

  • clinical exam (characteristics of the lump, size/texture/moves)
  • breast imaging (mammogram, ultrasound, to diff between solid/fluid filled lump)
  • pathological evaluation (biopsy, assessment of tissue from lump)
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6
Q

What is first line Tx?

A

surgery

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7
Q

aim of surgery as first line Tx

A

remove the primary breast tumour, sent to lab for assessment

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8
Q

4 types of surgery for BC

A
  1. wide local excision
  2. radical mastectomy surgery
  3. conventional mastectomy surgery
  4. axillary surgery
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9
Q

What is wide local excision?

A

breast conserving surgery/lumpectomy

tumuor removed with small margin (1cm) of uninvolved surrounding tissue

better cosmetic outcome

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10
Q

patients not suitable for wide local excision

A

proir radiotherapy

widespread disease

tumour >5cm

persistent pathological margin

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11
Q

What is radical mastectomy surgery?

A

removal of breast, pectoralis major and minor muscles and axillary contents

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12
Q

What is conventional mastectomy surgery?

A

removal of breast including skin and nipple

pectoral muscle maintained unless evidence of tumour invasion

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13
Q

What is axillary surgery?

A

used to get lymph nodes for pathological examination required for all bc cases
- sentinel lymph node biopsy
- axillary lymph node dissection
- axillary lymph node clearance

axilla frequent site of lymph node metastases

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14
Q

What is lymphoedema?

A

build up of lymphatic fluid in lymph nodes

caused by surgery/radiotherapy

they cut off some of the lymph nodes

lymph fluid normally flows along lymph vessels and drains through lymph nodes

arm can become stiff, uncomfortable, tight

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15
Q

Tx for lymphoedema

A

compression tockings

massage

exercises

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16
Q

consideration for patient with lymphoedema

A

take blood/BP/injections in other arm

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17
Q

When can radiotherapy be used?

A

after surgery for early bc

combined with systemic therapy and surgery for locally advanced cancer

combined with systemic therapy for Tx of metastatic disease

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18
Q

What patients should receive radiotherapy?

A

all patients who have undergone bresat conserving surgery

  • LT survival equivalent to mastectomy
19
Q

Should radiotherapy be given after axillary surgery?

A

not recommended

30-40% risk of significant lymphoedema

20
Q

adverse effects of radiotherapy

A

EARLY
- skin Tx areas become more sensitive, red, swollen
- fatigue
- hair loss

LATE
- breast changes (smaller, harder, skin changes)
- bone damage (ribs, collar bone)
- cardiac, respiatoty toxicity (less comon now, more targeted)

21
Q

adjuvant chemotherapy

A

started within 31 days of surgery or earliest clinically appropriate date

22
Q

considerations for adjuvant chemotherapy

A

nodal involvement

oestrogen R status

HER2 status

23
Q

When is neo-adjuvant chemotherapy considered?

A

for locally advanced disease and tumours where down staging may facilitate breast conserving surgery

24
Q

What to determine before neo-adjuvant chemotherapy?

A

ER, PR, HER2 status

25
Q

oestrogen receptor in breast cancer

A

oestrogen only effects cells with oestrongen receptors

oestrogen main effect in some tissues is to cause cells to grow/divide

ER overexpressed in up to 70% of BC

26
Q

Tx for oestrogen R overexpression in BC

A

Tamoxifen

aromatase inhibitors

27
Q

s/e of hormonal therapy

A
  1. bone loss - monitor bone density, BP if required
  2. menopausal Sx - hot flushes/sweats, abnormal vaginal bleeding, dec libido, vaginal dryness, mood changes
  3. inc risk of venothromboembolism (Tamoxifen)
28
Q

What does HER2 stand for?

A

human epidermal growth factor receptor 2

29
Q

What type of R is HER2?

A

tyrosine kinase receptor

30
Q

HER2 in BC

A

overexpressed in 20-30% of BC

HER2 overexpression/amplification associated with
- accelerated cell growth and proliferation
- increased risk of disease recurrence
- shortened overall patient survival

31
Q

Herceptin

A

MAB that blocks HER2 R

32
Q

Herceptin (Trastuzumab)

A

MAB that blocks HER2 R

33
Q

adverse effetcs of herceptin

A

neutropenia
amaenia
thrombocytopenia
hypersensitivity rxn
CVD

34
Q

What does Tx for metastatic disease depend on?

A

R status
previous Tx
performance status
patient choice

35
Q

What does Tx for metastatic disease depend on?

A

R status
previous Tx
performance status
patient choice

36
Q

1st line Tx for hormone receptor positive (E+ve) patients for metastatic disease

A

endocrine therapy 1st line

  • premenopause: tamoxifen + ovarian ablation
  • postmenopause: aromatase inhibitor
37
Q

1st line Tx for HER2 positive patients for metastatic disease

A

chemotherapy

38
Q

most common sites for metastases in BC and Tx

A

bone
- ribs
- spine
- pelvis
- arms
- legs
liver
lungs

Tx = bisphosphoantes (zoledronic acid) or denosumab

39
Q

problems metastatic disease can cause

A

pain
impaired mobility
pathological #
hyperglycaemia

40
Q

Tx for brain metastases

A

surgery
whole brain radiotherapy
palliative care + steroids to reduce swelling

41
Q

Tx for liver/lung metastases

A

systemic therapy
surgery
radiotherapy

42
Q

What is ulcerating/fungating disease?

A

grows in shape of fungus
rare
devleops in untreated cancer
cancer grows upwards and breaks through skin
- painful, itchy, affects movement
wound mamagement/ABX

43
Q

strongest RF for BC

A

FHx

PHAM02 (32 decks)

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