Breast cancer oncology

Question 1

What are the oncological treatment options for breast cancer

Answer 1

Radiotherapy
Chemotherapy
Hormonal therapy
Antibodies

Question 2

define neo-adjuvant

Answer 2

treatment given before surgery

usually to reduce tumour size and make surgery easier

Question 3

define adjuvant

Answer 3

treatment given alongside surgery, just after

Question 4

Radiotherapy is an option for neo-adjuvant treatment, true or false

Answer 4

FALSE

chemo and hormonal therapy are options

Question 5

what are options of adjuvant therapy

Answer 5

radiotherapy - after breast conservation therapy
hormonal therapy
chemotherapy
antibodies - trastuzumab/herceptin

Question 6

give examples of hormonal therapy

Answer 6

SERMs - tamoxifen

Aromatase inhibitors - letrozole

Question 7

what are risks of tamoxifen

Answer 7

DVT
PE
endometrial hyperplasia, polyps 
endometrial cancer 
PV bleeding

Question 8

what are risks of AIs

Answer 8

osteoporosis

Question 9

which group can AIs only be given to

Answer 9

post menopausal

Question 10

what kinds of chemo can be given

Answer 10

anthracycline + taxanes

Question 11

what injection can be given to stimulate bone marrow after depletion from chemo

Answer 11

GCSF

Question 12

what are side effects of breast chemotherapy

Answer 12

anorexia 
alopecia 
peripheral neuropathy 
myalgia 
neutropaenia 
malaise

Question 13

how is trastuzumab administered and what are its side effects

Answer 13

SC injection
cardiac failure
allergic reactions

Question 14

what monitoring is needed with herceptin

Answer 14

cardiac monitoring

Question 15

neo-adjuvant chemotherapy has survival advantage, true or false

Answer 15

false

it is used as it gives better cosmetic outcome

Question 16

after discharge from oncology what is the follow up

Answer 16

seen by surgeon after 1 year

yearly mammograms for 3 years

Question 17

list palliative treatment options

Answer 17

systemic treatment for widespread disease
radiotherapy for fungating breast disease or bone mets
bisphosphonates

Question 18

what could bone pain be a sign of

Answer 18

bone metastases

Question 19

what 3 factors can be used to estimate the likelihood of recurrence

Answer 19

tumour grade
size of tumour
number of axillary nodes involved

Question 20

if a breast cancer patient on treatment is septic or has a high fever what is it a sign of and what should be done

Answer 20

neutropaenia

ASAP admission to oncology

Question 21

what are a side effect of tamoxifen/AIs

Answer 21

hot flushes

Question 22

if someone has breast cancer and has a mirena coil, what should be done

Answer 22

breast cancer is a contraindication to mirena coil therefore it should be removed

Question 23

tumour markers are essential in diagnosing breast cancer, true or false

Answer 23

false, they are rubbish for diagnosis and alright for monitoring

Question 24

list breast cancer tumour markers

Answer 24

CEA

CA15-3

Question 25

when are tumour markers for breast cancer used

Answer 25

when there is metastatic disease

Question 26

indications for bisphosphonates

Answer 26

bone metastases | alongside aromatase inhibitors

Question 27

what should be checked/done before starting bisphosphonates

Answer 27

dental work

Question 28

in a post menopausal woman with endometrial hyperplasia (or other side effects), tamoxifen should be switched to __

Answer 28

AI eg letrozole

Question 29

in a pre menopausal woman with endometrial hyperplasia (or other side effects), tamoxifen should be switched to __

Answer 29

GnRH agonist eg goserilin

Question 30

in radiotherapy, the bigger the size of breast, the greater/lower the reaction

Answer 30

greater side effects

Question 31

management of lymphoedema in the arm

Answer 31

sleeves and skincare early on | avoid BP readings, cannulation etc of that arm!

Question 32

what is a new lump after surgery/radiotherapy likely to be

Answer 32

fat necrosis from trauma

Question 33

what could back pain be a sign of

Answer 33

malignant spinal cord compression

Question 34

signs + symptoms of spinal cord compression

Answer 34

severe back pain difficulty walking radicular pain

Question 35

management of spinal cord compression

Answer 35

urgent MRI | radiotherapy

Question 36

which group of drugs interact with tamoxifen

Answer 36

antidepressants

Question 37

which hormone receptor + type of breast cancer has the higher rate of recurrence

Answer 37

HER2 +

Question 38

in addition to the "normal" areas of metastases, where can HER2 + tumours additionally spread to

Answer 38

CNS - brain + meninges Pleura Retina

Question 39

what could be the cause of a low grade headache in a HER2+ patient

Answer 39

CNS metastases

Question 40

what could be the cause of blurry vision in a HER2+ patient

Answer 40

retinal metastases

Question 41

which type of breast cancer is often missed on imaging

Answer 41

lobular

Question 42

lobular carcinoma is easy/difficult to identify on mammogram

Answer 42

difficult

Question 43

in addition to the "normal" areas of metastases, where can lobular carcinomas additionally spread to and how can patients present

Answer 43

gut and peritoneum | subacute bowel obstruction

Question 44

how can you reduce your risk of developing breast cancer

Answer 44

healthy BMI + exercise self screening no excessive alcohol intake