Breast Cancer Oncology and Palliative Care Flashcards
(38 cards)
Other than oncologists, who has the ability to diagnose cancer?
- GPs
- Surgeons (breast, plastics, urologists, hepatobiliary, ENT, orthopaedic…)
- Physicians (gastroenterologists, dermatologists, respiratory physicians, endocrinologists,…)
- Interventional radiologists
- Haematologists
- Paediatricians
Why are patients usually referred to oncology?
- This indicates the clinician thinks there is a need for radiotherapy or chemotherapy
- This treatment is carried out by the oncology team
What treatments can oncologists offer?
Radiotherapy
Chemotherapy
Hormonal therapy (oestrogen blockade)
Antibodies (e.g. trastuzumab (Herceptin))
How does treatment intent and timing change if the cancer is deemed curable or non-curable?
if curable:
- Neo-adjuvant (before main tx = surgery)
- Adjuvant (with or after => radiotherapy)
If non-curable:
=> Palliative treatment
WHat therapies are offered as neo-adjuvant?
- hormonal (e.g. ER receptor blockers)
- chemotherapy
What are the advantages and disadvantages of neoadjuvant chemotherapy?
Adv:
- more cosmetic outcome (shrinks tumour so that wide local excision could be performed instead of mastectomy)
- less extensive nodal clearance done if there is an excellent response to treatment
Disadv:
- no overall survival benefit
- no better than adjuvant treatment
- complications may cause patients previously fit for surgery to then not be suitable
- 6 extra imaging investigations
What treatment is usually used as adjuvant therapy?
Radiotherapy
- Used routinely after wide local excision
- given over 3 weeks (+ extra tx if young and positive margins)
By how much does adjuvant radiotherapy reduce risk of recurrence?
Reduces recurrence by about half
however remember relative risk indicates if patient is already at low risk then this doesn’t make much of a difference
HOw many years of Tamoxifen treatment is thought to reduce the rate of relapse?
5 years = most benefit
10 years max therapy (not as much benefit over the 2nd 5 years but still some)
What are the side effects of oestrogen receptor blockers?
- Clots (DVTs)
- Partial agonist => can stimulate endometrium
=> PV bleeding
=> polyp formation
=> endometrial cancer
What two drugs usually are combined in chemotherapy for breast cancer?
Anthracyclines (e.g. Idarubicin)
Taxanes (e.g. paclitaxel)
What side effects may occur due to chemotherapy?
Anthracyclines cause alopecia and nail changes (including nails falling off completely)
Taxanes cause mylagia aches
Other Side effects may include:
- anorexia, malaise, neutropenia, peripheral neuropathy, severe axial skeleton pain from marrow stimulation
What adjuvant therapy can be given in HER2 expressing breast cancers?
Trastuzumab (Herceptin)
- by s/c injection (sometimes IV)
- One year of 3-weekly treatment
- Improves survival by 3% absolute
What are the potential side effects of Trastuzumab (Herceptin)?
- Allergic reactions
- Reversible cardiac failure
How are patients reviewed after treatment?
- Review at end of adjuvant treatment
- Discharge from Oncology clinic
- Surgical review on anniversary of surgery
- No clinic follow up but ANNUAL mammograms for 3 years
WHat treatments against the cancer are still used even if patients are palliative?
- Systemic treatment if widespread disease (e.g. ER-blockade or chemotherapy)
- Radiotherapy for fungating breast disease or bone metastases
- Bisphosphonates for bone metastases as prevention of crush fractures
What techniques have developed when delivering radiotherapy in order to reduce the radiation dose on non-target tissues?
- electron beam (more superficial) rather than photon beam which is more penetrative
(Aim to reduce lung and heart irradiation) - breath-hold
Why is irradiation of the heart a risk?
- increased radiation delivered to heart causes ischaemic heart disease and increased risk of MI
Trastuzumab has been combined with another drug emtansine to create a combination preparation. What is the aim of this new drug?
combining chemotherapy with trastuzumab
=> Delivers chemotherapy directly to the tumour
A patient presents with new onset bone pain after being treated for breast cancer. What factors increase the likelihood that the pain is caused by bony metastases and the cancer has recurred?
If previous cancer was
- high grade
- large in size
- nodal infiltration occurred
=> cancer is more likely to have recurred and this pain should be presumed as bony metastases until proven otherwise
WHat imaging modalities can be used to investigate if bone pain after breast cancer is in fact bony metastases?
- localized CT (or MRI) of the affected bone
- Ribs = problematic in terms of diagnosis
- Bone scan only helpful if it shows shower of metastases affecting axial skeleton
Neutropenia is common in patients undergoing chemotherapy. What symptoms would indicate an urgent referral to oncology is needed?
- septic (increased HR, RR and Temp, low BP, etc)
- OR Well but with fever
=> admit to oncology urgently
What can be used to treat the hot flushes that patients experience with Tamoxifen or Aromatase Inhibitors?
- Clonidine (careful if pt suffers from depression or hypertension)
- Phyto-oestrogens best avoided (don’t want to add EXTRA oestrogens)
- Progestogens (safety unclear)
- Stop the ER-blockade?
The mirena coil is contraindicated after a diagnosis of breast cancer. TRUE/FALSE?
TRUE
- Contra-indicated by the company if breast cancer is diagnosed
