Common Breast Cancer Problems Flashcards
BONE PAIN AFTER BREAST CANCER
If a person has a history of breast cancer and presents with bone pain, it is what until proven otherwise?
If a bone scan is + for an area of bone pain, what investigation is needed to confirm the diagnosis?
What area of the body is especially problematic when dealing with bony pain and why?
Bony metastases
CT scan
Ribs - people with osteoporosis of the rib will have a positive bone scan, giving false positive results
What are the three factors that increase the likelihood of a breast cancer recurring?
Nodal involvement
Large sized tumour
High grade
BISPHOSPHONATES
When are bisphosphonates used?
If there is a lack of oral tolerance, how can these be given?
What is the risk with this treatment?
Use in metastatic disease in high doses, and if the patient is taking aromatase inhibitors and has an abnormal DEXA scan (i.e. osteopenia or worse)
IV
Jaw osteonecrosis
BACK PAIN WITH BONE METS
There is a major risk of what?
What are some factors you should look out for that could signal this risk?
What investigation should be used to assess for the risk?
Spinal cord compression
Severe back pain, radicular back pain, non-specific walking difficulty
MRI
NEUTROPENIA DURING CHEMOTHERAPY
If the person is asymptomatic, what is the management?
What may be some symptoms?
If the person is symptomatic, what is the management?
Nothing
Fever, sepsis
Send them back to oncology
TAMOXIFEN AND THE ENDOMETRIUM
What problems may taking tamoxifen cause in the endometrium?
Hyperplasia
Polyps
Carcinoma
HOT FLUSHES WHEN TAKING AI’S OR TAMOXIFEN
If affecting QoL very badly, what is the management?
What is a pharmacological management option?
Who should this drug be avoided in?
What other thing is best avoided?
Stop taking the drugs
Clonidine 50-75mg bd
People with depression or hypertension
Plant oestrogens
VAGINAL DRYNESS WITH ER BLOCKAGE
What is the first thing to consider?
When can this be used?
When should it not be used?
Can vagifem be used?
If the patient is on Tamoxifen
If the patient is on an AI and has a high risk cancer
ANTI-DEPRESSANTS AND TAMOXIFEN
Which anti-depressant should be avoided?
What may be the case if someone has brittle depression?
Paroxetine
The risk of change of anti-depressant may be greater than any effect on tamoxifen
MIRENA COIL
This is contra-indicated when?
If someone has what type of cancer, this shouldn’t be aproblem?
Breast cancer has been diagnosed
ER receptor negative
TUMOUR MARKERS
What are some tumour markers for breast cancer?
What are these good/poor for?
Don’t check them unless for what two reasons?
CEA, CA15-3
Good for monitoring, poor for diagnosis
Unless metastatic disease is present or it is going to change the treatment
RADIOTHERAPY PROBLEMS
When does a skin reaction tend to appear?
How long does a skin reaction tend to last?
Towards the end of treatment or once treatment has stopped
Lasts a few weeks and then spontaneously heals
NEW LUMP
What are the chances of local recurrence during or shortly after treatment?
What is a cause of a firm, localised lump that can be caused by treatment?
Unlikely, unless the cancer has been extremely aggressive
Fat necrosis
HER2+ TUMOURS
What is the risk of recurrence of these compared to HER2- tumours?
These have a similar distribution of mets to other breast cancers but have a preferential pattern of mets to where?
If this group presents with headaches what should you do?
If this group presents with blurred vision what should you consider?
Higher
CNS and pleura
Get a head scan
Consider retinal mets
LOBULAR CANCER
Has a similar distribution of mets but preferentially to where?
These mets can often present how?
What is the relationship between these cancers and mammography?
Peritoneum and gut
Subacute bowel obstruction
More difficult to see on mammography
