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Reproductive - Breast > Medical Treatments for Breast Cancer > Flashcards

Medical Treatments for Breast Cancer Flashcards

1
Q

What are the 4 main medical treatment options for breast cancer?

A

Radiotherapy, chemotherapy, hormone therapy and targeted therapy

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2
Q

What are the two main points to consider before starting treatment for breast cancer?

A

Is the patient fit enough for treatment? Can the cancer be cured?

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3
Q

What is neoadjuvant therapy?

A

A treatment given in advance of the main treatment (i.e. surgery)

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4
Q

What is usually the main goal of neoadjuvant treatment?

A

To shrink the tumour before surgery

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5
Q

How long can neoadjuvant treatment be given for?

A

Months - a year

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6
Q

Which types of medical therapies can be used for neoadjuvant treatment?

A

Chemotherapy and hormone therapies

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7
Q

When is hormone therapy used as a neoadjuvant treatment?

A

In ER+ cancers, and in less fit patients/those who you are unsure if they surgery will go ahead or not

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8
Q

Why is neoadjuvant chemotherapy better than adjuvant chemotherapy?

A

They both have the same survival outcome, but neoadjuvant chemotherapy has better cosmetic outcome

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9
Q

How does neoadjuvant therapy provide a better cosmetic outcome?

A

It sometimes allows wide local incision to be done instead of mastectomy

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10
Q

In Tayside, what is different about breast surgery if the patient has an excellent response to neoadjuvant chemotherapy?

A

Less extensive axillary nodal clearance is done - lymph nodes only get sampled, not taken out

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11
Q

What is the disadvantage of neoadjuvant chemotherapy?

A

Have to attend for a lot more imaging investigations

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12
Q

Which group of people tend not to cope well with neoadjuvant chemotherapy?

A

Those with chronic co-morbid conditions

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13
Q

What is adjuvant therapy?

A

Back up therapy, given after the main treatment (i.e. surgery)

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14
Q

What is the main goal of adjuvant treatment?

A

To reduce the risk of systemic relapse

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15
Q

What are the three factors which increase the risk of future systemic relapse?

A

Nodal involvement, high grade tumour, large sized tumour

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16
Q

Which types of medical therapies can be used for adjuvant therapy?

A

Radiotherapy, chemotherapy, hormone therapy, targeted therapy

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17
Q

Which type of medical therapy is an essential component of breast conserving surgery?

A

Radiotherapy

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18
Q

When is adjuvant radiotherapy always used? What is the reason for this?

A

After WLE - reduces the risk of systemic relapse by 50%

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19
Q

What are the 3 indications for post-mastectomy radiotherapy?

A

Involvement of more than 3 lymph nodes, positive surgical margins, tumour larger than 5cm

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20
Q

How is adjuvant radiotherapy usually given?

A

By external beam radiotherapy using LINAC

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21
Q

How long is adjuvant radiotherapy usually given for?

A

5 days a week for 3 weeks

22
Q

Adjuvant radiotherapy can be given for longer to certain patient groups, this is known as ‘boost’. Who would get this?

A

Younger patients and those with positive surgical margins

23
Q

What is used to minimise the effects of radiation in radiotherapy?

A

Carefully individualised radiation therapy planning and modern equipment

24
Q

What is the major disadvantage of using radiotherapy?

A

Can result in the formation of another cancer

25
Q

Give some examples of non-invasive hormone therapy?

A

Tamoxifen, aromatase inhibitors (e.g. letrozole/anastrozole) and GnRH

26
Q

Give an example of an invasive hormone therapy?

A

Oophorectomy

27
Q

How long is Tamoxifen used for as adjuvant therapy? What is the purpose of this?

A

5 years - reduces the risk of systemic relapse by 15%

28
Q

What type of drug is Tamoxifen?

A

Oestrogen receptor antagonist

29
Q

What type of side effects can Tamoxifen cause? Give examples?

A

Oestrogeneric side effects e.g. vaginal bleeding, vaginal dryness, hot flushes

30
Q

Is there a difference in survival benefit between Tamoxifen and aromatase inhibitors?

A

No

31
Q

There are various adjuvant chemotherapy regimes, but what do they usually include?

A

Anthracycline and a taxane

32
Q

What are some general side effects of adjuvant chemotherapy?

A

Anorexia, malaise, neutropenia, alopecia

33
Q

What are some side effects of adjuvant chemotherapy specifically caused by taxanes?

A

Myalgia and peripheral neuropathy

34
Q

gCSF injections given during adjuvant chemotherapy may cause what side effect?

A

Axial skeleton pain due to marrow stimulation

35
Q

Why is adjuvant chemotherapy not given to everyone with breast cancer?

A

It is a tough treatment and should only be given to people who it is really going to benefit

36
Q

What is the main targeted treatment used in breast cancer?

A

Herceptin

37
Q

What is Herceptin?

A

Monoclonal antibody against the HER2 receptors

38
Q

How is Herceptin given?

A

SC injection

39
Q

Who has HER2 receptors? Herceptin is a particularly useful treatment in people who have what?

A

Most people will have HER2 receptors, about 15% of breast cancers will show HER2 overexpression

40
Q

How often is Herceptin given and how long for?

A

3 weekly for a year

41
Q

What are some side effects of Herceptin?

A

Allergic reactions and reversible cardiac failure

42
Q

What monitoring is required for patients taking Herceptin?

A

4 monthly scans to assess for reversible cardiac failure

43
Q

When are breast cancer patients reviewed and discharged from the oncology clinic?

A

At the end of adjuvant treatment

44
Q

When do breast cancer patients get a surgical review and are discharged from clinic follow-up?

A

A year after their surgery

45
Q

What follow-up do breast cancer patients get after adjuvant treatment has ended?

A

Yearly mammograms for 3 years and back into usual screening thereafter

46
Q

What is palliative treatment?

A

Non-curative treatment, systemic treatment for widespread disease

47
Q

Which medical therapies for breast cancer are most commonly used as palliative treatment?

A

Chemotherapy or hormonal therapy

48
Q

When would radiotherapy be used as a palliative treatment?

A

For fungating breast disease or bony metastases

49
Q

What medication is used as palliative treatment for bony metastases? What does this reduce the risk of?

A

Bisphosphonates, reduce the risk of crush and pathological fractures

50
Q

Which imaging modality is now used for image acquisition before radiotherapy?

A

CT

Reproductive - Breast (10 decks)

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