Oncology with Breast Cancer

Question 1

What is involved in the oncological rx of breast cancer ?

Answer 1

Radiotherapy
Chemotherapy
Hormone Therapy
Antibodies (Herceptin) - trastuzumab

Question 2

If the cancer can be CURED; which rx is given?

Answer 2

• Neoadjuvant

- Adjuvant

Question 3

If the cancer is NOT curable?

Answer 3

• palliative treatment is offered

Question 4

WHat is included in neoadjuvant rx?

Answer 4

1. Hormone Therapy

2. Chemotherapy

Question 5

In which conditions may hormone therapy be given?

Answer 5

• ER+ tumors
• less fit patients
• pts in whom it is not certain when surgery can be done (or LONG waiting list)

Question 6

What are the advs of neo-adjuvant chemotherapy?

Answer 6

• COSMETIC; wide local excision is enough (as opposed to mastectomy)
• — less extensive nodal clearance is done, if GOOD response to rx (in TAYSIDE)

Question 7

What are the disadv. of neoadjuvant chemotherapy?

Answer 7

• attendance for 6 extra imaging ivx (compared to adjuvant rx)

Question 8

What is the difference between adjuvant and neoadjuvant therapy?

Answer 8

• Neoadjuvant= rx done BEFORE the surgery

- Adjuvant= rx done AFTER the surgery

Question 9

What occurs in adjuvant therapy?

Answer 9

• RADIOTHERAPY
• –used routinely after wide local excision
• ER-blockade
• Chemotherapt

Question 10

What occurs during radiotherapy?

Answer 10

• external beam therapy using LINAC over 3 weeks

- boost (extra rx) may be needed

Question 11

What are the indications for BOOST rx?

Answer 11

• young age

- (+)ve margins

Question 12

How effective is radiotherapy?

Answer 12

(reduces recurrence by 1/2) —–one life saved for every 4 recurrences

Question 13

How effective and how long must one take ER blockade during Adjuvant therapy?

Answer 13

• 5 years of TAMOXIFEN
• reduces risk of RELAPSE by 15% at 10 years

—-same with Aromatase inhibitors (LETROZOLE and ANASTROZOLE)

Question 14

What drug is used for chemo adjuvant therapy?

Answer 14

• anthracycline

- Taxane

Question 15

What are the side effects of adjuvant chemo-therapy?

Answer 15

• anorexia
• malaise
• neutropenia
• alopecia
• myalgia
• peripheral neuropathy
• —-axial skeleton pain (gCSF injections)

Question 16

What adjuvant therapy is given to a patient with tumors that are HER2 +?

Answer 16

• Trastuzumab (HERCEPTIN)

- —by s/c injection (IV)

Question 17

What is trastuzumab?

Answer 17

• antibody against HER2 receptor (seen in 15%V of breast cancer)
• —given for one YEAR thrice a week

Question 18

How effective is herceptin?

Answer 18

• improves overal survival by 3% absolute

Question 19

What are the side effects of trastuzumab?

Answer 19

• allergic rxns and cardiac failure

Question 20

What occurs after adjuvant rx is complete?

Answer 20

• surgical review on anniversary of surgery
• discharge from clinic
• follow-up YEARLY mammograms (for 3 years)

Question 21

What occurs with palliative rx?

Answer 21

• systemic rx for widespread disease (ER- block/ Chemotherapy)
• radiotherapy for BONE metastases or FUNGATING breast disease
• bisphosphonates

Question 22

Name a bisphosphonate and what is its use?

Answer 22

• Oral ibandronic acid
• those with high levels of calcium (d.t bone metastasis) —-reduces calcium loss from bone (to strengthen it)
• those with BONE PAIN (from bone metastasis)

Question 23

What is done routinely?

Answer 23

CT

Question 24

What is a new development with radiotherapy?

Answer 24

IORT

- intraoperative radiotherapy

Question 25

What is trastuzumab-emtansine?

Answer 25

- new drug combining chemotherapy moiety with trastuzumab

Question 26

Main concern post therapy?

Answer 26

- metastasis to the bone ----bone pain? (confirm with CT/ MRI of affected bone) ---usually ribs Recurrence?

Question 27

What should be made aware to the patient about fever during chemo?

Answer 27

- if pt is well and NO fever, IGNORE | - if pt is SEPTIC or well WITH fever==> ADMIT to oncology

Question 28

IS mirena coil c.i in cancer survivors?

Answer 28

yes | - by the company

Question 29

How reliable are tumor markers ?

Answer 29

- OK for monitoring - poor for dx - NOT to be checked unless metastatic disease is KNOWN to be present

Question 30

What is a side effect seen with tamoxifen ? How to treat ?

Answer 30

- hot flushes - ----give CLONIDINE (to be reduced and stopped slowly) - ---progestogens work (tho maybe unsafe)

Question 31

What risk is there with the use of bisphosphonates>

Answer 31

- osteonecrosis of the jaw

Question 32

What are side effects seen with tamoxifen?

Answer 32

- vaginal bleeding - endometrial cancer risk - endometril polyps and hyperplasia -

Question 33

What alternative for tamoxifen if the pt is post-menopausal?

Answer 33

- Aromatase inhibitors

Question 34

What alternate drug is the pt is pre-menopausal?

Answer 34

- goserelin

Question 35

Greater reaction with radiotherapy occurs if the breast has ______

Answer 35

greater volume | lasts a few weeks and then heals spontaneously

Question 36

Can a lump appear after surgery?

Answer 36

- yes - UNLIKELY to be recurrence shortly after rx - ---common for fat necrosis to occur after trauma

Question 37

How may bone metastasis present as?

Answer 37

- severe back pain - radicular back - difficulty walking - ---d.t compression of spine - ----urgent MRI of spine needed