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Cancer CE & VP > VP L1 Breast cancer > Flashcards

VP L1 Breast cancer Flashcards

(65 cards)

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1
Q

5 main methods of treating cancer

A 
Surgery
Radiotherapy
Hormonal therapies
Chemotherapy
Monoclonal antibodies
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2
Q

Risk factors for developing breast cancer (10)

A

Age
Age of menarche & menopause
Age at first full term pregnancy

Lactiation
Oral contraceptives

Weight
Diet
Alcohol

Geographical location
Radiation

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3
Q

Presenting BC (breast cancer) symptoms: (4)

A

lump
pain
nipple discharge
symptoms from metastisis

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4
Q

Examination of suspected breast cancer might show (2)

A

skin dimpling

swollen lymphnodes

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5
Q

3 investigations to confirm BC?

A

Mammography
Ultrasound
Fine needle aspiration/biopsy

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6
Q

What are the limitations of mammogrphy

A

doesnt show all breast cancers (only 90%)

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7
Q

What is the purpose of ultrasound of breast?

A

To see if lump is cancerous or cystic

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8
Q

At what age are benefits shown from BC screening?

A

50

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9
Q

How often are people screened?

A

3 years - experts say not enough but cost!

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10
Q

What is non-invasive BC?

A

Confined to ducts and lobules

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11
Q

What is invasive BC?

A

Spread to basement membrane and surrounding breast tissue (this is not the same as metastasis)

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12
Q

How is breast cancer staged?

A

Using TNM system - that looks at size/ ulceration of skin/ fixation to chest wall

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13
Q

How is breast cancer staged?

A

TNM rating
Tumour status (size)
Lymph node status
Metastases

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14
Q

3 main stages of breast cancer

A

Early (

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15
Q

3 main stages of breast cancer

A

Early (

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16
Q

Adverse prognostic factors in BC (6)

A
  • high TNM stage
  • poorly differentiated tumours
  • lymph/vascular invasion
  • ER or PR -ve
  • HER2 +ve
  • young at diagnosis
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17
Q

Why measure ER (oestrogen receptor) conc?

A

Predicts response to hormonal therapy

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18
Q

e.g of hormonal therapy (4)

A

tamoxifen
anaztrazole
letrozole
exemestane

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19
Q

ER and (progesterone receptor) PR +ve cancers give better or worse prognosis?

A

better

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20
Q

What is the action of oestrogen binding to the ER?

A

Bound receptor sends signals to stimulate cell division adn growth

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21
Q

e.g. of new agent

A

Everolimus

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22
Q

2 main surgery types

A

masectomy

breast conserving surgery (lumpectomy)

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23
Q

What might also be given post surgery?

A

adjuvant therapy - radio, chemo, hormonal, trastuzamab

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24
Q

Who is given radiotherapy?

A

All surgery patients at high right of recurrance (tumour >5cm, 4 positive lymph nodes)

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25
How often is radio administered?
5 days a week for 3-5 weeks
26
Who are hormonal therapies given to?
All women with ER/PR positive tumours
27
When is hormonal therapy given
5 days after surgery or to shrink tumours before surgery
28
How does hormonal therapy work?
Sensitive cells need oestrogen to stay alive so removing oestrogen is effective at controlling/killing
29
What is tamoxifen
a oestrogen antagonist
30
Side effects of tamoxifen
hot flush weight gain sweats increased risk of endometrial cancer
31
How does tamoxifen work?
binds to ER in the cell | ER can no longer bind co factors needed for gene transcription
32
What is letrozole
aromatase inhibitor
33
What is anastrazole
aromatase inhibitor
34
What is exemestane
aromatase inhibitor
35
How do aromatase inhibitors work?
block conversion of androgens from the adrenal cortex ---> oestrogen in peripheral tissues
36
Who do aromatase inhibitors work in?
post menopausal women
37
What is the treatment of choice in postmenopausal women?
Anastrazole
38
s/e of anasztrazole
reduced bone mineral density - therefore have bone density scan when started
39
When is chemo given?
Before/after surgery | - there is no optimum regime and many variations are used
40
What are the most effective chemo regimes?
anthracycline based ones
41
Who is chemo most effective in?
Premenopausal women | Node +ve patients
42
s/e of chemo (6)
``` nausea vom bone marrow supression mucositis cardiac arrhythmias/myopathy alopecia ```
43
FEC 100 regieme consits of
Flurouracil 500mg/m2 Eipirubicin 100mg/m2 Cyclophosphamide 500mg/m2
44
How is FEC 100 adiministerd?
IV
45
How often do we give FEC100
every 21 days for 6 cycles
46
What should you check before next FEC100 dose
FBC (neuts >1 platelets >100) Renal funciton LFT cumulatibe dose of epirubucin
47
What do you change in FEC100 if LFTs are derranged?
reduce E and F doses
48
What should always be dispensed with FEC100
antiemetics
49
what might older patients need before chemo?
ECHO - to check the heart
50
What should patients be aware of before chemo (2)
1. How to take antiemetic - start the day before chemo start | 2. Be vigilant for signs of infection (risk of neurtopenic sepsis)
51
What is Capecitabine? | what is given in combo for breast cancer?
oral chemo | docetaxel
52
Trastuzamab is also called
Herceptin
53
What is trastuzamab?
MAB targetting HER2
54
Who benefits from trastuzumab?
patients with HER 2 expression of 3+ or higher
55
How does trastuzumab work?
prevents EGF binging to the HER2 receptor. | This prevents HER2 oncogene being amplified
56
s/e of trastuzumab? (5)
``` cardiotox nausea and vom diarrhoea joint/muscle pain rash ```
57
Duration of treatments
``` Surgery Chemo - 5 months radio - 4 weeks trastuzumab - 1 year hormonal therapy - 5 years ```
58
What is everolimus
oral Selective mTOR ihibitor - mTOR is a key serine kinase upregulated in breast cancer
59
Who is everolimus licensed for
treatment of ER/PR +ve, HER2/neu -ve advanced BC postmenopasual women
60
s/e of everolimus
``` stomatatis rash fatigue diarrhoea infections nausea decreased appetie ```
61
What is Eribulin
IV chemo agent
62
s/e of Eribulin
``` myelosupression peripheral neuropathy headache alopecia muscle and joint pain infertility ```
63
Eribulin works by...
inhibiting microtubule dynamics
64
before starting Eribulin....
correct low mag and sodium levels
65
Eribulin dose should be reduced if
low neutrophil count

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