Breast Cancer 06
Terms
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- What is the number 1 risk factor for the development of BC?
- Age > 50yrs
- What are 4 major risk factors for BC?
- Age, Endocrine factors, Genetics, Environmental factors
- What genetic factors predispose women to BC?
- Family history of BRCA1/BRCA2 gene.. also associated with ovarian cancer.
- What dietary factors may contribute to development of BC?
- High fat intake, alcohol consumption
- What lifestyle factor may contribute to the development of BC?
- Obesity
- When should self-breast exams be done and started?
- Age 20, monthly. Or let Curt do it (if you're hot...)
- When should CBE (clinicial breast exams) start being done and how often?
- At age 40 then q 1-2 years until age of 50, then q 1 year
- For high risk patients, when should mammograms be started?
- Starting 5 years of age before youngest affeced relative's diagnosis age.
- What is the clinical presentation of BC?
- ASx, painless lump (solitary, unilateral, solid, hard, irregular/nonmobile), stabbing/aching pain, nipple discharge retraction or dimpling, skin edema, redness, warmth, induration of underlying tissue.
- What would characterize advanced metastatic BC?
- Bone pain, dyspnea, abdominal enlargement, jaundice, mental status changes, NV
- How is BC staged?
- Based on that TMN thing...
- Age <35, poor or good prognosis?
- Poor
- HR- poor or good prognosis?
- Poor
- Black person: poor or good prognosis?
- Poor
- Tumor > 2cm poor or good prognosis?
- poor
- Positive nodes, poor or good prognosis?
- poor
- High s-phase fraction: poor or good prognosis?
- Poor
- Aneuploid: poor or good prognosis?
- Poor
- Her2/neu overexpression: poor or good prognosis?
- Poor
- Age > 70: poor or good prognosis?
- Good
- HR+ : poor or good prognosis?
- Good
- Tumor <2cm: poor or good prognosis?
- Good
- No nodal involvement: poor or good prognosis?
- Good
- Low s-phase fraction: poor or good prognosis?
- Good
- Diploid: poor or good prognosis?
- Good
- Her2/neu negative: poor or good prognosis?
- Good
- Her2/neu oncogene positive typically indicates (Aggressive/non-aggressive)?
- Aggressive
- Describe Infiltrating Ductal BC
- Invasive, most common, spreads to axillary nodes, poor prognosis, metastasize to bone, liver, lungs and CNS
- Which is the most common type of BC?
- Infiltrating ductal
- Which type of BC has a 50% chance of opposite breast involvment?
- Lobular carcinoma in situ (LCIS)... patients may consider bilateral mastectomy.
- Can BC be cured?
- Yes, if caught early enough.
- Which surgery results in breast conservation?
- Lumpectomy
- Which surgery has the highest morbidity?
- Radical mastectomy
- When CAN adjuvant radiation be used?
- In all stages.
- For which grade of BC is radiation always warranted?
- Locally advanced
- Purpose of Adjuvant radiation therapy with BC?
- Minimize local recurrence.
- Why would radiation therapy be used for metastatic BC?
- Typically for Sx management (i.e. bone mets, CNS disease and spinal cord lesions)
- Chronologically, when is Hormone therapy done vs. chemotherapy?
- Afterwards
- When should hormonal therapy be used always?
- ER/PR+ patients
- Gold standard of endocrine therapy
- Tamoxifen
- Tamoxifen/Nolvadex MOA in breast tissue
- Antiestrogen (SERM, selective estrogen receptor modulator)
- Non-carcinoma related positive effects of Tamoxifen
- Beneficial lipid/bone density effects
- MOA of Tamoxifen toxicity
- Acts as an estrogen agonist in non-breast tissues
- ADR's associated with Tamoxifen
- Hot flashes, NV, edema, thrombembolism, endometrial cancer
- Goserelin CLASS
- LH/RH agonist
- Leuprolide CLASS
- LH/RH agonist
- What do LHRH agonists do?
- Induce menopause (ovarian oblation)
- LHRH agonists can only be used in ____-menopausal women.
- PRE
- LHRH Agonist ADR
- Amenorrhea, hot flashes, nausea
- Anastrozole/Arimidex Class
- Aromatase inhibitor
- Letrozole/Femara CLASS
- Aromtase inhibitor
- Exemestane/Aromasin CLASS
- Aromatase inhibitor
- Do Aromatase inhibitors inhibit this enzyme in the ovary?
- No, thus cannot be used in premenopausal women (no point)
- Aromatase inhibitors can only be used in ____-menopausal women
- POST
- Compare the efficacy of Aromatase inhibitors in post-menopausal women vs. tamoxifen
- Shown to be more efficacious
- Describe the benefit of using Tamoxifen and Aromatase inhibitors concurrently.
- There is no advantage.
- Aromatase inhibitor ADR
- Lethargy, rash, postural dizziness, nystagmus, nausea
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Describe Adjuvant Tx for Breast cancer in the following case:
PreMen ER/PR+ Node- - LHRH+Tamoxifen or LHRH or TMX alone or after chemo
-
Describe Adjuvant Tx for Breast cancer in the following case:
PreMen ER/PR- Node- - No hormonal, Chemotherapy only
-
Describe Adjuvant Tx for Breast cancer in the following case:
PostMen ER/RP+ Node- - TMX or TMX after chemo
-
Describe Adjuvant Tx for Breast cancer in the following case:
PostMen ER/PR- Node- - No hormonal, Chemotherapy a must
-
Describe Adjuvant Tx for Breast cancer in the following case:
PreMEN ER/PR+ Node+ - Tamoxifen +/- LHRH +/- Chemo
-
Describe Adjuvant Tx for Breast cancer in the following case:
PreMEN ER/PR- Node+ - No hormonal, Chemo a must
-
Describe Adjuvant Tx for Breast cancer in the following case:
PostMEN ER/PR+ Node+ - Tamoxifen +/- Chemo
-
Describe Adjuvant Tx for Breast cancer in the following case:
PostMEN ER/PR- Node+ - No hormonal, chemo a must
- Gold standard of BC Chemo Regimen
- Taxane + Anthracycline
- Indication for Neoadjuvant chemotherapy
- Locally advanced breast cancer
- Advantages of Neoadjuvant chemotherapy
- Early initiation of chemo, intact vasculature, in vivo assessment of response, study of biologic effects
- Disadvantages of Neoadjuvant chemotherapy
- Loss of pathologic prognostic factors
- What do you do with ER/PR+ patientts with unresectable tumors that cannot receive chemo?
- Hormonal therapy
- What are the most active agents against BC?
- Anthracyclines
- Indication for Anthracyclines regarding Node status
- Node+ or Node- use
- Patients with HER2/neu may benefit especially from which CHEMOtherapy?
- Anthracyclines
- Taxanes should be used (sequentially or concurrently) with anthracyclines?
- Concurrently
- How would decreasing the time between treatment cycles affect dose density?
- It would increase
- What are the units of dose intensity?
- mg/M2/week
- How does concurrent therapy affect side effect profile?
- Worsens it
- Hypersensitivity reactions would be attributed to ____________
- Taxane (Paclitaxel)
- DVT's could be attributed to _______________.
- Tamoxifen
- Cardiomyopathy could be attributed to __________________.
- Doxurubicin (Anthracyclines)
- Immunohistochemistry wise, what requirement exists for the use of Trastuzumab/Herceptin?
- Must be 3+
- What can herceptin NOT be used with Chemo wise?
- Anthracyclines, due to cardiotoxicity
- Is concurrent therapy with paclitaxel and Trastuzumab ok?
- Yes, actually much more efficacious
- How does Bevacizumab/Avastin work?
- Binds to VEGF that prevents angiogensis
- BEvacizumab/Avastin ADR
- Thrombosis, hypertension
- If recurrence occurs within one year, what do you do?
- Pick agents that work differently.
- Patient is prescribed Paclitaxel, what do you add the order?
- Benadryl, APAP and Dex