17: Breast Flashcards
What type of cancer makes up the majority of breast cancers?
Carcinomas –
Ductal and Lobular
What is DCIS?
ductal carcinoma in situ (DCIS) - a condition in which abnormal cells replace normal epithelial cells in the ducts of the breast. Its a noninvasive CA as it hasn’t extended to the stroma, but it can progress to invasive.
What is needed to complete staging for breast cancer?
a mammogram
clinical breast exam
ultrasound
MRI
lumpectomy and biopsy may all be required
ER/PR/HER2 status is needed as well
histological grading
multigene assay recurrence score (Oncotype DX)–genetic testing
What are modifiable risk factors for breast cancer?
alcohol consumption
overweight/obesity
low levels of physical activity
use of oral contraceptives for birth control
use of hormone replacement therapy
childbearing and breastfeeding
What are non modifiable risk factors for breast cancer?
inherited genes (BRCA1 and BRCA2)
Race and ethnicity
having dense breast tissue
having onset of menarche before 12
reaching menopause after 55
receiving radiation to the chest
What are the different types of surgeries for breast cancer?
sentinel lymph node biopsy
axillary lymph node dissection
breast-conserving surgery
total mastectomy
modified radical mastectomy
radical mastectomy
contralateral prophylactic mastectomy
ovarian ablation
What is a type of therapy that is very common in breast outside of surgery/chemo/radiation? How long is it commonly used?
Endocrine or hormone therapy – particularly for any positive cancers (ER+ etc)
HER2-targeted – 1 year post op
aromatase inhibitor — 5 years in post menopausal
osteoclast inhibitor — for avoiding bone breaks – 3-10 years
selective estrogen receptor modulator – 5-10 years
What are some good, basic nutrition needs for breast cancer patients (assuming no other conditions)?
25 kcal/kg —- doesn’t change their metabolism unless metastatic
1.2-1.5 g/kg for protein — maintain muscle loss
How common is Lymphedema? What is the recommended treatment?
20-42% of patients
compression bandaging, manual lymphatic drainage and exercise. Weight loss can help but there isn’t a specific diet recommendation
What can help with hot flashes, intense sweating and flushing (vasomotor symptoms)?
increase consumption of soy might help
Vitamin E supplementation of 800 IU/d decreased frequency of hot flashes by one episode/day
Aromatase inhibitors (anastrozole, letrozole, exemastane) tend to cause musculoskeletal symptoms like pain at joints/large bones. What are some possible nutrition recommendations?
What about with bone loss?
Vitamin D, Ca and omega-3 fatty acids have been studied with mixed results for reducing pain.
Bone Loss:
NCCN recommend 1,200 mg/day of Ca – supplement if can’t get in diet by using calcium carbonate with meals or calcium citrate for those on PPIs. Shouldn’t be taken at same time as oral bisphosphonates, but 2 hours before/after to max absorption.
If Vit D is tested to be low (20-30 mg/mL), recommend administering 1000 IU of Vit D2 or D3 daily for 3 months.
Peripheral neuropathy occurs in 15-23% of patients getting a taxane-based chemo. Are there any nutrition concerns that can factor into this?
Obesity, limited fruit/veggie intake and some supplemental antioxidants have been found to possibly make this worse.
One study found using Omega-3s 3 times/day during paclitaxel chemo and for 1 month post had reduced CIPN incidence although severity might not be better.
What is the average weight gain seen in breast cancer patients?
1.95-4.5 kg (average 3.8kg)
60% of patients gain within the first year of diagnosis with a plateau 2-3 years post diagnosis
What are the possible reasons for weight gain in breast cancer patients? Who is at higher risk?
Ovarian failure/transition to menopause
fatigue
decreased activity
higher energy intake during treatment
Younger, closer to IBW and who get chemo (particularly CMF) are at higher risk for weight gain
Can breast cancer patients in treatment lose weight?
It is okay (pending MD approval) to do so as long as there aren’t reasons to contraindicated like wounds or advanced disease. Still would only aim for moderate (1-2#/week)
