7: Breast oncology and palliative care

Question 1

What are the treatment options for breast cancer in oncology?

Answer 1

Radiotherapy

Chemotherapy

Hormonal therapies e.g tamoxifen, aromatase inhibitors, GnRH agonist

Herceptin

Question 2

What is offered to breast cancer patients who are not suitable for curative treatment?

Answer 2

Palliative care

Question 3

What is meant by

a) adjuvant
b) neo-adjuvant treatment?

Answer 3

a) Adjuvant treatments are given alongside curative treatments i.e surgery

b) Neo-adjuvant treatments are given BEFORE curative treatments

Question 4

Is radiotherapy a neo-adjuvant treatment for breast cancer?

Answer 4

No

Adjuvant - given ALONGSIDE or AFTER curative surgery

Question 5

What therapies are given as neo-adjuvants in breast cancer?

Answer 5

Chemotherapy

Hormonal therapies

(Herceptin for HER2 positive cancers)

Question 6

Why are neo-adjuvant therapies given before breast cancer surgery?

Answer 6

To reduce the size of the tumour

To improve cosmesis

Question 7

What is adjuvant therapy?

Answer 7

Treatments given AFTER curative breast surgery

Question 8

What is the most commonly given adjuvant therapy for breast cancer?

Answer 8

Radiotherapy

Question 9

What are four adjuvant therapies given for breast cancer?

Answer 9

Radiotherapy

Chemotherapy

Hormonal therapy (tamoxifen, aromatase inhibitors)

Herceptin

Question 10

Tamoxifen (an oestrogen receptor blocker) increases a patient’s chances of developing which cancer?

Answer 10

Endometrial cancer

Question 11

What pathological features increase the risk of a cancer relapsing?

Answer 11

Lymph node invasion

High grade (i.e how well differentiated it is)

High stage (i.e size, local invasion)

Question 12

What specific chemotherapy drugs are used in breast cancer?

Answer 12

Anthracycline

Taxanes

Question 13

What are some side effects of chemotherapy?

Answer 13

Hair loss

Fatigue

Nausea and vomiting

Susceptibility to infection

Question 14

Which receptor does herceptin act on?

Answer 14

HER2 receptor

Question 15

Out of every 100 people treated with herceptin, how many more survive?

Answer 15

3 out of 100

so an absolute benefit of 3%

Question 16

How are breast cancer patients followed up surgically?

Answer 16

Surgical review one year following procedure

Then breast screening every 3 years

Question 17

What are some palliative treatments for breast cancer?

Answer 17

Radio/chemo/hormonal therapy

Bisphosphonates

Question 18

Why are bisphosphonates given to some palliative breast cancer patients?

Answer 18

1. Drugs affecting oestrogen metabolism e.g tamoxifen can cause osteoporosis

2. Bone destruction in metastatic disease

bisphosphonates reduce bone turnover

Question 19

The beneficial effects of chemotherapy must be weighed up against the ___ of the patient.

Answer 19

QOL

quality of life

Question 20

Trastuzumab (Herceptin) is effective for which type of breast cancer?

Answer 20

HER2+ cancers

Question 21

Transtuzumab can be combined with what to increase its effectiveness?

Answer 21

Chemotherapy

Question 22

What are the three factors influencing the chance of breast cancer recurrence?

Answer 22

Local invasion (stage)

Degree of differentiation (grade)

Lymph node involvement

Question 23

What are the chances that a low grade tumour will spread to the bones?

Answer 23

Little to none

Question 24

Which imaging modalities are used to check the bones of patients complaining of bony pain?

Answer 24

Bone scan

MRI/CT scan

Question 25

What is a sinister complaint of patients with breast cancer?

Answer 25

Bony pain

Question 26

What is an important immunological side effect of chemotherapy?

Answer 26

Neutropenia

Question 27

Neutropenia caused by chemotherapy can cause which complication?

Answer 27

Infection

so admit if patient on chemo has a fever

Question 28

What is a common side effect of tamoxifen and aromatase inhibitors in women with breast cancer?

Why?

Answer 28

Menopausal symptoms e.g hot flushes, pain on intercourse, vaginal dryness

Reduces oestrogen effects by blocking receptors

Question 29

Which type of contaception contains oestrogen?

Answer 29

IUS (i.e Merina coil)

there’s more

Question 30

Why are Merina coils contraindicated in breast cancer?

What’s the problem with this?

Answer 30

Release oestrogen, theoretically increasing the growth of ER positive cancers

Not all breast cancers are ER positive

Question 31

What is a tumour marker for breast cancer?

Answer 31

CA125

Question 32

CA125 is for ___, not ___ of breast cancer.

Answer 32

monitoring, not diagnosis

Question 33

A breast cancer patient complains of a sore jaw.

Which type of drug can cause this?

Answer 33

Bisphosphonates

Jaw osteonecrosis

Question 34

Fat necrosis is an inflammatory response caused by breast trauma.

What are some traumas which can cause it?

Answer 34

Seatbelt injuries

Dogs jumping up on women (really)

Reconstructive surgery (uncommon cause of breast lump immediately following surgery)

Question 35

What is an urgent neurological complication of bony metastasis?

Answer 35

Spinal cord compression

Question 36

Which class of drug influences the circulating levels of tamoxifen?

Answer 36

Antidepressants

Question 37

common metastasis sites: bones, lungs, liver, brain

HER2 positive cancers PREFERENTIALLY go for the brain

Question 38

Where does lobular breast cancer preferentially spread to?

Answer 38

Peritoneum

Causing GI symptoms e.g obstruction

Question 39

What are lifestyle factors which increase your risk of developing breast cancer?

Answer 39

Obesity

Lack of physical activity

Excessive alcohol consumption

Question 40

Which organs do

a) HER2+ breast cancers
b) lobular breast cancers

commonly invade?

Answer 40

a) Brain

b) GI organs