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PT3 Oncology > Breast and Prostate cancer > Flashcards

Breast and Prostate cancer Flashcards

1
Q

breast cancer rate

A

1 in 8 women

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2
Q

2 most common types of breast cancer

A

lobular carcinoma

ductal carcinoma

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3
Q

risk factors for breast cancer

A
  • past history
  • BRCA mutation
  • age
  • age of menarche
  • age of first live birth
  • 1st degree relatives with breast cancer
  • previous breast biopsy w/ atypical hyperplasia
  • race/ethnicity
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4
Q

most common mutation in breast cancer

A

BRCA1 or BRCA2

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5
Q

when to do breast MRI

A
  • when 2D or 3D screens were unclear or radiologist needs more info
  • usually for high risk patients >20%
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6
Q

breast cancer diagnosis steps

A
  • positive mammogram or breast exam
  • diagnostic bilateral mammogram
  • biopsy of tissue
  • determine lymph node involvement
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7
Q

what has to be done before treatment can start

A

biopsy so you know what receptors are involved

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8
Q

most common place for metastasis to hit

A

lungs

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9
Q

approach for treating in-situ lobular carcinoma

A

-Counsel on risk reduction strategies
+surgery
+anti-hormonal therapy for 5 years

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10
Q

approach for treating in-situ ductal carcinoma

A

-surgery and/or radiation
+lumpectomy with whole breast radiation
+total mastectomy and tamoxifen or aromatase x5 years

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11
Q

approach for treating invasive carcinoma

A
  • clinical staging
  • lymph node status determination during surgery/biopsy
  • search for metastasis with MRI, PET scan, bone scan
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12
Q

curable stages of breast cancer

A

stage 1 and 2

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13
Q

potentially curable stage of breast cancer

A

stage 3

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14
Q

not curable stage of breast cancer

A

stage 4 (metastasis)

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15
Q

treatment techniques for stages 1-3 of breast cancer

A
  • debulking

- systemic treatment

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16
Q

debulking treatments in breast cancer

A

sugery

radiation

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17
Q

systemic treatments in breast cancer

A

antineoplastics

anti-hormonals

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18
Q

general treatment regimen for ER/PR + and HER2 +

A

endocrine and targeted therapy

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19
Q

general treatment regimen for ER/PR - and HER2 +

A

targeted therapy

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20
Q

general treatment regimen for ER/PR + and HER2 -

A

endocrine therapy

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21
Q

general treatment regimen for ER/PR - and HER2 -

A

chemotherapy only

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22
Q

HER2 features

A
  • epidermal growth factor receptor
  • overexpressed in ~30% of breast cancer
  • worse prognosis
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23
Q

two drugs that target HER2

A

trastuzumab

pertuzumab

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24
Q

regimens for HER2 positive

A

dose dense AC THP

TCHP

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25
Q

dose dence AC THP regimen (including cycles and length)

A

-doxorubicin + cyclophosphamide on day one
-pegfilgrastim on day 2
14 day cycle, for 4 cycles
THEN
-Pertuzumab + trastuzumab + paclitaxel
21 day cycle, for 4 cycles
THEN
trastuzumab q3wk for one year

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26
Q

ddAC+T regimen (including cycles and length)

A

-doxorubicin + cyclophosphamide on day one
-pegfilgrastim on day 2
14 day cycle, for 4 cycles
THEN
-paclitaxel
21 day cycle, for 4 cycles

27
Q

regimen for HER2 negative

A

ddAC+T

28
Q

ddAC+T monitoring areas

A
  • cardiac (baseline EF)
  • bone marrow effects
  • hepatic
  • neurologic
  • infusion reactions
29
Q

doxorubicin side effects

A
  • red urine
  • nausea (acute and delayed)
  • low wbc count
  • sun sensitivity
30
Q

paclitaxel side effects

A
  • low wbc
  • neuropathy
  • skin changes
  • infusion reactions
31
Q

cyclophosphamide side effects

A
  • low wbc
  • mouth sores
  • diarrhea
32
Q

endocrine therapy drugs for breast cancer

A

tamoxifen

anastrozole

33
Q

when treating pre-monopausal women for breast cancer what other thing should be done in addition to endocrine drugs

A

ovarian suppression or ablation

34
Q

treatment regimen for ER/PR - and HER2 -

A

paclitaxel + carboplatin
THEN
ddAC

35
Q

induction treatment for stage 1-3 breast cancer

A

surgery +/- radiation

36
Q

consolidation treatment for stage 1-3 breast cancer

A

ddAC+T and add HER2 mabs if necessary

37
Q

maintenance treatment for stage 1-3 breast cancer

A

trastuzumab to finish a year if HER2+

and/or antihormonal if ER positive

38
Q

general treatment for locoregional metastasis

A

surgery

radiation

39
Q

general treatment for systemic metastasis

A

endocrine therapy
chemotherapy
targeted therapy

40
Q

goal of treatment in stage 4 breast cancer

A

preserve maximum quality of life

41
Q

additional drug class you can add to endocrine therapy for breast cancer metastasis

A

CDK-4/6 inhibitor

42
Q

main determinants of breast cancer therapy

A
  • stage of the disease
  • receptor status
  • intent of therapy
43
Q

lifetime risk of prostate cancer

A

1 in 6

44
Q

the controversy of prostate cancer screening

A

it is a slow growing cancer and you can go a long time without symptoms, leading to overtreating unnecessary cases and treatment can be invasive and debilitating with little benefit

45
Q

prostate screening techniques

A
  • digital rectal exam
  • prostate specific antigen
  • transrectal ultrasonography
46
Q

what is PSA

A

enzyme normally secreted from prostate that is elevated in serum in prostate cancer

47
Q

PSA can be elevated in

A
  • BPH
  • inflammtion
  • ejactulation
  • peritoneal trauma
  • acute urinary retention
48
Q

prostate treatment decision is based on

A
  • life expectancy
  • gleason grade
  • risk stratificatin
  • PSA
  • symptoms
  • patient wishes
49
Q

PSA risk grading

A 
low = <10
intermediate = 10-20
high = >20
50
Q

gleason score grading

A

low =< 6
intermediate = 7
high => 8

51
Q

treatment options for localized tumors

A
  • active surveillance
  • radical prostatectomy
  • radiation therapy
52
Q

active surveillance of prostate cancer consists of

A

serial PSAs and repeat biopsies

53
Q

why is there hesitation for surgery/radiation therapy in prostate cancer?

A
  • urinary incontinence/impotence rate is about 30%

- urinary strictures requiring treatment occur at about 15%

54
Q

sensitive parts of anatomy near prostate

A

cavernous nerves and dorsal veil complex make surgery hard

55
Q

post prostate surgery/radiation therapy options

A
  • watch and wait

- androgen deprivation therapy for high risk

56
Q

in recurrent or advanced prostate cancer ADT can be started with…(types of treatment)

A
  • luteinizing hormone releasing hormone agonist
  • LHRH antagonist
  • complete androgen blockate
  • orchiectomy
  • estrogen therapy
57
Q

LHRH agonist

A

leuprolide

58
Q

LHRH antagonist

A

degarelixc

59
Q

side effects of ADT

A
  • decreased libido
  • hot flashes
  • gynecomastia
  • loss of muscle mass
  • increased weight gain
  • decrease in bone density
60
Q

castration resistant prostate cancer treatment

A

continue ADT and add:

  • anti-androgen
  • ketoconazole
  • diethylstilbestrol
61
Q

treatment for metastatic prostate cancer

A

-bisphosphonates or denosumab to prevent it from going to bone

-change therapy to:
+chemo with docetaxel or cabazitaxel
+2nd gen anti-androgen
+androgen biosynthesis inhibitor

62
Q

chemo drugs and regimen for prostate cancer

A

-docetaxel + daily prednisone
21 day cycle, 6 cycles
-carbazitaxel + daily prednisone
21 day cycle, 6 cycles

63
Q

monitoring for docetaxel/prednisone

A
  • ANC, anemia, platelets
  • AST/ALT
  • neuropathy
  • infusion reactions
64
Q

side effects to watch for in prostate cancer chemo/ADT

A
  • bone marrow suppression
  • fluid retention
  • skin and nail changes
  • neuropathy

PT3 Oncology (9 decks)

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