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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
dose dence AC THP regimen (including cycles and length)
-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
26
ddAC+T regimen (including cycles and length)
-doxorubicin + cyclophosphamide on day one -pegfilgrastim on day 2 14 day cycle, for 4 cycles THEN -paclitaxel 21 day cycle, for 4 cycles
27
regimen for HER2 negative
ddAC+T
28
ddAC+T monitoring areas
- cardiac (baseline EF) - bone marrow effects - hepatic - neurologic - infusion reactions
29
doxorubicin side effects
- red urine - nausea (acute and delayed) - low wbc count - sun sensitivity
30
paclitaxel side effects
- low wbc - neuropathy - skin changes - infusion reactions
31
cyclophosphamide side effects
- low wbc - mouth sores - diarrhea
32
endocrine therapy drugs for breast cancer
tamoxifen | anastrozole
33
when treating pre-monopausal women for breast cancer what other thing should be done in addition to endocrine drugs
ovarian suppression or ablation
34
treatment regimen for ER/PR - and HER2 -
paclitaxel + carboplatin THEN ddAC
35
induction treatment for stage 1-3 breast cancer
surgery +/- radiation
36
consolidation treatment for stage 1-3 breast cancer
ddAC+T and add HER2 mabs if necessary
37
maintenance treatment for stage 1-3 breast cancer
trastuzumab to finish a year if HER2+ | and/or antihormonal if ER positive
38
general treatment for locoregional metastasis
surgery | radiation
39
general treatment for systemic metastasis
endocrine therapy chemotherapy targeted therapy
40
goal of treatment in stage 4 breast cancer
preserve maximum quality of life
41
additional drug class you can add to endocrine therapy for breast cancer metastasis
CDK-4/6 inhibitor
42
main determinants of breast cancer therapy
- stage of the disease - receptor status - intent of therapy
43
lifetime risk of prostate cancer
1 in 6
44
the controversy of prostate cancer screening
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
prostate screening techniques
- digital rectal exam - prostate specific antigen - transrectal ultrasonography
46
what is PSA
enzyme normally secreted from prostate that is elevated in serum in prostate cancer
47
PSA can be elevated in
- BPH - inflammtion - ejactulation - peritoneal trauma - acute urinary retention
48
prostate treatment decision is based on
- life expectancy - gleason grade - risk stratificatin - PSA - symptoms - patient wishes
49
PSA risk grading
``` low = <10 intermediate = 10-20 high = >20 ```
50
gleason score grading
low =< 6 intermediate = 7 high => 8
51
treatment options for localized tumors
- active surveillance - radical prostatectomy - radiation therapy
52
active surveillance of prostate cancer consists of
serial PSAs and repeat biopsies
53
why is there hesitation for surgery/radiation therapy in prostate cancer?
- urinary incontinence/impotence rate is about 30% | - urinary strictures requiring treatment occur at about 15%
54
sensitive parts of anatomy near prostate
cavernous nerves and dorsal veil complex make surgery hard
55
post prostate surgery/radiation therapy options
- watch and wait | - androgen deprivation therapy for high risk
56
in recurrent or advanced prostate cancer ADT can be started with...(types of treatment)
- luteinizing hormone releasing hormone agonist - LHRH antagonist - complete androgen blockate - orchiectomy - estrogen therapy
57
LHRH agonist
leuprolide
58
LHRH antagonist
degarelixc
59
side effects of ADT
- decreased libido - hot flashes - gynecomastia - loss of muscle mass - increased weight gain - decrease in bone density
60
castration resistant prostate cancer treatment
continue ADT and add: - anti-androgen - ketoconazole - diethylstilbestrol
61
treatment for metastatic prostate cancer
-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
chemo drugs and regimen for prostate cancer
-docetaxel + daily prednisone 21 day cycle, 6 cycles -carbazitaxel + daily prednisone 21 day cycle, 6 cycles
63
monitoring for docetaxel/prednisone
- ANC, anemia, platelets - AST/ALT - neuropathy - infusion reactions
64
side effects to watch for in prostate cancer chemo/ADT
- bone marrow suppression - fluid retention - skin and nail changes - neuropathy

PT3 Oncology (9 decks)

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