Breast and Prostate cancer Flashcards
breast cancer rate
1 in 8 women
2 most common types of breast cancer
lobular carcinoma
ductal carcinoma
risk factors for breast cancer
- 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
most common mutation in breast cancer
BRCA1 or BRCA2
when to do breast MRI
- when 2D or 3D screens were unclear or radiologist needs more info
- usually for high risk patients >20%
breast cancer diagnosis steps
- positive mammogram or breast exam
- diagnostic bilateral mammogram
- biopsy of tissue
- determine lymph node involvement
what has to be done before treatment can start
biopsy so you know what receptors are involved
most common place for metastasis to hit
lungs
approach for treating in-situ lobular carcinoma
-Counsel on risk reduction strategies
+surgery
+anti-hormonal therapy for 5 years
approach for treating in-situ ductal carcinoma
-surgery and/or radiation
+lumpectomy with whole breast radiation
+total mastectomy and tamoxifen or aromatase x5 years
approach for treating invasive carcinoma
- clinical staging
- lymph node status determination during surgery/biopsy
- search for metastasis with MRI, PET scan, bone scan
curable stages of breast cancer
stage 1 and 2
potentially curable stage of breast cancer
stage 3
not curable stage of breast cancer
stage 4 (metastasis)
treatment techniques for stages 1-3 of breast cancer
- debulking
- systemic treatment
debulking treatments in breast cancer
sugery
radiation
systemic treatments in breast cancer
antineoplastics
anti-hormonals
general treatment regimen for ER/PR + and HER2 +
endocrine and targeted therapy
general treatment regimen for ER/PR - and HER2 +
targeted therapy
general treatment regimen for ER/PR + and HER2 -
endocrine therapy
general treatment regimen for ER/PR - and HER2 -
chemotherapy only
HER2 features
- epidermal growth factor receptor
- overexpressed in ~30% of breast cancer
- worse prognosis
two drugs that target HER2
trastuzumab
pertuzumab
regimens for HER2 positive
dose dense AC THP
TCHP
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
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
regimen for HER2 negative
ddAC+T
ddAC+T monitoring areas
- cardiac (baseline EF)
- bone marrow effects
- hepatic
- neurologic
- infusion reactions
doxorubicin side effects
- red urine
- nausea (acute and delayed)
- low wbc count
- sun sensitivity
paclitaxel side effects
- low wbc
- neuropathy
- skin changes
- infusion reactions
cyclophosphamide side effects
- low wbc
- mouth sores
- diarrhea
endocrine therapy drugs for breast cancer
tamoxifen
anastrozole
when treating pre-monopausal women for breast cancer what other thing should be done in addition to endocrine drugs
ovarian suppression or ablation
treatment regimen for ER/PR - and HER2 -
paclitaxel + carboplatin
THEN
ddAC
induction treatment for stage 1-3 breast cancer
surgery +/- radiation
consolidation treatment for stage 1-3 breast cancer
ddAC+T and add HER2 mabs if necessary
maintenance treatment for stage 1-3 breast cancer
trastuzumab to finish a year if HER2+
and/or antihormonal if ER positive
general treatment for locoregional metastasis
surgery
radiation
general treatment for systemic metastasis
endocrine therapy
chemotherapy
targeted therapy
goal of treatment in stage 4 breast cancer
preserve maximum quality of life
additional drug class you can add to endocrine therapy for breast cancer metastasis
CDK-4/6 inhibitor
main determinants of breast cancer therapy
- stage of the disease
- receptor status
- intent of therapy
lifetime risk of prostate cancer
1 in 6
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
prostate screening techniques
- digital rectal exam
- prostate specific antigen
- transrectal ultrasonography
what is PSA
enzyme normally secreted from prostate that is elevated in serum in prostate cancer
PSA can be elevated in
- BPH
- inflammtion
- ejactulation
- peritoneal trauma
- acute urinary retention
prostate treatment decision is based on
- life expectancy
- gleason grade
- risk stratificatin
- PSA
- symptoms
- patient wishes
PSA risk grading
low = <10 intermediate = 10-20 high = >20
gleason score grading
low =< 6
intermediate = 7
high => 8
treatment options for localized tumors
- active surveillance
- radical prostatectomy
- radiation therapy
active surveillance of prostate cancer consists of
serial PSAs and repeat biopsies
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%
sensitive parts of anatomy near prostate
cavernous nerves and dorsal veil complex make surgery hard
post prostate surgery/radiation therapy options
- watch and wait
- androgen deprivation therapy for high risk
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
LHRH agonist
leuprolide
LHRH antagonist
degarelixc
side effects of ADT
- decreased libido
- hot flashes
- gynecomastia
- loss of muscle mass
- increased weight gain
- decrease in bone density
castration resistant prostate cancer treatment
continue ADT and add:
- anti-androgen
- ketoconazole
- diethylstilbestrol
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
chemo drugs and regimen for prostate cancer
-docetaxel + daily prednisone
21 day cycle, 6 cycles
-carbazitaxel + daily prednisone
21 day cycle, 6 cycles
monitoring for docetaxel/prednisone
- ANC, anemia, platelets
- AST/ALT
- neuropathy
- infusion reactions
side effects to watch for in prostate cancer chemo/ADT
- bone marrow suppression
- fluid retention
- skin and nail changes
- neuropathy
