Breast Ca Tx + Prognosis

Question 1

What are some Tx options for breast ca?

Answer 1

Hormonal therapy (oestrogen)
Biological therapy (HER-2)
Surgery + LN clearance
Radiotherapy
chemotherapy

Question 2

Hormonal therapy (oestrogen), what 2 groups of women are they given to?

Answer 2

premenopausal
postmenopausal

Question 3

Premenopausal hormonal therapy - oestrogen

what drug is given?
mechanism?
SE?

Answer 3

Tamoxifen
(selective oestrogen modulator - inhibit at breast + agonist at endometrium and bone)

SE = Hot flushes, VTE, Endometrial ca (1:200,000)

Question 4

Postmenopausal hormonal therapy - oestrogen

what drugs are given?
mechanism?
SE?

Answer 4

Anastrozole/Letrozole
(aromatase-i = lower oestrogen levels)

SE = Osteoporosis (oestrogen receptor - inhibitor at bone = low BMD) - give Vit D, Ca2+, bisphosphonates
-vaginal dryness
-flushes

Question 5

Biological therapy - HER-2 +VE:
What drug is given?
sometimes combined with?
SE?

Answer 5

Trastuzumab (Herceptin)

Sometimes combined with PERTUZUMAB

SE = cardio toxicity!!! - baseline ECHO needed

Question 6

What is the main SEs of surgery and LN clearance?

Answer 6

lymphedema + seroma + damage to brachial plexus

Question 7

Surgery
What are the main 2 surgeries and fraction?

Answer 7

1/3 Mastectomy
2/3 Lumpectomy

Question 8

Mastectomy
What happens?
% reoccurrence?
good if?
% breast vol affected?
CI?

Answer 8

Total breast removal
leave pec major and minor

5% reoccurrence

good if patient choice

> 20% breast volume affected

CI radiotherapy

Question 9

Lumpectomy
What happens?
What happens after surgery?
% reoccurrence?
good if?
% breast vol affected?

Answer 9

conserving surgery
need adjuvant radiotherapy (15 doses for 3 weeks)

No radio = 35% reoccurrence
Radio = 5-10% reoccurrence

good patient choice

<20% removal

good radio Px

Question 10

Radiotherapy:
-when is radiotherapy recommended after?
-Reduces risk of reoccurrence by?
-SE?

Answer 10

recommended after wide local excision
adjuvant for lumpectomy (after surgery)

reduces risk of reoccurrence by 2/3

SE = Local eg. skin damage, lung radiation

Question 11

Chemotherapy:
-when is chemo done and why?
-in aggressive Ca mets, improves mortality by %?
-SE?

Answer 11

Used before surgery to downstage primary lesion

18-25%

Alopecia, N+V, Neutropenic sepsis, infertility

Question 12

What Tx for breast ca can be done in pregnancy and what is CI and when?

Answer 12

in preg = surgery and chemo
Chemo CI in first trimester
Radiotherapy + tamoxifen = CI

Question 13

What is used to determine prognosis in breast ca?

Answer 13

Nottingham prognosis index
NHS predict

Question 14

Nottingham prognosis index:
what is the prognosis of and scores?

Answer 14

prognosis of 10y life expectancy post surgery 2-7
<2.4 = normal life
2.4 - 5.4 = 50-80% 10y
>5.4 = 20% (survival)

Question 15

NHS predict
what does it predict?

Answer 15

10y survival after chemotherapy