Breast Cancer Flashcards
Whats Breast Cancer?
Breast cancer is a malignancy originating from breast tissue.
The strongest risk factors for breast cancer are
female gender and increasing age.
Additional risk factors include endocrine factors (e.g., early menarche, nulliparity, late age at first birth, hormone replacement therapy), genetic factors (e.g., personal and family history, mutations of tumor suppresser genes [BRCA1 and BRCA2]), and environmental and lifestyle factors (e.g., radiation exposure).
What causes Metastatic disease of Breast Cancer
Breast cancer cells often spread undetected by contiguity, lymph channels, and through the blood early in the course of the disease, resulting in metastatic disease after local therapy
• The most common metastatic sites are lymph nodes, skin, bone, liver, lungs, and brain.
Clinical presentation of Breast Cancer?
The initial sign in more than 90% of women with breast
cancer is a painless lump that is typically solitary, unilateral,solid, hard, irregular, and nonmobile.
• Less common initial signs are pain and nipple changes.
More advanced cases present with prominent skin edema, redness, warmth, and induration.
• Symptoms may include bone pain, difficulty breathing,
abdominal pain or enlargement, jaundice, and mental
status changes.
mammography in asymptomatic women.
Diagnosis
Breast Biopsy
How is Stage Classified
Stage is based on the size of the primary tumor (T1–4), presence and extent of lymph node involvement (N1–3), and presence or absence of distant metastases (M0–1).
✓ Early Breast Cancer- what happens
• Stage 0: Disease that has not invaded the
basement membrane.
• Stage I: Small primary tumor without lymph node involvement.
• Stage II: Involvement of regional lymph nodes.
✓ Locally Advanced Breast Cancer- what happens
• Stage III: Usually a large tumor with extensive nodal involvement
in which node or tumor is fixed to the chest wall; also includes inflammatory breast cancer, which is rapidly progressive.
✓ Advanced or Metastatic Breast Cancer
• Stage IV: Metastases in organs distant from the primary tumor.
What’s the problem with Breast Cancer treatment?
Treatment can cause substantial toxicity, which
differs depending on the individual agent,
administration method, and combination regimen.
Local-Regional Therapy
• Surgery - stage 1 and 2
• Breast-conserving therapy (BCT) stage I and II disease; it is preferable to modified radical mastectomy because it produces equivalent survival rates with cosmetically superior results.
• BCT consists of lumpectomy (i.e., excision of the
primary tumor and adjacent breast tissue) followed by
radiation therapy (RT) to prevent local recurrence. Continue 4- 6 weeks after.
• Simple or total mastectomy
• Systemic adjuvant therapy is the administration
of systemic therapy following definitive local
therapy (surgery, radiation, or both) when there
is no evidence of metastatic disease but a high
likelihood of disease recurrence.
• Chemotherapy, hormonal therapy, or both result
in improved disease-free survival and/or overall
survival (OS) for all treated patients. 3 weeks after for 3-6 months
Drugs that significantly reduce the rate of
recurrence and improve OS 5 and 10 years after
treatment as compared with regimens that contain
• Anthracycline-containing regimens (e.g., doxorubicin
and epirubicin)
cyclophosphamide, methotrexate, and fluorouracil.
• The addition of taxanes, docetaxel and paclitaxel,
What is indicated in patients with early
stage, HER2-positive breast cancer.
• Trastuzumab in combination with adjuvant
chemotherapy
What is the gold standard for adjuvant
endocrine therapy.
Tamoxifen- It has both estrogenic and
antiestrogenic properties, depending on the tissue
and gene in question. After surgery for 5 years, to avoid reoccurrence
METASTATIC BREAST CANCER (STAGE IV)- what’s treatment of choice
• Endocrine therapy is the treatment of choice for patients who havehormone receptor-positive metastases in soft tissue, bone, pleura,
or, if asymptomatic, viscera.
Drugs for Metastatic Breast Cancer
Aromatase inhibitors reduce circulating and target organ estrogens by blocking peripheral conversion from an androgenic precursor, the primary source of estrogens in postmenopausal women.
• Newer agents like aminoglutethimide.
What drugs are second in line therapy
• Anastrozole, letrozole, and exemestane are approved as second-line
therapy; anastrozole and exemestane have been shown to improve OS and time to progression compared with progestins.
• As first-line therapy:
anastrozole and letrozole
increase time to progression and are better
tolerated compared with tamoxifen.
Endocrine therapy of choice in premenopausal women
• Ovarian ablation (oophorectomy); produces similar
overall response rates as tamoxifen.
What is a reversible alternative to surgery.
Medical castration with an LHRH analog,
goserelin, leuprolide, or triptorelin,
Single or multiple agents?
Single agents are associated with lower response rates
than combination therapy, but time to progression and
OS are similar.
• Single agents are better tolerated, an important
consideration in the palliative metastatic setting.
Whats used as first-line therapy for MBC. Metastatic breast cancer
Anthracyclines and taxanes produce response rates of 50% to 60% when
•What’s Lapatinib,
Its a tyrosine kinase inhibitor that targets both
HER2 and the epidermal growth factor receptor,
improved response rates and time to progression in
combination with capecitabine.
The most common adverse events were rash and
diarrhea.
What’s the role of bevacizumab
Its a monoclonal antibody targeted against vascular endothelial growth factor
