Breast cancer Flashcards
(40 cards)
Non-genetic risk factors for breast cancer
Female sex Older age Younger age at menarche or older age at menopause Atypical ductal hyperplasia LCIS Chest radiation
Use/effectiveness of tamoxifen chemoprevention for breast cancer
Reduces incidence of invasive BC but no effect on breast-cancer specific or all cause mortality
Can use in pre or post menopausal
Increased risk of endometrial CA and VTE
Use/effectiveness of raloxifene chemoprevention for breast cancer
Reduced incidence of invasive breast cancer but no effect on overall mortality
Postmenopausal only
Not associated with endometrial cancer
Does have VTE risk
Her2 positive definition
IHC 3+
Her2/Cep17 ratio >= 2 and average Her2 copy number >= 4
Oncotype Dx recurrence score patient inclusion criteria and cut points
HR+, Her2-, LN neg breast CA
> 25 -> adjuvant chemo + endocrine tx
In women 50 or younger, >=16 benefits from chemo
DCIS treatment
Breast conserving surgery with 2mm margins + radiation
ER+ give adjuvant tamoxifen/anastrozole x 5 years
Adjuvant endocrine tx reduces risk of local recurrence or contralateral disease but no established OS benefit
Stage I-III breast CA definition of adequate surgical margins
No tumor present at inked margin
Stage I-III breast CA axilla management, clinically node negative
SLN biopsy at surgery
Management of positive SLN
Micromets only -> no ALND
1-2 positive nodes + T1-T2 + lumpectomy planning for RT + no neoadjuv therapy -> no ALND
Otherwise -> ALND
Regional nodal radiation indication
After BCS or mastectomy with more than 3 involved nodes
Can consider in patients with 1-3 nodes
Post-mastectomy RT indications
Tumor > 5cm
T4 disease
Positive margins
Consider for LVI
Post-BCS radiation recommendations
Hypofractionated whole breast RT over 3 weeks equivalent to RT over 5-6 weeks
Women > 65 or 70 with small, node neg, ER positive tumors who are going to get endocrine therapy can omit RT
LCIS management
Now classified as a benign entity
Don’t need to remove but does increase risk of cancer in both breasts
Can use tamoxifen- lowers risk of invasive BC
Invasive tubular carcinoma management
Excellent prognosis
Generally treat the same as IDC but typically don’t need chemo
Inflammatory breast cancer management
Neoadjuvant chemotherapy ->
Mastectomy + ALND ->
Radiation
Avoid immediate reconstruction d/t high risk of local recurrence
Phyllodes tumor characteristics and management
US suggestive of fibroadenoma but tumor is big and rapidly growing
Can be benign, borderline, or malignant
Benign -> observe
Borderline/malignant -> wide excision
Paget disease characteristics and work up
Nipple/areolar eczema, ulceration, bleeding, itching
Often have underlying invasive BCa
Need full-thickness skin biopsy of nipple-areolar complex + core biopsy of any breast lesion
Paget disease management
Paget only (w/o invasive BCa) -> lumpectomy including nipple-areolar complex + RT or mastectomy Paget + invasive BCa -> follow invasive disease management
Intraductal papilloma management
Can present with bloody nipple discharge
Benign but can harbor areas of atypia or DCIS
Excise if evidence of atypia on biopsy
Indications for genetic testing
45 or younger at BCa diagnosis
TNBC and 60 or younger
Family hx of BCa and pt <50
Male breast cancer at any age
(Neo)adjuvant chemo regimens for HR+/Her2 neg
Generally don’t give chemo if tumor <0.5cm and pN0
Adjuvant chemo recommended for recurrence score > 25 (or > 16 and pt under 50 years)
Docetaxel + cyclophosphamide x4 for node neg
ddAC (doxorubicin, cyclophosphamide) x4 followed by weekly paclitaxel x12 better if 4+ nodes involved
Give chemo before giving endocrine tx
Endocrine therapy choices
Premenopausal and under 35 -> ovarian suppression (OS) + AI
Premenopausal with indication for chemo -> OS + AI
Premenopausal, over 35, no chemo indication -> tamoxifen with transition to AI when post-menopausal
Postmenopausal -> AI
Men -> tamoxifen
Give ET for 5-10 years
Management of TNBC with residual disease after neoadjuvant therapy
OS benefit with adjuvant capecitabine x6-8 cycles
Management of Her2+ with residual disease after neoadjuvant therapy
Switch to TDM-1 to complete 1 year
