Breast Cancer

Question 1

Which age group is most affected by breast cancer

Answer 1

Most women who are diagnosed with breast cancer are over the age of 50
Most men who get breast cancer are over 60.

Question 2

What is the benefit of adjuvant treatment following breast cancer surgery

Answer 2

It reduces the risk of recurrence - 10%

Improves survival

Question 3

Who gets adjuvant treatment for breast cancer

Answer 3

Patients with high risk of recurrence:
- Pathology (type of tumour, size of tumour, lymphovascular invasion)
- LN status (biggest predictor)
Receptor / hormone status

Question 4

Which types of adjuvant treatment can be used in breast cancer

Answer 4

Radiotherapy
Chemotherapy
Biological therapy
Hormone therapy
Bisphosphonates

Question 5

What is the purpose of radiotherapy to the axilla/SCF in breast cancer

Answer 5

Reduces risk of recurrence and the need for axillary LN clearance

Question 6

How long after breast surgery should chemo be started

Answer 6

within 3-6 weeks after surgery

Question 7

List some of the side effects of adjuvant biological therapies for breast cancer

Answer 7

Cardiotoxicity
Allergic reaction
Fever
Fatigue

Question 8

List some of the adjuvant biological therapies used for breast cancer

Answer 8

Herceptin - Trastuzumab
Used if cancer is HER2+

Pertuzumab

Question 9

List some of the adjuvant hormone therapies used for breast cancer

Answer 9

Ovarian ablation
Tamoxifen

Aromatase inhibiotrs for ER+ cancers:
Letrozole
Anastrozole

Question 10

List some potential side effects of adjuvant hormone therapies used for breast cancer

Answer 10

Hot flushes
Joint pains
Weight gain
Infertility

Aromatase inhibitors - osteoporosis

Tamoxifen specific:
Thromboembolic events
Endometrial hyperplasia (small risk of endometrial cancer)

Question 11

How do aromatase inhibitors work to treat breast cancer

Answer 11

They block aromatase from converting androgens to oestrogen
Oestrogen can drive tumours if they are oestrogen receptor (ER) positive
Example: Letrozole

Question 12

List some potential side effects of bisphosphonate use

Answer 12

Osteonecrosis of the jaw
Renal impairment
Atypical fratures

Question 13

List examples of bisphosphonates used in the treatment of breast cancer

Answer 13

Zolendronic acid
Pamidronate
Ibandronic acid
Risedronate

Question 14

What is the most common cancer in women

Answer 14

Breast cancer

Question 15

Which women are offered breast screening

Answer 15

Those aged 50-70
Get a 3 yearly mammogram - more if family history

Detects small and impalpable tumours

Question 16

Which treatments are available for breast cancer

Answer 16

Surgery
Radiotherapy
Systemic therapy
-  hormonal therapy
- cytotoxic chemotherapy
- immunotherapy

Question 17

How is radiotherapy used palliatively in breast cancer

Answer 17

Palliatively to painful bony mets, skin deposits, brain mets etc.

Question 18

How is radiotherapy used radically in breast cancer

Answer 18

This is it’s primary use - radical

Used for locally advanced disease

Question 19

Which patients get post-operative radiotherapy

Answer 19

All patients being treated conservatively (wide local excision/lumpectomy)

Mastectomy patients selectively – large tumour, extensive nodal involvement, involved margins etc

Question 20

Radiation to the supraclavicular fossa can cause which side effect

Answer 20

Dysphagia

Question 21

List some late effects of postoperative radiotherapy for breast cancer

Answer 21

Local fibrosis and telangectasia
Lung fibrosis (rarely symptomatic)
Cardiac damage (ischaemic heart disease) – rarer now treatment better planned

Question 22

Where does breast cancer often met to

Answer 22

Local recurrence in lymph nodes 
Lung - can cause effusions 
Liver- can cause effusions 
Bone - can cause pathological fractures 
Brain 

Rarely: skin, peritoneum, leptomeninges

Question 23

How are bisphosphonates used in the treatment of breast cancer

Answer 23

Used for bony mets

Zolendronic acid - prevents tumour adhesion to the bone, induces tumour cell apoptosis, and inhibits angiogenesis

Question 24

How does breast cancer present

Answer 24

Asymptomatic - picked up by screening 
Lump 
Change in breast
Non-cyclical breast pain
Nipple change/discharge
Skin change - e.g. inflammatory

Question 25

List risk factors for breast cancer

Answer 25

Age,
Genetics – BRCA mutations
High BMI
Inactivity
Alcohol
OCP
HRT
Low parity
Less breastfeeding

Question 26

What is involved in the triple assessment for breast cancer

Answer 26

Examination
USS/mammogram
Biopsy

Question 27

Which chemos are often used for breast cancer

Answer 27

Multiple regimes tailored to patient

3rd generation – antracycline, taxanes

Question 28

When would you suspect a BRCA mutation

Answer 28

If very young
Strong FHx
Bilateral cancers
Breast/ovarian or male breast cancer histories

Question 29

How do breast cancer mets present

Answer 29

General: malaise, anorexia, weight loss, Ca2+

Related to site e.g pain, SOB

Emergency: seizure, jaundice, pathological fractures, SCC

Incidental finding: PE/DVT, asymptomatic

Question 30

What are the options for palliative breast cancer therapy

Answer 30

Can use radiotherapy, chemo, other SACT such as hormones
Have to balance the benefit of this with the actual response and how the side effects impact QoL

Other option is supportive - Macmillan nurses, meds for symptoms, pleural/ascitic drains (?permanent), palliative mastectomy, end of life care