Breast Cancer Flashcards
Which age group is most affected by breast cancer
Most women who are diagnosed with breast cancer are over the age of 50
Most men who get breast cancer are over 60.
What is the benefit of adjuvant treatment following breast cancer surgery
It reduces the risk of recurrence - 10%
Improves survival
Who gets adjuvant treatment for breast cancer
Patients with high risk of recurrence:
- Pathology (type of tumour, size of tumour, lymphovascular invasion)
- LN status (biggest predictor)
Receptor / hormone status
Which types of adjuvant treatment can be used in breast cancer
Radiotherapy Chemotherapy Biological therapy Hormone therapy Bisphosphonates
What is the purpose of radiotherapy to the axilla/SCF in breast cancer
Reduces risk of recurrence and the need for axillary LN clearance
How long after breast surgery should chemo be started
within 3-6 weeks after surgery
List some of the side effects of adjuvant biological therapies for breast cancer
Cardiotoxicity
Allergic reaction
Fever
Fatigue
List some of the adjuvant biological therapies used for breast cancer
Herceptin - Trastuzumab
Used if cancer is HER2+
Pertuzumab
List some of the adjuvant hormone therapies used for breast cancer
Ovarian ablation
Tamoxifen
Aromatase inhibiotrs for ER+ cancers:
Letrozole
Anastrozole
List some potential side effects of adjuvant hormone therapies used for breast cancer
Hot flushes
Joint pains
Weight gain
Infertility
Aromatase inhibitors - osteoporosis
Tamoxifen specific:
Thromboembolic events
Endometrial hyperplasia (small risk of endometrial cancer)
How do aromatase inhibitors work to treat breast cancer
They block aromatase from converting androgens to oestrogen
Oestrogen can drive tumours if they are oestrogen receptor (ER) positive
Example: Letrozole
List some potential side effects of bisphosphonate use
Osteonecrosis of the jaw
Renal impairment
Atypical fratures
List examples of bisphosphonates used in the treatment of breast cancer
Zolendronic acid
Pamidronate
Ibandronic acid
Risedronate
What is the most common cancer in women
Breast cancer
Which women are offered breast screening
Those aged 50-70
Get a 3 yearly mammogram - more if family history
Detects small and impalpable tumours
Which treatments are available for breast cancer
Surgery Radiotherapy Systemic therapy - hormonal therapy - cytotoxic chemotherapy - immunotherapy
How is radiotherapy used palliatively in breast cancer
Palliatively to painful bony mets, skin deposits, brain mets etc.
How is radiotherapy used radically in breast cancer
This is it’s primary use - radical
Used for locally advanced disease
Which patients get post-operative radiotherapy
All patients being treated conservatively (wide local excision/lumpectomy)
Mastectomy patients selectively – large tumour, extensive nodal involvement, involved margins etc
Radiation to the supraclavicular fossa can cause which side effect
Dysphagia
List some late effects of postoperative radiotherapy for breast cancer
Local fibrosis and telangectasia Lung fibrosis (rarely symptomatic) Cardiac damage (ischaemic heart disease) – rarer now treatment better planned
Where does breast cancer often met to
Local recurrence in lymph nodes Lung - can cause effusions Liver- can cause effusions Bone - can cause pathological fractures Brain
Rarely: skin, peritoneum, leptomeninges
How are bisphosphonates used in the treatment of breast cancer
Used for bony mets
Zolendronic acid - prevents tumour adhesion to the bone, induces tumour cell apoptosis, and inhibits angiogenesis
How does breast cancer present
Asymptomatic - picked up by screening Lump Change in breast Non-cyclical breast pain Nipple change/discharge Skin change - e.g. inflammatory
List risk factors for breast cancer
Age, Genetics – BRCA mutations High BMI Inactivity Alcohol OCP HRT Low parity Less breastfeeding
What is involved in the triple assessment for breast cancer
Examination
USS/mammogram
Biopsy
Which chemos are often used for breast cancer
Multiple regimes tailored to patient
3rd generation – antracycline, taxanes
When would you suspect a BRCA mutation
If very young
Strong FHx
Bilateral cancers
Breast/ovarian or male breast cancer histories
How do breast cancer mets present
General: malaise, anorexia, weight loss, Ca2+
Related to site e.g pain, SOB
Emergency: seizure, jaundice, pathological fractures, SCC
Incidental finding: PE/DVT, asymptomatic
What are the options for palliative breast cancer therapy
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
