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Oncology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What does ER-positive mean in a patient with breast cancer?

A

Oestrogen receptor positive

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2
Q

What does it mean if a patient has ER-positive breast cancer?

A

This means that hormonal therapies normally work well.

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3
Q

What does HER2 positive mean in breast cancer?

A

This means that the breast cancer has a lot of human epidermal growth factor receptor 2 (HER2)

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4
Q

What is the implication if someone is HER2+ with breast cancer?

A

It means that they have an increased risk of the cancer from growing quickly as HER2 encourages the cancer cells to divide and grow.

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5
Q

What is ‘Triple negative breast cancer’?

A

Cancer that does not have receptors for either HER2 or Oestrogen/Progesterone

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6
Q

What percentage of women with breast cancer have a triple negative breast cancer?

A

20%

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7
Q

Which age group is more commonly associated with triple negative breast cancer?

A

Younger women

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8
Q

If a patient presents with clinical signs of Metastatic Spinal Cord Compression (MSCC), what should be done?

A 
An urgent (24-48 hour) referral
There is often an MSCC coordinator in oncology
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9
Q

What are the signs/symptoms that NICE say clinically point towards MSCC?

A
  1. Progressive spinal pain
  2. Severe unremitting spinal pain
  3. Spinal pain worsened by straining (e.g. defecating, coughing, sneezing, moving)
  4. Pain described as ‘band-like’
  5. Localised spinal tenderness
  6. Nocturnal spinal pain preventing sleep
  7. Neurological Sx: radicular pain, limb weakness, walking impairment, sensory loss, bladder/bowel dysfunction
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10
Q

What scan is required to confirm or disprove a diagnosis of MSCC?

A

MRI spine

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11
Q

When there is a diagnosis of MSCC, what should the management plan be for the patient?

A
  1. High dose corticosteroids - usually dexamethasone
  2. Opioid analgesia
  3. Neurosurgical stabilisation
  4. Radiotherapy - either palliative to surgery or instead of surgery
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12
Q

If a patient presented to the ED with suspected MSCC, as a Junior what bloods would you take?

A
  1. FBC - bone marrow suppression with anaemia and thrombocytopenia risk
  2. Bone profile - hypercalcaemia in bone mets
  3. U&Es
  4. LFTs - checking for further mets
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13
Q

What scan, after an MRI spine, would be needed in a patient with suspected MSCC?

A

CT TAP - help to make decisions about surgery

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14
Q

What are the systemic treatment options for available for patients with metastatic breast cancer?

A
  1. Endocrine therapy
  2. Chemotherapy
  3. HER2 targeted therapy - trastuzumab and pertuzumab
  4. Bone targeted therapy - bisphosphonates (zoledronic acid)
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15
Q

Why is it not as relevant to know the Progesterone Receptor status of a patient’s breast cancer in comparison to knowing their ER status?

A

This is because there is limited influence on choice of treatment by knowing the PR status

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16
Q

How do hormone treatments work in breast cancer (specifically HER2 +)?

A

They prevent tumour cells from being stimulated to divide by circulating oestrogen

17
Q

Give an example of hormonal treatment in breast cancer.

A

Tamoxifen

18
Q

What type of hormonal treatment is Tamoxifen?

A

Selective Oestrogen Receptor Modulator (SERM)

19
Q

How do SERM’s work?

A

They block oestrogen receptors (ERs) therefore preventing any oestrogen uptake.

20
Q

How do aromatase inhibitors work?

A

They prevent the conversion of androgens to oestrogen and effectively reduce the levels of oestrogen in the blood to undetectable levels.

21
Q

Which group of women are the only ones allowed to use Aromatase Inhibitors?

A

Post-menopausal women

22
Q

When would chemotherapy be used instead of hormonal therapy for patients with breast cancer?

A

If the patient has a HER2 negative breast cancer

23
Q

What percentage of breast cancers are HER2 positive?

A

15%

24
Q

What is the current recommended first line treatment for metastatic HER2 positive breast cancer?

A

It is a combination of;

  1. Pertuzumab
  2. Trastuzumab
  3. Chemotherapy (most commonly docetaxel)
25
Q

What is the common serious side effect of the HER2 targeted therapy drugs (e.g. trastuzumab and pertuzumab)?

A

Implication for cardiac function

26
Q

What monitoring is required for patients who are receiving anti-HER2 therapy for breast cancer?

A

LVEF must be assessed before starting treatment, as well as continual monitoring during treatment via echocardiogram or MUGA

27
Q

What is the common monoclonal antibody that is prescribed in a patient with metastatic cancer and osteoporosis?

A

Denosumab

28
Q

What type of monoclonal antibody is Denosumab?

A

RANK ligand inhibitor

29
Q

What do RANK ligand inhibitors impact?

A

The bone remodelling process

30
Q

What is the dose route and frequency of Denosumab when treating metastatic cancer?

A

120mg once every weeks via SC injection

31
Q

What are the 2 common and significant side effects of Denosumab?

A
  1. Hypocalcaemia

2. Osteonecrosis of the jaw

32
Q

What blood tests do patients need to have before they start Denosumab and just after commencing?

A

A calcium blood test

Oncology (7 decks)

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