Breast Cancer Flashcards
What does ER-positive mean in a patient with breast cancer?
Oestrogen receptor positive
What does it mean if a patient has ER-positive breast cancer?
This means that hormonal therapies normally work well.
What does HER2 positive mean in breast cancer?
This means that the breast cancer has a lot of human epidermal growth factor receptor 2 (HER2)
What is the implication if someone is HER2+ with breast cancer?
It means that they have an increased risk of the cancer from growing quickly as HER2 encourages the cancer cells to divide and grow.
What is ‘Triple negative breast cancer’?
Cancer that does not have receptors for either HER2 or Oestrogen/Progesterone
What percentage of women with breast cancer have a triple negative breast cancer?
20%
Which age group is more commonly associated with triple negative breast cancer?
Younger women
If a patient presents with clinical signs of Metastatic Spinal Cord Compression (MSCC), what should be done?
An urgent (24-48 hour) referral There is often an MSCC coordinator in oncology
What are the signs/symptoms that NICE say clinically point towards MSCC?
- Progressive spinal pain
- Severe unremitting spinal pain
- Spinal pain worsened by straining (e.g. defecating, coughing, sneezing, moving)
- Pain described as ‘band-like’
- Localised spinal tenderness
- Nocturnal spinal pain preventing sleep
- Neurological Sx: radicular pain, limb weakness, walking impairment, sensory loss, bladder/bowel dysfunction
What scan is required to confirm or disprove a diagnosis of MSCC?
MRI spine
When there is a diagnosis of MSCC, what should the management plan be for the patient?
- High dose corticosteroids - usually dexamethasone
- Opioid analgesia
- Neurosurgical stabilisation
- Radiotherapy - either palliative to surgery or instead of surgery
If a patient presented to the ED with suspected MSCC, as a Junior what bloods would you take?
- FBC - bone marrow suppression with anaemia and thrombocytopenia risk
- Bone profile - hypercalcaemia in bone mets
- U&Es
- LFTs - checking for further mets
What scan, after an MRI spine, would be needed in a patient with suspected MSCC?
CT TAP - help to make decisions about surgery
What are the systemic treatment options for available for patients with metastatic breast cancer?
- Endocrine therapy
- Chemotherapy
- HER2 targeted therapy - trastuzumab and pertuzumab
- Bone targeted therapy - bisphosphonates (zoledronic acid)
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?
This is because there is limited influence on choice of treatment by knowing the PR status
How do hormone treatments work in breast cancer (specifically HER2 +)?
They prevent tumour cells from being stimulated to divide by circulating oestrogen
Give an example of hormonal treatment in breast cancer.
Tamoxifen
What type of hormonal treatment is Tamoxifen?
Selective Oestrogen Receptor Modulator (SERM)
How do SERM’s work?
They block oestrogen receptors (ERs) therefore preventing any oestrogen uptake.
How do aromatase inhibitors work?
They prevent the conversion of androgens to oestrogen and effectively reduce the levels of oestrogen in the blood to undetectable levels.
Which group of women are the only ones allowed to use Aromatase Inhibitors?
Post-menopausal women
When would chemotherapy be used instead of hormonal therapy for patients with breast cancer?
If the patient has a HER2 negative breast cancer
What percentage of breast cancers are HER2 positive?
15%
What is the current recommended first line treatment for metastatic HER2 positive breast cancer?
It is a combination of;
- Pertuzumab
- Trastuzumab
- Chemotherapy (most commonly docetaxel)
What is the common serious side effect of the HER2 targeted therapy drugs (e.g. trastuzumab and pertuzumab)?
Implication for cardiac function
What monitoring is required for patients who are receiving anti-HER2 therapy for breast cancer?
LVEF must be assessed before starting treatment, as well as continual monitoring during treatment via echocardiogram or MUGA
What is the common monoclonal antibody that is prescribed in a patient with metastatic cancer and osteoporosis?
Denosumab
What type of monoclonal antibody is Denosumab?
RANK ligand inhibitor
What do RANK ligand inhibitors impact?
The bone remodelling process
What is the dose route and frequency of Denosumab when treating metastatic cancer?
120mg once every weeks via SC injection
What are the 2 common and significant side effects of Denosumab?
- Hypocalcaemia
2. Osteonecrosis of the jaw
What blood tests do patients need to have before they start Denosumab and just after commencing?
A calcium blood test
