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Cancer > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What causes breast cancer?

A

A combination of genetic and environmental risk factors

A genetic mutation occurs in tumour suppressor genes BRCA1 and 2 which are responsible for ensuring function of DNA repair or arresting cell cycle

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2
Q

What are the risk factors for breast cancer?

A 
Age > 50 
Earl menopause 
Obesity 
Alcohol (>5u/day) 
Smoking 
No previous breast feeding 
Lifetime oestrogen exposure 
Socioeconomic status 
Race
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3
Q

How does breast cancer present?

A 
Lumps 
Skin dumpling 
Inverted nipples
Nipple discharge 
Breast pain 
Change is breast size/shape 
Axilliary lymphadenopathy
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4
Q

How can you diagnose breast cancer?

A

Palpation - identify characteristics of lump (size, texture, can it move easily?), benign often distinct from malignant

Mammography 
Ultrasonography 
Biopsy 
Fine needle aspirate 
CT scan
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5
Q

What is the first line treatment for breast cancer?

A
  1. Simple mastectomy (removal of breast, tumour and lymph nodes, pectoralis major and minor)
  2. Modified mastectomy (removal of breast, lymph nodes and pectoral is muscle lining)
  3. Wide local excision (cut section out bigger than tumour
  4. Quadrantectomy

IN COMBINATION WITH

  1. Chemotherapy
  2. Radiotherapy
  3. Hormonal therapy
  4. Biological therapy (Trastuzamab)
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6
Q

How is tumour growth stimulated in breast cancer?

A

The presence of oestrogen

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7
Q

How would you reduce tumour growth?

A

Selective Oestrogen receptor modulators (Tamoxifen)

Aromatase enzymes (Letrozole)

Ovarian ablation in premenopausal women

reducing exposure to oestrogen reduces tumour growth

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8
Q

How does Tamoxifen work?

A

It is a selective oestrogen receptor antagonist

It binds to the oestrogen receptor to prevent oestrogen from binding

This slows down proliferation of cancer cells driven by oestrogen

Therefore it is a cytostatic drug

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9
Q

How do aromatase inhibitors (Letrozole) work?

A

They bind to the aromatase enzyme and prevent it from converting androgens into oestrogen

This prevents tumour growth

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10
Q

When is Tamoxifen started? State the dose

A

It is started after chemotherapy

Dose = 10mg BD or 20mg OD for 5 years

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11
Q

What is a benefit of Letrozole compared to Tamoxifen?

A

Neoadjuvant use of Letrozole has been shown to result in more women retaining their breast than for tamoxifen

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12
Q

How does Trastuzumab work?

A

It is a monoclonal antibody (immune checkpoint inhibitor)
That targets the Her-2 receptor which over expressed on tumour cells
It is licensed for metastatic disease

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13
Q

How is Trastuzamab administered?

A

IV infusion given as a loading dose of 4mg/kg and then started 1 week later at 2mg/kh

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14
Q

What is the main disadvantage of Trastuzumab?

A

Implicated in cardiotoxicity especially when used with anthracyclines

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15
Q

How is radiotherapy used in breast cancer?

A

Used as an adjuvant to eradicate local spread following tumour excision

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16
Q

What combinations of chemotherapy are used for breast cancer?

A 
Cyclophosphamide 
Methotrexate 
Epirubicin 
5-FU 
Doxorubicin 
& Taxanes (Docetaxel)
17
Q

Which 2 agents are typically used in the treatment for breast cancer?

A

Cyclophosphamide

Doxorubicin

18
Q

What is the main side effect of cyclophosphamide?

A

An alkylating agent
/ Pro drug that is activated by liver metabolism
Acrolein is a urinary metabolite which is very toxic to the urinary tract
Can lead to haemorrhagic cystitis

19
Q

What is the treatment of haemorrhagic cystitis?

A

Mesna given routinely to pts on IV high dose cyclophosphamide

It reacts with acrolein and neutralises it in the urinary tract to prevent toxicity

20
Q

What is the main side effect of Doxorubicin?

A

Development of cardiomyopathy resulting in a reduced ejection fraction

Occurs due to cumulative dosages of the drug so a limit of 450mg/m2 is given in any tx course

Weekly low dose administration may result in less toxicity

21
Q

Staging of breast cancer

A 
T0 = No tumour
T1 = less than 2cm 
T2 = more than 2cm less than 5cm
T3 = more than 5cm 
T4 = fixation to chest wall/ulceration 
N0 = No palpable axilliary nodes
N1a = palpable nodes do NOT contain tumour
N1b = palpable nodes contain tumour
N2 = Nodes more than 2cm fixed to one another and deep structure 
N3 = Supraclavicular/infraclavicular nodes
M0 = no distant metastases
M1 = distant metastases present
22
Q

What are the haemorrhagic risk factors?

A

High dose IV >2g

Previous pelvic irradation

23
Q

Describe the structure of SERMs

A
  • lack steroid structure of oestrogens

- but possess tertiary structure so can bind to oestrogen receptor

24
Q

why is the binding to selective of SERMs

A
  • differential ostrogen receptor expression in a given target tissue
  • differential oest receptor confirmation on ligand binding
  • differential expression and binding to the oest receptor of co regulator proteins

Cancer (16 decks)

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