Breast cancer Flashcards
what are the risk factors for breast cancer
age, early onset of menstruation, late menopause and older age of pregnancy, fh of breast cancer, obesity and alcohol consumption
Medications that increase risk of breast cancer
oral contraceptives and HRT
What can protect against breast cancer
physical activity and breast feeding
types of treatment for breast cancer
Chemotherapy endocrine therapy biological therapy bisphosphonate therapy suregy to breast with or without radiotherapy follwed by adjuvant therapy based on risk and benefits and hormone receptors. adjuvants are above
what is the name of the chemo used for invasive breast cancer
anthracycline-taxane combination combination is recommended in pts with invasive breast cancer who are at risk of reoccurrence and chemotherapy
what is teh name of the biological therapyfor breast cancer. when is it used? what needs to be monitored alonside this
For tumour size T1C and above HER2 positive invasive breast cancer trastuzumab is used
also for small tumour size
cardiac function should be assessed throughput and caution in pts with underlying cardiac disease
what medication should be used in men and pre menoupausal women with oestrogen receptor positive invasive breast cancer
tamoxifen as adjuvant endocrine therapy before chemo
what mendication should be used in post menopausal women with oestrogen positive invasive breast cancer invasive breast cancer who are high ror medium risk of reoccurrence
aromatase inhibitor
Tamoxifen i fthis is contra-indicated
which drugs have been shown to improve disease free survival and overall survival in postmenopausal women with node positive invasive breast cancer
zolendronic acid and sodium clodronate
for pts with oestrogen receptor negative breast cancer what should be used to reduce tumour size
neoadjuvant chemo
in pts with HER2 positive invsaive breast cancer what should be used
neoadjuvant alongside tratuzumab and pertuzumab
what meds should be used for triple negative invasive breast cancer
platinum and an anthracycline
if pt oestrogen receptor positive advanced breast cancer
endocrine therapy first line
post menopausal with no hostory of endocrine treatment or those previously treated with tamoxifen what is used
aromatase ihibotors
for pre and perimenopausal wone with oestrogen receptor posistive advanced breast cancer not treated with tamoxifen what should be used
tamoxifen and ovarian supression
for men with oestrogen receptor positive advanced breast cancer what can be used
Tamoxifen
for pts with her2 positive advance breast cancer
trastuzumab
with bisphosphonates to prevent bone metastasis
when is chemoprotection used and how long
5 years max
high risk if developing breast cancer
what should be uswd in post menoupausal women who do not have server osteoporosis
anastrozole
what should be used in premenopausal women eho do not have a history or increased risk of thromboembolic disease or endometrial cancer
tamoxifen
in which women should raloxifene hydrochloride be used
postmenopausal women with a uterus who do not wish to take tamoxifen
common side effects of tamoxifen
hot flushes genital itching menstrual changes endometrial changes n and v
pt and carere advice surrounding tamoxifen
risk of thromboembolism
esp after surgey and sededntary like
pt report breathlessness or pain in calf
report irregular vaginal bleeding with pelvic pain or pressure
Contraceptive used during treatment and 2 months after stopping, risk of multiple pregnancy
name the aromatase inhibitors
moa
anastrozole, letrozole, exemestane
aromatase is the enzyme whihc facilitates the conversion of androgens into oestrogens. aromatase inhibotrs inhibit this reducing oestrogen
when are aromatase inhibitors used and what are the side effects
post-menopausal women (CI in pre-menopausal women)
side effects: hot flushes, vulvovaginal dryness, osteoporosis, vaginal haemorrhage
name the selective oestrogen receptor down regulators (SERDs) and moa and s/e
fulvestrant
block oestrogen receptor as well as down regulates
side effects- hot flushes and VTE
NAME examples and moa of selective oestrogen receptor modulators
can it be used in pre post menopausal
tamoxifen, raloxifene
partial agonists of oestrogen receptors
can be used in both pre and post menopausal women
what are the side effects associated with selective oestrogen receptor modulators
what drug does it interact with
endometrial changes (hyperplasia, polys, uterine sarcoma which prompts investigation if abnormal bleeding occurs. increased risk of vte, vaginal dryness, hot flushes, mood changes. tamoxifen= pro drug which requires activation by CYP2D6 therefore interaction with SSRI whihc inhibit this enzyme
which types of cancers should trastuzumab be given for and what is the major side effect
HER2 + breast cancer
cardiotoxicity- cardiac function monitored before and during treatment
should not be given with anthracycline containing regimens due to cardiotoxicity risk
name the luteinising hormone releasing hormone analogues and moa
goserelin, leuprorelin, buserelin
used to induce chemical castration in female of oestrogen and progesterone and testosterone in males via continuous stimulation of the pituitary gland
initial treatment causes a flare up
used in pre menopausal women not post as they no longer make oestrogen
s/e= breast abnormalities, gynaecomastia, hot flushes, altered mood, sexual dysfunction, vulvovaginal dryness
