Breast cancer

Question 1

what are the risk factors for breast cancer

Answer 1

age, early onset of menstruation, late menopause and older age of pregnancy, fh of breast cancer, obesity and alcohol consumption

Question 2

Medications that increase risk of breast cancer

Answer 2

oral contraceptives and HRT

Question 3

What can protect against breast cancer

Answer 3

physical activity and breast feeding

Question 4

types of treatment for breast cancer

Answer 4

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

Question 5

what is the name of the chemo used for invasive breast cancer

Answer 5

anthracycline-taxane combination combination is recommended in pts with invasive breast cancer who are at risk of reoccurrence and chemotherapy

Question 6

what is teh name of the biological therapyfor breast cancer. when is it used? what needs to be monitored alonside this

Answer 6

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

Question 7

what medication should be used in men and pre menoupausal women with oestrogen receptor positive invasive breast cancer

Answer 7

tamoxifen as adjuvant endocrine therapy before chemo

Question 8

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

Answer 8

aromatase inhibitor

Tamoxifen i fthis is contra-indicated

Question 9

which drugs have been shown to improve disease free survival and overall survival in postmenopausal women with node positive invasive breast cancer

Answer 9

zolendronic acid and sodium clodronate

Question 10

for pts with oestrogen receptor negative breast cancer what should be used to reduce tumour size

Answer 10

neoadjuvant chemo

Question 11

in pts with HER2 positive invsaive breast cancer what should be used

Answer 11

neoadjuvant alongside tratuzumab and pertuzumab

Question 12

what meds should be used for triple negative invasive breast cancer

Answer 12

platinum and an anthracycline

Question 13

if pt oestrogen receptor positive advanced breast cancer

Answer 13

endocrine therapy first line

Question 14

post menopausal with no hostory of endocrine treatment or those previously treated with tamoxifen what is used

Answer 14

aromatase ihibotors

Question 15

for pre and perimenopausal wone with oestrogen receptor posistive advanced breast cancer not treated with tamoxifen what should be used

Answer 15

tamoxifen and ovarian supression

Question 16

for men with oestrogen receptor positive advanced breast cancer what can be used

Answer 16

Tamoxifen

Question 17

for pts with her2 positive advance breast cancer

Answer 17

trastuzumab

with bisphosphonates to prevent bone metastasis

Question 18

when is chemoprotection used and how long

Answer 18

5 years max

high risk if developing breast cancer

Question 19

what should be uswd in post menoupausal women who do not have server osteoporosis

Answer 19

anastrozole

Question 20

what should be used in premenopausal women eho do not have a history or increased risk of thromboembolic disease or endometrial cancer

Answer 20

tamoxifen

Question 21

in which women should raloxifene hydrochloride be used

Answer 21

postmenopausal women with a uterus who do not wish to take tamoxifen

Question 22

common side effects of tamoxifen

Answer 22

hot flushes
genital itching
menstrual changes
endometrial changes
n and v

Question 23

pt and carere advice surrounding tamoxifen

Answer 23

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

Question 24

name the aromatase inhibitors

moa

Answer 24

anastrozole, letrozole, exemestane
aromatase is the enzyme whihc facilitates the conversion of androgens into oestrogens. aromatase inhibotrs inhibit this reducing oestrogen

Question 25

when are aromatase inhibitors used and what are the side effects

Answer 25

post-menopausal women (CI in pre-menopausal women)

side effects: hot flushes, vulvovaginal dryness, osteoporosis, vaginal haemorrhage

Question 26

name the selective oestrogen receptor down regulators (SERDs) and moa and s/e

Answer 26

fulvestrant
block oestrogen receptor as well as down regulates
side effects- hot flushes and VTE

Question 27

NAME examples and moa of selective oestrogen receptor modulators
can it be used in pre post menopausal

Answer 27

tamoxifen, raloxifene
partial agonists of oestrogen receptors
can be used in both pre and post menopausal women

Question 28

what are the side effects associated with selective oestrogen receptor modulators
what drug does it interact with

Answer 28

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

Question 29

which types of cancers should trastuzumab be given for and what is the major side effect

Answer 29

HER2 + breast cancer
cardiotoxicity- cardiac function monitored before and during treatment
should not be given with anthracycline containing regimens due to cardiotoxicity risk

Question 30

name the luteinising hormone releasing hormone analogues and moa

Answer 30

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