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PY3 > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the tumor suppressor gene that gets mutated in cancer?

A

P53

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2
Q

Which mutation has an increased incidence of breast and ovarian cancers?

A

BRCA1

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3
Q

Which mutation can increase the risk of ovarian cancer and both male and female breast cancer?

A

BRCA2

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4
Q

What are the 5 risk factors of breast cancer?

A
  1. Female
  2. Age
  3. Genetic mutations
  4. Family history of breast cancer
  5. Endogenous estrogen exposure
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5
Q

What 3 things would cause endogenous estrogen exposure?

A
  1. Early menarche (</14)
  2. Late menopause (>/ 55)
  3. Age at birth of first child (> 30)
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6
Q

What are 5 risk factors that can cause breast cancer (continued)?

A
  1. Benign breast disease
  2. Radiation exposure
  3. Obesity/ high BMI
  4. Low physical activity
  5. Alcohol consumption
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7
Q

What are 3 controversial risk factors?

A
  1. Exogenous estrogen exposure
  2. Oral contraceptives
  3. Estrogen replacement therapy
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8
Q

What are 3 factors associated with lower risk?

A
  1. Breastfeeding
  2. Moderate or vigorous physical activity
  3. Maintaining a healthy body weight
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9
Q

What are the 3 screening tests for BC?

A
  1. Breast self-examination
  2. Clinical breast examination
  3. Mammography
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10
Q

For women of average risk, when should they start getting screened for BC?

A

Around age 40

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11
Q

What 3 things can be used to help prevent BC?

A
  1. Prophylactic mastectomies
  2. Bilateral oophorectomies
  3. Drug therapy prevention
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12
Q

What are the 2 most common symptoms of BC?

A
  1. Painless lump
  2. Stabbing or aching pain
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13
Q

What are 4 less common symptoms of BC?

A
  1. Nipple tenderness
  2. Change in size or shape of the breast
  3. Erythema, scaling, eczema, swelling
  4. Peu d’orange
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14
Q

What are the 5 main sites of metastases?

A
  1. Bone
  2. Liver
  3. Lung
  4. Brain
  5. Skin
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15
Q

What is the most common pathological type of BC?

A

Invasive ductal carcinoma

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16
Q

Which pathological type has the worst prognosis?

A

Invasive ductal carcinoma

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17
Q

ER and PR __tumors are generally less aggressive than _____ ones.

A

+; negative

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18
Q

What is Her2neu overexpression associated with?

A

Poorer prognosis

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19
Q

_____ proliferation index when high, shows when a patient needs chemo

A

Ki-67

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20
Q

What is the standard treatment for stage I, IIA, IIB?

A

Surgical resection

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21
Q

To get a lumpectomy what must patients also be willing to receive?

A

Radiation

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22
Q

What should you consider for tumors too large for lumpectomy?

A

Neoadjuvant chemotherapy

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23
Q

What is used for sentinel lymph node biopsy?

A

Methylene blue

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24
Q

What happens if the lymph nodes turn blue with sentinel lymph node biopsy?

A

Radiation is needed

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25
Q

For systemic therapy for early stage what should you do?

A

Irradiate micrometastatic disease

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26
Q

What are 3 situations where the patients must receive chemotherapy?

A
  1. ER and PR -
  2. Her2neu +
  3. Cancer is present in lymph nodes
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27
Q

What 3 criteria must be met so that a patient can get more specific testing on the tumor to determine the benefit of chemotherapy?

A
  1. ER+ or PR+
  2. Her2neu -
  3. Negative lymph nodes
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28
Q

What test can be used to help determine likelihood of recurrence and the benefit of chemotherapy

A

Oncotype DX

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29
Q

What is preferred adjuvant chemotherapy?

A

AC followed by T

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30
Q

What does AC stand for in preferred adjuvant chemotherapy?

A

Anthracycline + alkylating agent

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31
Q

If the first line preferred adjuvant chemotherapy can’t be tolerated, what regimen can be used?

A

TC

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32
Q

For adjuvant chemotherapy what is TC?

A

Taxane + alkylating agent

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33
Q

What adjuvant chemotherapy regimen should be used for patients who are old and have a HF risk?

A

TC

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34
Q

What adjuvant chemotherapy regimen is the most aggressive?

A

TAC

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35
Q

What patient population can TAC be used in?

A

Younger patients

36
Q

Trastuzumab

A

HERCEPTIN

37
Q

What is the major ADR of herceptin?

A

Cardiac

38
Q

What should you not administer trastuzumab with?

A

Anthracyclines

39
Q

For patients that are HER2NEU+, what regimen should they receive?

A

AC—> T + concurrent trastuzumab

40
Q

If a patient cannot receive an anthracycline and are HER2NEU+, what regimen should you use?

A

TCH (herceptin)

41
Q

What are two therapeutic options that can be used to prevent recurrence in ER+ or PR+ tumors?

A
  1. Tamoxifen
  2. Aromatase inhibitors
42
Q

What does tamoxifen compete with?

A

Estradiol

43
Q

What are serious ADEs caused by tamoxifen? 2

A
  1. Thromboembolism
  2. Endometrial/ uterine cancer
44
Q

What two drugs should you avoid taking with tamoxifen?

A
  1. Fluoxetine
  2. Paroxitine
45
Q

What decreases when aromatase is inhibited?

A

Estrogen

46
Q

What are the 2 non-steroidal aromatase inhibitors?

A
  1. Anastrazole
  2. Letrozole
47
Q

What is a steroidal aromatase inhibitor?

A

Exemestane

48
Q

What are 2 ADEs of aromatase inhibitors?

A
  1. Osteoporosis
  2. Musculoskeletal pain/ arthralgias
49
Q

What endocrine therapy can be used for premenopausal women?

A

Tamoxifen

50
Q

What endocrine therapy can be used for post menopausal women?

A

Aromatase inhibitors

51
Q

How long are patients on endocrine therapy?

A

5-10 years

52
Q

True or false: the optimal regimen for stage III BC is AC —> T

A

False; no optimal regimen

53
Q

How would you begin to treat stage III BC?

A

Neoadjuvant systemic chemotherapy

54
Q

If there is no response with the treatment in stage III BC, what should be considered?

A

Other neoadjuvant chemotherapy or neoadjuvant XRT

55
Q

If there is a response with the treatment for stage III BC, what can be done?

A

Surgery

56
Q

When can you give adjuvant endocrine therapy in stage III BC?

A

After all systemic therapy is completed

57
Q

What is the goal of therapy for metastatic breast cancer?

A

Palliative care

58
Q

What type of BC metastases has a better prognosis?

A

Bone and soft tissue

59
Q

What is bone and soft tissue metastases more likely to respond to?

A

Endocrine therapy

60
Q

What does symptomatic visceral metastases require?

A

Chemotherapy

61
Q

What type of metastases generally does not respond to chemotherapy?

A

Brain metastases

62
Q

If a patient has no prior therapy, is ER + or PR+ and has bone metastases only, what are they treated with?

A

Endocrine therapy

63
Q

If a patient has had no prior therapy, is ER+ or PR+, and has visceral metastases, what should they be treated with?

A

Systemic chemotherapy

64
Q

When is endocrine therapy the most useful? 3

A
  1. ER+ or PR+
  2. Post menopausal
  3. Bone or soft tissue metastases only
65
Q

What patient population can ovarian ablation be an option?

A

In pre-menopausal women only

66
Q

Pure antiestrogen

A

Fulvestrant

67
Q

Fulvestrant

A

FASLODEX

68
Q

What is the main ADE caused by Fulvestrant?

A

Injection site reactions

69
Q

What patients are able to use CDK4/6 inhibitors?

A
  1. HR+
  2. Advanced or metastatic breast cancer
70
Q

What can CDK4/6 inhibitors be used in combination with?

A

Fulvestrant or aromatase inhibitor

71
Q

How are the CDK4/6 inhibitors administrated?

A

Orally

72
Q

What are the 3 CDK4/6 inhibitor available agents? 3

A
  1. Abemaciclib
  2. Palbociclib
  3. Ribociclib
73
Q

Abemaciclib

A

VERZENIO

74
Q

Palbociclib

A

IBRANCE

75
Q

Ribociclib

A

Kisqali

76
Q

What are 3 common ADEs of the CDK4/6 inhibitors?

A
  1. Myelosuppression
  2. Fatigue
  3. Nausea
77
Q

What are the most active agents used in systemic chemotherapy for scenario 1?

A

Anthracyclines and taxanes

78
Q

What is the use of combination or sequential chemotherapy based on?

A

Individual basis

79
Q

When a patient has no prior therapy and is ER- or PR- what therapy is not effective?

A

Endocrine therapy

80
Q

Patients who require a rapid response due to large disease burden may require what?

A

Combination chemotherapy

81
Q

What must a patient who has had no prior chemotherapy and is ER- or PR- receive?

A

Chemotherapy

82
Q

If a patient has had prior therapy, is ER+ or PR+, and has bone mets only, what should be used?

A

Endocrine therapy

83
Q

If a patient has had prior therapy, is ER+ or PR+ and has visceral mets, what should be used?

A

Chemotherapy

84
Q

If a patient has had prior therapy and is ER- or PR-, what should be used?

A

Chemotherapy

85
Q

If a patient has had prior therapy and is ER- or PR-, what will not be effective?

A

Endocrine therapy

86
Q

For recurrence, treatment is based on _______ decision

A

Case by case

87
Q

Each attempt at chemotherapy has a ______ median duration

A

Shorter

PY3 (24 decks)

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