Breast Cancer Flashcards
What is the tumor suppressor gene that gets mutated in cancer?
P53
Which mutation has an increased incidence of breast and ovarian cancers?
BRCA1
Which mutation can increase the risk of ovarian cancer and both male and female breast cancer?
BRCA2
What are the 5 risk factors of breast cancer?
- Female
- Age
- Genetic mutations
- Family history of breast cancer
- Endogenous estrogen exposure
What 3 things would cause endogenous estrogen exposure?
- Early menarche (</14)
- Late menopause (>/ 55)
- Age at birth of first child (> 30)
What are 5 risk factors that can cause breast cancer (continued)?
- Benign breast disease
- Radiation exposure
- Obesity/ high BMI
- Low physical activity
- Alcohol consumption
What are 3 controversial risk factors?
- Exogenous estrogen exposure
- Oral contraceptives
- Estrogen replacement therapy
What are 3 factors associated with lower risk?
- Breastfeeding
- Moderate or vigorous physical activity
- Maintaining a healthy body weight
What are the 3 screening tests for BC?
- Breast self-examination
- Clinical breast examination
- Mammography
For women of average risk, when should they start getting screened for BC?
Around age 40
What 3 things can be used to help prevent BC?
- Prophylactic mastectomies
- Bilateral oophorectomies
- Drug therapy prevention
What are the 2 most common symptoms of BC?
- Painless lump
- Stabbing or aching pain
What are 4 less common symptoms of BC?
- Nipple tenderness
- Change in size or shape of the breast
- Erythema, scaling, eczema, swelling
- Peu d’orange
What are the 5 main sites of metastases?
- Bone
- Liver
- Lung
- Brain
- Skin
What is the most common pathological type of BC?
Invasive ductal carcinoma
Which pathological type has the worst prognosis?
Invasive ductal carcinoma
ER and PR __tumors are generally less aggressive than _____ ones.
+; negative
What is Her2neu overexpression associated with?
Poorer prognosis
_____ proliferation index when high, shows when a patient needs chemo
Ki-67
What is the standard treatment for stage I, IIA, IIB?
Surgical resection
To get a lumpectomy what must patients also be willing to receive?
Radiation
What should you consider for tumors too large for lumpectomy?
Neoadjuvant chemotherapy
What is used for sentinel lymph node biopsy?
Methylene blue
What happens if the lymph nodes turn blue with sentinel lymph node biopsy?
Radiation is needed
For systemic therapy for early stage what should you do?
Irradiate micrometastatic disease
What are 3 situations where the patients must receive chemotherapy?
- ER and PR -
- Her2neu +
- Cancer is present in lymph nodes
What 3 criteria must be met so that a patient can get more specific testing on the tumor to determine the benefit of chemotherapy?
- ER+ or PR+
- Her2neu -
- Negative lymph nodes
What test can be used to help determine likelihood of recurrence and the benefit of chemotherapy
Oncotype DX
What is preferred adjuvant chemotherapy?
AC followed by T
What does AC stand for in preferred adjuvant chemotherapy?
Anthracycline + alkylating agent
If the first line preferred adjuvant chemotherapy can’t be tolerated, what regimen can be used?
TC
For adjuvant chemotherapy what is TC?
Taxane + alkylating agent
What adjuvant chemotherapy regimen should be used for patients who are old and have a HF risk?
TC
What adjuvant chemotherapy regimen is the most aggressive?
TAC
What patient population can TAC be used in?
Younger patients
Trastuzumab
HERCEPTIN
What is the major ADR of herceptin?
Cardiac
What should you not administer trastuzumab with?
Anthracyclines
For patients that are HER2NEU+, what regimen should they receive?
AC—> T + concurrent trastuzumab
If a patient cannot receive an anthracycline and are HER2NEU+, what regimen should you use?
TCH (herceptin)
What are two therapeutic options that can be used to prevent recurrence in ER+ or PR+ tumors?
- Tamoxifen
- Aromatase inhibitors
What does tamoxifen compete with?
Estradiol
What are serious ADEs caused by tamoxifen? 2
- Thromboembolism
- Endometrial/ uterine cancer
What two drugs should you avoid taking with tamoxifen?
- Fluoxetine
- Paroxitine
What decreases when aromatase is inhibited?
Estrogen
What are the 2 non-steroidal aromatase inhibitors?
- Anastrazole
- Letrozole
What is a steroidal aromatase inhibitor?
Exemestane
What are 2 ADEs of aromatase inhibitors?
- Osteoporosis
- Musculoskeletal pain/ arthralgias
What endocrine therapy can be used for premenopausal women?
Tamoxifen
What endocrine therapy can be used for post menopausal women?
Aromatase inhibitors
How long are patients on endocrine therapy?
5-10 years
True or false: the optimal regimen for stage III BC is AC —> T
False; no optimal regimen
How would you begin to treat stage III BC?
Neoadjuvant systemic chemotherapy
If there is no response with the treatment in stage III BC, what should be considered?
Other neoadjuvant chemotherapy or neoadjuvant XRT
If there is a response with the treatment for stage III BC, what can be done?
Surgery
When can you give adjuvant endocrine therapy in stage III BC?
After all systemic therapy is completed
What is the goal of therapy for metastatic breast cancer?
Palliative care
What type of BC metastases has a better prognosis?
Bone and soft tissue
What is bone and soft tissue metastases more likely to respond to?
Endocrine therapy
What does symptomatic visceral metastases require?
Chemotherapy
What type of metastases generally does not respond to chemotherapy?
Brain metastases
If a patient has no prior therapy, is ER + or PR+ and has bone metastases only, what are they treated with?
Endocrine therapy
If a patient has had no prior therapy, is ER+ or PR+, and has visceral metastases, what should they be treated with?
Systemic chemotherapy
When is endocrine therapy the most useful? 3
- ER+ or PR+
- Post menopausal
- Bone or soft tissue metastases only
What patient population can ovarian ablation be an option?
In pre-menopausal women only
Pure antiestrogen
Fulvestrant
Fulvestrant
FASLODEX
What is the main ADE caused by Fulvestrant?
Injection site reactions
What patients are able to use CDK4/6 inhibitors?
- HR+
- Advanced or metastatic breast cancer
What can CDK4/6 inhibitors be used in combination with?
Fulvestrant or aromatase inhibitor
How are the CDK4/6 inhibitors administrated?
Orally
What are the 3 CDK4/6 inhibitor available agents? 3
- Abemaciclib
- Palbociclib
- Ribociclib
Abemaciclib
VERZENIO
Palbociclib
IBRANCE
Ribociclib
Kisqali
What are 3 common ADEs of the CDK4/6 inhibitors?
- Myelosuppression
- Fatigue
- Nausea
What are the most active agents used in systemic chemotherapy for scenario 1?
Anthracyclines and taxanes
What is the use of combination or sequential chemotherapy based on?
Individual basis
When a patient has no prior therapy and is ER- or PR- what therapy is not effective?
Endocrine therapy
Patients who require a rapid response due to large disease burden may require what?
Combination chemotherapy
What must a patient who has had no prior chemotherapy and is ER- or PR- receive?
Chemotherapy
If a patient has had prior therapy, is ER+ or PR+, and has bone mets only, what should be used?
Endocrine therapy
If a patient has had prior therapy, is ER+ or PR+ and has visceral mets, what should be used?
Chemotherapy
If a patient has had prior therapy and is ER- or PR-, what should be used?
Chemotherapy
If a patient has had prior therapy and is ER- or PR-, what will not be effective?
Endocrine therapy
For recurrence, treatment is based on _______ decision
Case by case
Each attempt at chemotherapy has a ______ median duration
Shorter