Breast Cancer Flashcards
1
Q
What is the tumor suppressor gene that gets mutated in cancer?
A
P53
2
Q
Which mutation has an increased incidence of breast and ovarian cancers?
A
BRCA1
3
Q
Which mutation can increase the risk of ovarian cancer and both male and female breast cancer?
A
BRCA2
4
Q
What are the 5 risk factors of breast cancer?
A
- Female
- Age
- Genetic mutations
- Family history of breast cancer
- Endogenous estrogen exposure
5
Q
What 3 things would cause endogenous estrogen exposure?
A
- Early menarche (</14)
- Late menopause (>/ 55)
- Age at birth of first child (> 30)
6
Q
What are 5 risk factors that can cause breast cancer (continued)?
A
- Benign breast disease
- Radiation exposure
- Obesity/ high BMI
- Low physical activity
- Alcohol consumption
7
Q
What are 3 controversial risk factors?
A
- Exogenous estrogen exposure
- Oral contraceptives
- Estrogen replacement therapy
8
Q
What are 3 factors associated with lower risk?
A
- Breastfeeding
- Moderate or vigorous physical activity
- Maintaining a healthy body weight
9
Q
What are the 3 screening tests for BC?
A
- Breast self-examination
- Clinical breast examination
- Mammography
10
Q
For women of average risk, when should they start getting screened for BC?
A
Around age 40
11
Q
What 3 things can be used to help prevent BC?
A
- Prophylactic mastectomies
- Bilateral oophorectomies
- Drug therapy prevention
12
Q
What are the 2 most common symptoms of BC?
A
- Painless lump
- Stabbing or aching pain
13
Q
What are 4 less common symptoms of BC?
A
- Nipple tenderness
- Change in size or shape of the breast
- Erythema, scaling, eczema, swelling
- Peu d’orange
14
Q
What are the 5 main sites of metastases?
A
- Bone
- Liver
- Lung
- Brain
- Skin
15
Q
What is the most common pathological type of BC?
A
Invasive ductal carcinoma
16
Q
Which pathological type has the worst prognosis?
A
Invasive ductal carcinoma
17
Q
ER and PR __tumors are generally less aggressive than _____ ones.
A
+; negative
18
Q
What is Her2neu overexpression associated with?
A
Poorer prognosis
19
Q
_____ proliferation index when high, shows when a patient needs chemo
A
Ki-67
20
Q
What is the standard treatment for stage I, IIA, IIB?
A
Surgical resection
21
Q
To get a lumpectomy what must patients also be willing to receive?
A
Radiation
22
Q
What should you consider for tumors too large for lumpectomy?
A
Neoadjuvant chemotherapy
23
Q
What is used for sentinel lymph node biopsy?
A
Methylene blue
24
Q
What happens if the lymph nodes turn blue with sentinel lymph node biopsy?
A
Radiation is needed
25
For systemic therapy for early stage what should you do?
Irradiate micrometastatic disease
26
What are 3 situations where the patients must receive chemotherapy?
1. ER and PR -
2. Her2neu +
3. Cancer is present in lymph nodes
27
What 3 criteria must be met so that a patient can get more specific testing on the tumor to determine the benefit of chemotherapy?
1. ER+ or PR+
2. Her2neu -
3. Negative lymph nodes
28
What test can be used to help determine likelihood of recurrence and the benefit of chemotherapy
Oncotype DX
29
What is preferred adjuvant chemotherapy?
AC followed by T
30
What does AC stand for in preferred adjuvant chemotherapy?
Anthracycline + alkylating agent
31
If the first line preferred adjuvant chemotherapy can’t be tolerated, what regimen can be used?
TC
32
For adjuvant chemotherapy what is TC?
Taxane + alkylating agent
33
What adjuvant chemotherapy regimen should be used for patients who are old and have a HF risk?
TC
34
What adjuvant chemotherapy regimen is the most aggressive?
TAC
35
What patient population can TAC be used in?
Younger patients
36
Trastuzumab
HERCEPTIN
37
What is the major ADR of herceptin?
Cardiac
38
What should you not administer trastuzumab with?
Anthracyclines
39
For patients that are HER2NEU+, what regimen should they receive?
AC—> T + concurrent trastuzumab
40
If a patient cannot receive an anthracycline and are HER2NEU+, what regimen should you use?
TCH (herceptin)
41
What are two therapeutic options that can be used to prevent recurrence in ER+ or PR+ tumors?
1. Tamoxifen
2. Aromatase inhibitors
42
What does tamoxifen compete with?
Estradiol
43
What are serious ADEs caused by tamoxifen? 2
1. Thromboembolism
2. Endometrial/ uterine cancer
44
What two drugs should you avoid taking with tamoxifen?
1. Fluoxetine
2. Paroxitine
45
What decreases when aromatase is inhibited?
Estrogen
46
What are the 2 non-steroidal aromatase inhibitors?
1. Anastrazole
2. Letrozole
47
What is a steroidal aromatase inhibitor?
Exemestane
48
What are 2 ADEs of aromatase inhibitors?
1. Osteoporosis
2. Musculoskeletal pain/ arthralgias
49
What endocrine therapy can be used for premenopausal women?
Tamoxifen
50
What endocrine therapy can be used for post menopausal women?
Aromatase inhibitors
51
How long are patients on endocrine therapy?
5-10 years
52
True or false: the optimal regimen for stage III BC is AC —> T
False; no optimal regimen
53
How would you begin to treat stage III BC?
Neoadjuvant systemic chemotherapy
54
If there is no response with the treatment in stage III BC, what should be considered?
Other neoadjuvant chemotherapy or neoadjuvant XRT
55
If there is a response with the treatment for stage III BC, what can be done?
Surgery
56
When can you give adjuvant endocrine therapy in stage III BC?
After all systemic therapy is completed
57
What is the goal of therapy for metastatic breast cancer?
Palliative care
58
What type of BC metastases has a better prognosis?
Bone and soft tissue
59
What is bone and soft tissue metastases more likely to respond to?
Endocrine therapy
60
What does symptomatic **visceral** metastases require?
Chemotherapy
61
What type of metastases generally does not respond to chemotherapy?
Brain metastases
62
If a patient has no prior therapy, is ER + or PR+ and has bone metastases only, what are they treated with?
Endocrine therapy
63
If a patient has had no prior therapy, is ER+ or PR+, and has visceral metastases, what should they be treated with?
Systemic chemotherapy
64
When is endocrine therapy the most useful? 3
1. ER+ or PR+
2. Post menopausal
3. Bone or soft tissue metastases only
65
What patient population can ovarian ablation be an option?
In pre-menopausal women only
66
Pure antiestrogen
Fulvestrant
67
Fulvestrant
FASLODEX
68
What is the main ADE caused by Fulvestrant?
Injection site reactions
69
What patients are able to use CDK4/6 inhibitors?
1. HR+
2. Advanced or metastatic breast cancer
70
What can CDK4/6 inhibitors be used in combination with?
Fulvestrant or aromatase inhibitor
71
How are the CDK4/6 inhibitors administrated?
Orally
72
What are the 3 CDK4/6 inhibitor available agents? 3
1. Abemaciclib
2. Palbociclib
3. Ribociclib
73
Abemaciclib
VERZENIO
74
Palbociclib
IBRANCE
75
Ribociclib
Kisqali
76
What are 3 common ADEs of the CDK4/6 inhibitors?
1. Myelosuppression
2. Fatigue
3. Nausea
77
What are the most active agents used in systemic chemotherapy for scenario 1?
Anthracyclines and taxanes
78
What is the use of combination or sequential chemotherapy based on?
Individual basis
79
When a patient has no prior therapy and is ER- or PR- what therapy is not effective?
Endocrine therapy
80
Patients who require a rapid response due to large disease burden may require what?
Combination chemotherapy
81
What must a patient who has had no prior chemotherapy and is ER- or PR- receive?
Chemotherapy
82
If a patient has had prior therapy, is ER+ or PR+, and has bone mets only, what should be used?
Endocrine therapy
83
If a patient has had prior therapy, is ER+ or PR+ and has visceral mets, what should be used?
Chemotherapy
84
If a patient has had prior therapy and is ER- or PR-, what should be used?
Chemotherapy
85
If a patient has had prior therapy and is ER- or PR-, what will not be effective?
Endocrine therapy
86
For recurrence, treatment is based on _______ decision
Case by case
87
Each attempt at chemotherapy has a ______ median duration
Shorter
