Breast cancer

Question 1

What is the most common type of breast cancer?

Answer 1

Ductal (75%)

Question 2

What are the different biomarkers for breast cancer?

Answer 2

Oestrogen receptor
Progesterone receptor
HER2 status

Proliferation index (Ki-67): assessed by point counting 500 to 1000 cells and is reported as percent positive cells

Question 3

What are the different subtypes of breast cancer?

Answer 3

-Hormone receptor + luminal (75%)
Luminal A: ER and PR strongly +, low grade, low proliferation / genomic score
Luminal B: ER+, high grade, high proliferation / genomic score

-HER2 positive (15%): HER2 is overexpressed. Approx 50% are also ER+

-Triple negative (10%): ER, PR, and HER2 are negative

Question 4

What are the treatment options for operable breast cancer?

Answer 4

• Surgery
  Breast surgery: breast conserving or mastectomy
  Axillary staging: axillary dissection focused on sentinel nodes
• Adjuvant radiotherapy
  To the breast after conserving surgery, to the chest wall after mastectomy if the tumours were large or there were positive lymph nodes, and to the lymph nodes in selected high risk patient
• Adjuvant systemic therapy
  Eg. Anti-hormone treatment, CDK4/6 inhibitors, Chemotherapy, Anti-HER2, treatment, Bisphosphonates

Sometimes used as initial (neoadjuvant) treatment before surgery:
-locally advanced breast cancer
-operable HER2+/triple negative cancers

Question 5

What are sentinel nodes?

Answer 5

Defined as the first lymph node to which cancer cells are most likely to spread from a primary tumour

Question 6

What is an oncotype score?

Answer 6

Used to assign each women’s cancer a score for recurrence risk on a scale of 0‒100

0-25 is a low risk
26-100 is high risk

Question 7

What is the drug Letrozole for?

Answer 7

It reduces amount of oestrogen levels

Question 8

What is the drug Zoledronic acid for?

Answer 8

-Prevents problems with the bones like fractures in myeloma and cancers that have metastasised to the bone

• lowers the chance of breast cancer coming back after surgery in certain situations
• And prevents bone loss in people having aromatase inhibitors

Question 9

What is inflammatory breast cancer?

Answer 9

A rare type of breast cancer that develops rapidly, making the affected breast red, swollen and tender.

Occurs when cancer cells block the lymphatic vessels in skin covering the breast, causing the characteristic red, swollen appearance of the breast

Question 10

What is the treatment for stage 4 metastatic breast cancers?

Answer 10

Hormone receptor positive:
- Responds to anti-hormones, CDK4/6i, chemotherapy

HER2 positive
- anti-HER2 agents and anti-hormones if concomitant ER+

Triple negative
- Responds (transiently) to chemotherapy
- Selected patients may respond to immunotherapy, PARP inhibitors

In all subtypes: add bone-directed treatment (zoledronic acid, denosumab) if bone mets are present