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Clinical Oncology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is primary breast cancer?

A

Local tumour presented only in breast tissue with no extension to lymph nodes or distant metastases

Clinical sense early BC is tumour < 2cm or T1 stage

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2
Q

What are the risk factors of Primary BC?

A
  • early menarche late menopause
  • nullparity
  • absence of breastfeeding
  • BRCA1 mutation
  • female and advanced age (>65)
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3
Q

Early diagnosis methods of BC?

A
  • anamnesis
  • clinical examination of breast and axilla
  • echo with doppler of breast, clavicle and axilla region
  • Mammography X ray
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4
Q

How is BC definitively diagnosed?

A
  • Mamotom biopsy- vacuum assisted
  • core needle biopsy
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5
Q

What are early cancer lesions of BC?

A
  • Ductal carcinoma in situ (DCIS) > 80%
  • Lobular Neoplasia in situ 15%
  • Ductal-lobular carcinoma
  • Rare types: medullar, adenoid cystic etc
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6
Q

What aspects of immunohistochemistry and receptor status is important?

A

ER & PgR: intensity of hormone expression

HER2 expression

Ki67 proliferative index

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7
Q

Why is plasminogen activator inhibitor (uPA-PAI-1) important?

A
  • Tissue levels help predict metastatic spread of BC
  • Useful to aid treatment decision making in early BC
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8
Q

TNM classification of BC?

A

T1: > 1mm and < 20mm (a,b,c)
T2: > 20mm and < 50mm
T3: > 50mm
T4a: extension to chest wall w/o Pec.major invasion
T4b: edema of skin (P’eau de orange)
T4c: a and b
T4d: inflammatory BC

N1: regional axillary LN
N2: IMA, ipsilateral axillary LN deeper involvement
N3: supraclavicular ipsilateral LN and M1

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9
Q

ESMO recommendation for treating primary BC?

A

Tumour < 2cm (BCS)

Tumour > 2cm (potential for BCS)
- Systemic induction tx
- + then BCS
- - then mastectomy

Breast conserving not an issue/aggressive
- Mastectomy

  • all followed by postop chemo tx (if HER2+, trastuzumab) and RT (mandatory after BCS)
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10
Q

When is adjuvant RT absolutely indicated?

A
  • age < 50
  • after BCS
  • > 5cm
  • Extensive DCIS
  • vascular invasion
  • non radical tumour excision

45-50 Gy

Whole body RT (WBRT) after BCS for CIS reduces risk of recurrence, where survival is = to as after a mastectomy

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11
Q

What is the protocol with adjuvant hormonotherapy?

A

Indicated ER + expression irrespective of the use of chemo or target tx

Premenopausal women
- tamoxifen
- LHRH agonist e.g. goserelin

Reaching menopause women (first 5 years)
- switch tamoxifen to letrozole (Aromatase inhibitor)

Postmenopausal women
- Aromatase inhibitor
- letrozole
- Exernestan

*adjuvant tx must be administered 2-6 weeks after surgery, if after 12 week, efficacy reduces

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12
Q

What are the neoadjuvant chemotherapy protocols for BC?

A
  • used to downstage a tumour e.g. > 2cm before resection (can be BCS)

Anthracyclines e.g. doxirubicin (not to be used at the same time as trastuzumab) - due to high cardiotoxicity

Taxanes e.g. Pacliataxel
*Sequential use > concomitant use

Neratinib after 1 year of Neoadj Tx may be used with trastuzumab to prolong DFS and improve outcomes

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13
Q

When is surgery indicated in early BC?

A
  • T1a for local surgery
  • 80% of EU women undergo BCS
  • Mastectomy with LN axilla dissection in metastatic in regional LN BC
  • Bilateral mastectomy for prophylaxis in BRCA1,2 mutation
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14
Q

What is metastatic BC?

A
  • Incurable disease
  • survival 2-3 years (25% survive after 5 years)
  • beyond breast tissue with extension to LN and other organs
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15
Q

What are the tx aims of MBC?

A
  • Prolongue progression free survival
  • Extension of overall survival
  • CR/PR
  • QOL
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16
Q

What are the critical factors for tx of MBC?

A
  • age
  • disease free interval
  • extension of disease e.g. number of metastatic deposits
  • upfront adjuvant tx
  • performance status
17
Q

St Gallens

A
18
Q

What can be used as chemotherapy for MBC?

A
  • Doxorubicin
  • Pacliataxel
  • Platinum
  • Kapactabin
  • Vinorelbin
19
Q

What can be used as hormonotherapy for MBC?

A
  • Ovary ablation, surgery
  • AI e.g. letrozole
  • ER blockade e.g. tamoxifen
  • Fluvestrant
20
Q

St Gallen recommendation for premenopause women?

A
  • SERM (Selective ER modulator) e.g. tamoxifen for 5 years
  • w or w/o surgery or LHRH agonist
21
Q

St Gallen recommendation for postmenopause women?

A
  • AI e.g. letrozole
  • assess bone density before administration due to risk of osteoporosis
22
Q

What does HER2+ MBC mean?

A
  • more aggressive
  • shorter PFS
  • Poor survival
23
Q

First line treatment according to ESMO for MBC HER2 -/+?

A

HER2+

No contraindication for Cht
At least 6 cycles
- pacliataxel
- trastuzumab
- endocrine therapy

Cht Contraindicated:
- trastuzumab
- endocrine therapy

HER2-
No contraindication for Cht
At least 6 cycles
- pacliataxel
- trastuzumab, can be used

Cht Contraindication :
- trastuzumab until progression
- pertuzumab may be used

24
Q
A

Clinical Oncology (11 decks)

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