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703 > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are non-modifiable risk factors for breast cancer?

A
  • Female gender
  • Older age
  • Family history
  • Personal history
  • BRCA1 and BRCA2
  • Breast changes on biopsy
  • Ionizing radiation
  • Breast density
  • Early menarche/late menopause
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2
Q

What are modifiable risk factors for breast cancer?

A
  • Nulliparity or older age at first child birth
  • Postmenopausal hormone therapy
  • Postmenopausal obesity
  • Physical inactivity
  • Alcohol consumption
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3
Q

Which type of breast cancer is identified by a “lump”?

A

Invasive ductal carcinoma

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4
Q

Which type of breast cancer is seen as ill-defined thickening of the breast?

A

Invasive lobular carcinoma

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5
Q

What are the NCCN screening recommendations?

A

Women ages 25-39: Clinical breast exam very 1-3 years
Women ages >40: Clinical breast exam and mammogram annually

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6
Q

How is breast cancer diagnosed?

A
  • History and physical exam
  • Diagnostic bilateral mammogram
  • Breast ultrasound
  • Biopsy
  • Bloodwork and additional imaging are directed by signs and symptoms
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7
Q

What are prognostic factors of breast cancer?

A
  • Tumor size
  • Lymph node status
  • Tumor grade (differentiation)
  • Ki67 index
  • Lympho-vascular invasion
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8
Q

ER/PR/HER2 negative cancers are rapidly growing but are more sensitive to chemo

A

TRUE

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9
Q

HER2/neu positive breast cancer is less aggressive and slower growing than ER/PR receptor positive breast cancer

A

FALSE: other way around

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10
Q

How do we treat lobular carcinoma in situ?

A

Regular monitoring, no treatment

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11
Q

How do we treat ductal carcinoma in situ?

A

Lumpectomy + radiation
Mastectomy

+/- endocrine therapy

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12
Q

What is endocrine therapy for premenopausal patients?

A

Tamoxifen

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13
Q

What is endocrine therapy for postmenopausal patients?

A

Aromatase inhibitors

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14
Q

In which patients do we use the Oncotype diagnosis?

A

ER/PR+, HER2-
Tumor > 0.5 cm

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15
Q

What are the preferred chemo treatments for ER/PR(-/+), HER2(-) diease?

A
  • Dose-dense doxorubicin/cyclophosphamide x4 doses -> paclitaxel every 2 weeks x4-12 doses
  • Docetaxel and cyclophosphamide (TC) every 3 weeks for 4-6 doses
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16
Q

Which neoadjuvant treatment can only be used for triple negative patients?

A

Pembrolizumab every 3 weeks for 4 doses + weekly paclitaxel/carboplatin x12 doses -> pembrolizumab + doxorubicin/cyclophosphamide every 3 weeks x4 doses

17
Q

Which treatment should triple negative patients receive AFTER surgery?

A

Pembrolizumab every 3 weeks for 9 doses

18
Q

What treatment is preferred for HER2(+) disease?

A

Docetaxel/carboplatin/trastuzumab + pertuzumab every 3 weeks for 6 doses
Paclitaxel + trastuzumab every week for 12 doses

19
Q

What criteria must be met to use pertuzumab?

A

> T2 or >N1, HER2(+) tumor

20
Q

What are common chemotherapy toxicities?

A
  • Myelosuppression
  • N/V
  • Mucositis
  • Hair loss
  • Fatigue
  • Nail/skin toxicity
  • Appetite/weight changes
21
Q

How do we combat peripheral edema with docetaxel?

A

Dexamethasone

22
Q

What are ADEs of doxorubicin?

A
  • Cardiotoxic
  • Red secretions/urine
  • Cancer
  • Vesicant (use central line)
23
Q

What should we avoid giving with tamoxifen?

A

CYP2D6 inhibitors (strong) - careful of SSRI/SNRI

24
Q

What must be given with tamoxifen for premenopausal patients?

A

Ovarian suppression

25
Q

What are considerations of tamoxifen?

A
  • Cancer
  • VTE/stroke
  • Avoid in pregnancy
26
Q

What are considerations of aromatase inhibitors?

A
  • Bone loss
  • HLD
  • CV risk
27
Q

When can we consider capecitabine for breast cancer?

A

Triple negative patients who have tried a neoadjuvant

28
Q

When can we consider ado-trastuzumab for breast cancer?

A

HER2(+) patients who tried a neoadjuvant

29
Q

When can we consider neratinib for breast cancer?

A

HER2(+) patients after completion of adjuvant trastuzumab for high recurrence risk (use prophylactic loperamide)

30
Q

When can we consider olaparib? (PARP)

A

High risk HER2(-) breast cancer with BRCA mutation

31
Q

When can we consider abemaciclib?

A

Adjuvant for ER/PR(+), HER(-) high0risk breast cancer

32
Q

When should we give zoledronic acid in breast cancer?

A

For postmenopausal patients whenever possible (2 years)

33
Q

When do we use palbociclib?

A

ER/PR(+), HER2(-) MBC in combo with aromatase inhibitor, fulvestratn

34
Q

Which other CDK 4/6 inhibitors can be considered for ER/PR(+), HER2(-) MBC?

A

Ribociclib (monitor LFT, QT)
Abemaciclib (LFT, SCr)

35
Q

Which mTOR treatment can be used for ER/PR(+), HER2(-) MBC?

A

Everolimus

36
Q

When can we use Alpelisib?

A

PIK3CA-mutation

37
Q

When do we consider chemotherapy in MBC?

A
  • Failure of multiple endocrine manipulations
  • Visceral crisis
  • Patient is symptomatic
  • Patient decision
    With good performance status
38
Q

What is the dose-limiting toxicity of taxanes?

A

Neuropathy

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