Breast Cancer Flashcards
Name size of tumour in T stages T1-3
T1 <2cm, T2 2-5cm and T3 >5cm
Describe N1 stage
1-3 positive axillary LNs
Describe N1b stage
Internal mammary sentinel lymph node
Describe N1c stage
Up to 3 positive axillary lymph nodes + positive intramammary sentinel lymph nodes (ie. 1a+1b)
When might you offer neoadjuvant endocrine therapy and for how long?
Women for whom there is no definitive indication for chemotherapy where shrinkage is needed for BCS.
Who is likely to see shrinkage with neoadjuvant endocrine therapy, pre- or post- menopausal women.
Post menopausal women, shrinkage with neoadj ET as effective as NACT whereas NACT more effective in pre-menopausal women.
If LVEF drops below LLN (55%) on anti-HER2 therapy but remains >40%, what is the best next step?
Start ACEi, continue trastuzumab and arrange interval MUGA in 6-8 weeks.I
If LVEF drops below 40% on anti-HER2 therapy, what is the best next step?
Stop trastuzumab, start ACEi, refer to cardiology and MUGA in 6 weeks.
Describe the increase in chance of pCR with the addition of neoadjuvant immunotherapy in TNBC
51.2% with NACT alone, 64.8% with addition of immunotherapy.
What additional imaging should be considered in lobular carcinomas?
MRI breast as size often underestimated on other modalities, particularly if aiming for BCS.
How do you calculate NPI?
Maximum invasive cancer size (cm) x 0.2 + Lymph node stage (1= no LN involvement, 2= low axillary nodal involvement, 3= high axillary or IMN involvement) + grade
What NPI is considered low risk
<3.4
What NPI is considered high risk
> 5.4
When should Oncotype Dx be considered?
In patients with intermediate NPI with ER positive, HER2 negative disease.
What is the relative risk reduction with adjuvant tamoxifen in ER+ve disease?
41%
When would you consider a woman post menopausal?
FSH consistently >30 and no menstrual period for 1 year.
Which drugs would you consider if patients were struggling with hot flushes on endocrine therapy?
Venlafaxine, clonidine, gabapentin. Consider switch to tamoxifen if on AI.
When is abemaciclib licensed in the adjuvant setting?
> 4 axillary lymph nodes, 1-3 axillary lymph nodes AND/OR G3/T3
When would you consider 12 weeks of paclitaxel/trastuzumab in the adjuvant setting?
Lower risk T2N0 HER2 positive patients.
When would you give adjuvant radiotherapy despite mastectomy?
Mass >5cm (T3)
When would you consider omitting post operative radiotherapy in patients with BCS.
Age >65yrs, T1N0, ER+ve/HER2 -ve, G1-2, negative margins and willing to have adjuvant endocrine therapy.
What is radiation recall dermatitis?
Inflammatory skin reaction at the site of previous RT, typically caused by chemotherapy (docetaxel is common).
When should re-excision be considered in DCIS?
If margin is <1mm, 10mm margin preferred.
When should radiotherapy be offered in DCIS?
In all patients undergoing BCS, if RT declined then endocrine therapy should be offered.
