Breast Cancer

Question 1

Family Hx of breast cancer gene mutation

Answer 1

BRCA1, BRCA2 mutations

-10-20% of all cases have a genetic link

Question 2

T/F: Breast Cancer

1) Higher rates in western countries
2) Higher rates in rural areas

Answer 2

1) True

2) False- higher in urban areas

Question 3

Screening methods for breast cancer

Answer 3

1) Clinical breast exam
2) Mammography
3) U/S
4) MRI

Question 4

T/F: The American Cancer society recommends mammography every other year for all 50-75 and women 40-49 at high risk and stop at 76. MRI not recommended. BSE NOT recommended.

Answer 4

False: This is US prevention services Task Force.

ACA is mammogram annually from age 40 on. MRI anually for high risk after 30. BSE an option.

Question 5

Benign tumor, usually <30 y.o. Firm, solitary mass that may increase in size over months. U/S better than mammo. What is it?

Answer 5

Fibroadenoma

Question 6

Single most common disorder of breast. Frequently found age 20-40, peaks before menopause. OC use decrease risk of fibrocystic changes. Biopsy necessary if mass, thickening, discharge, pain. What is it?

Answer 6

Fibrocystic breast changes (disease)

Question 7

Diagnostics for breast cancer

Answer 7

• Fine needle aspiration
• Core needle biopsy
• Stereotactic biopsy
• Excisional biopsy
• Additional: CBC, CMP, LFTs, CXR (Mets?), CT (mets?), Bone scan (Mets?), PET scan (Mets?)

Question 8

Molecular markers for treatment in breast cancer.

Answer 8

1) Estrogen receptor (ER)
2) Progesterone receptor (PR)
3) Human epidermal growth factor 2 (HER 2-neu)
* Triple negative breast cancer has worst prognosis

Question 9

Treatment for breast cancer

Answer 9

1) Usually combo of surgery radiation and chemotherapy, and hormone therapy.
- Breast sparing surgery not available for tumors >4cm
- Early stage breast CA treated with surgery and radiation only. As cancer advances, chemo necessary.
* Lumpectomy, mastectomy, lymph node assessment

Question 10

What agents are used for chemotherapy in Breast CA. What toxicities?

Answer 10

• Adriamycin/Cytoxan
• Taxol
• Causes toxicities- Bone marrow suppression, GI tract, organ toxicities:
• Adriamycin/Cytoxan: Cardiotoxicity
• Taxol: Neurotoxicity

Question 11

If you take out all the axillary nodes in a breast CA patient, what will this cause and what does this mean?

Answer 11

Lymphedema- No procedures in the effected arm for rest of patients life.

Question 12

Hormonal manipulation:

1) Estrogen blocker
2) SERMs
3) Aromatase-inhibitors

Answer 12

1) Tamoxifen
2) Raloxifene
3) Arimidex, femara, aromasin (post-menopausal)

Question 13

What is HER-R-neu cancer treated with?

Answer 13

Herceptin- targets HER2