Breast cancer

Question 1

RF for breast CA?

Answer 1

female

inc age

lifestyle and SES

benign breast disease (prolif lesions with atypia)

inc. breast density on MMG

personal past hx of breast CA

endogenous hormones:

• weight
• early menarche/late menopause
• late childbirth/nulliparity

exogenous hormones:

• inc risk in HRT > 5 years
• no evidence that COCP is inc. risk

genetics?

Question 2

what are the risks of BRCA1 and 2 for disease?

Answer 2

see image

Question 3

do you know of any non-BRCA breast cancer genes?

Answer 3

p53 - very rare but high penetrance

PTEN - cowden syndrome - rare with high penetrance

ATM- ataxia telangiectasia - common with mod penetrance

STK11 - Peutz-Jeghers - rare with high penetrance

Question 4

what are the subtypes of invasive breast CA?

Answer 4

ductal makes up 80%

other types have better prognosis

• lobular
• mucinous
• tubular

Question 5

what breast cancer is resectable?

Answer 5

if <t4>
</t4>

Question 6

what age has an independently poorer prognosis?

Answer 6

less than 35 years

Question 7

which of the receptors have good and which have poor prognosis?

any other findings with genetics and prognosis?

Answer 7

ER and PR have good prognosis

HER2/neu has a poor prognosis and is over expressed in about 20%

p53 also has poor prognosis, but is not routinely checked

Question 8

define:

adjuvant

neoadjuvant

palliative

Answer 8

Definitions of Chemotherapy:

 Adjuvant chemotherapy:
Given after surgery for early breast cancer to reduce the

risk of relapse/dying from breast cancer

 Neoadjuvant chemotherapy:
Given before surgery with curative intent

 Palliative chemotherapy:

Given to patients with locally advanced or metastatic breast cancer to improve symptoms and/or prolong life but NOT with the aim of cure

Question 9

what are some of the “life threatening” toxicities of chemo?

Answer 9

Neutropenic sepsis

Acute leukemia

Cardiac dysfunction- anthracyclines irreversible,

trastuzumab reversible

Anaphylaxis (taxanes)

Question 10

which of the drugs are particularly responsible for neuropathy and arthralgia?

Answer 10

the taxane drugs are particularly bad

Question 11

what are the major side effects of tamoxifen versus aromatase inhibitors

Answer 11

tamoxifen causes hot flashes, tVTE, endometrial CA and GU adverse events

AI - arthralgias/myalgia and inc. OP risk

up to 24.20

Question 12

Why have the mTOR inhibitors been added to the management of metastatic breast cancer? What is the thing that they add?

Answer 12

Their major role is in the prevention of endocrine therapy resistance. They have been shown to extend survival periods.

Question 13

how do the taxanes work?

Do they have any side effect syndromes?

Answer 13

they work by halting the microtubule disassembly process, leading to accumulation and then cell apoptosis

the side effects are many but include capillary leak syndrome; periph neurology

it impacts dividing cells, therefore leads to alopecia, bone marrow suppression

Question 14

in a patient with prev breast CA, at follow up has a lump.

FNA is negative

What’s the next step?

Answer 14

repeat FNA. If negative and concern, proceed to excisional biopsy.

The point being that FNA can be neg

Question 15

patient with metastatic breast CA, starts complaining of nausea and vomiting. Just started on tamoxifen 2 weeks ago, no chemo. What should you do?

Answer 15

unexplained N/V in a patient with metastatic disease should be suspicious for brain lesion until proven otherwise.

Question 16

what agent gives the strongest oestrogen blockade in a pre-menopausal patient with ER+ breast CA?

Answer 16

the LHRH analogue is the strongest, although a SERM would be a good second choice.