Breast Cancer Flashcards
Endocrine increased risk factors
Early menarche before age 12
Late menopause after age 55
Nulliparity and first birth over 30
Long DUR of HRT and concurrent progestins
Endocrine decreased risk factors
Bilateral oophorectomy before age 40
Epidemiology
Most common occurrence
1 in 8 lifetime risk
Genetic RFs for BC
Dense Breast Tissue
BRCA-1 or 2 mutation
Family History
Environmental or Lifestyle Factors for BC
High Dietary Fat High BMI No exercise EtOH Radiation before age 20
Common sites for BC
Ducts and lobules
Lymph Nodes commonly removed
Axillary Lymph Nodes
Most common form of invasive carcinoma
Infiltrating Ductal Carcinoma (IDC) 75% of all invasive BC -Commonly spreads to axillary LN -Poor prognosis -Lump characteristic Metas: Bone, Liver, Lung, Brain
2nd most common form of invasive BC
Infiltrating Lobular Carcinoma (ILC) -similar to IDC -less frequent -thickening of breast Metas: Meninges, GI, Reproductive organs
Types of noninvasive BC
DCIS and LCIS
Ductal and Lobular
Tx for preinvasive BC
Prevent development of invasive dz DCIS - whole breast rad (WBR) LCIS - observation/masectomy Both goal is Removal Consider tamoxifen if (+) receptor
Mastectomy and oophorectomy suggested in
Pts with BRCA-1 or BRCA-2 mutations
Tamoxifen ADEs
Endometrial Cancer
VTEs, clots, PEs, etc.
STAR trial
Showed that raloxifine was similar to tamoxifen
BUT it has fewer ADEs of
endometrial cancer and VTEs
If done properly, ___ can detect 90% of BCs
Breast Self Examination
- monthly
- note changes that occur
Primary screening method for BC
Mammography -less than 30% of masses found are malignant -up to 15% of malignant masses are undetectable
How often should each screening occur
Mammogram -annually starting at 40 CBEs (by Dr.) -q 3 yrs 20-30's -annually at 40 Breast Self Exam -optional starting at 20
Based on location of a BC tumor, ___ lymph nodes are where it would be most likely to spread
Sentinel Lymph Nodes
SLNB (biopsy)
If neg, cancer hasn’t spread
-check prior to ALND
Poor prognostic factors for BC
Under age 35 Tumor size Nodal involvement ER negative status (young pts) HER-2 (+) dz
ER + or ER - pts
ER + is better
means they will respond to hormonal therapy
ER+/PR+ even better
only 5% of - pts respond
HER-2
Positive oncogene overexpression undicates
- more aggressive
- increased recurrence
- increased mortality
- poor prognosis
Agents for HER-2 (+) pts
Herceptin (trastuzumab)
Perjeta (Pertuzumab)
Adjuvant BIOLOGIC Tx
AC + Paclitaxel + biologic + tamox
Tamoxifen or AI
depends on menopausal status
Before menopause = tamoxifen
become post meno, switch to AI
Age over 60 or no menses for 12 mo
= AI
When are AIs used?
ONLY POST-MENOPAUSE
AIs do not work pre-meno
b/c estrogen from ovaries
will override
Tamoxifen vs AI ADEs
Tamoxifen
- thrombotic events
- endometrial cancer
- vasomotor (also in AIs)
AIs
-OSTEOPOROSIS
(Ca+Vit D)
-Arthralgias/myalgias
-vasomotor (also in tamox)
Tamoxifen drug interactions
Cyp2D6 Inhibitors
- fluoxetine
- duloxetine
- paroxetine
Mgmt of hot flashes with AIs and tamoxifen
Can’t use traditional hormonal drugs
Instead use:
- SSRIs
- SNRIs
- Gabapentin
Post-op surveillance for BC
Office visits q3-6 months for 3 yrs
then, 6-12 months for 2 yrs
then annually
