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Oncology G > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

What is BRCA 1 and 2 mode of inheritance ?

A

AD

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2
Q

What type of gene is BRCA 1/2?

A

tumour suppressor gene

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3
Q

Who do you refer for gene testing without strong family history ?

A 
Breast cancer under 30 
Triple negative breast cancer under 40
Male breast cancer under  60
Ovarian cancer under  70
All non-mucinous ovarian
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4
Q

What is mutation in Li-Fraumeni?

A

p53

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5
Q

What tumours do you get with Li-Fraumeni?

A 
Breast > 90%
Sarcoma
Brain
Adrenocortical
Leukaemia
Colon
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6
Q

What mutation in Peutz-jager?

A

STK11/LKB1

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7
Q

What mutation with Cowden?

A

PTEN

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8
Q

What mutation with diffuse gastric cancer (lobular breast ca)?

A

CDH1

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9
Q

What screening do you do for high risk breast ca ?

A
  • 6/12 clinical breast exam

- Mammogram (or MRI) from 40 or 5 years younger than cancer age

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10
Q

What prophylaxis do you use for high risk Breast Ca?

A

Mastectomy - decrease by 90%
BSO - decrease by 50%
Pre men - SERM
Post men - AI or SERM

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11
Q

What 2 types of adjuvant chemo do you usually use in breast cancer?

A

Anthracycline e.g -rubicin

Anti-microtubules e.g. taxanes

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12
Q

When do you use adjuvant RTx for breast cancer?

A 
Post WLE (provides similar recurrence rate to mastectomy)
or if post mastectomy if > 5 cm or > 4LN
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13
Q

When do you use adjuvant endocrine therapy?

A

For all PR/ER +ve breast cancers

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14
Q

MOA Tamoxifen?

A

Tamoxifen is SERM ( antagonist at breast and uterus, agonist in lipids and bone)

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15
Q

What are the risks of Tamoxifen?

A

IHD, VTE, endometrial cancer

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16
Q

What is a positive side effect of Tamoxifen?

A

Increases BMD - less non vertebral fractures

17
Q

How to Aromastase inhibitors work ?

A

The block the conversion of androstenedione and testosterone to oestrodial and and oestriol in fat, liver, muscle and breast tissue.

18
Q

Who do you use AI in?

A

Post menopausal women, doesn’t stop ovarian oestrogen production

19
Q

What are example of AI?

A

Letrozole, anastrazole, Exemestane

20
Q

Side effects of AI?

A

Reduced BMD, hot flushes, arthralgia

21
Q

How do you treat Her-2/neu positive breast cancer?

A

All get chemo + Tastuzumab

22
Q

What does HER-2/neu 1+, 2+, 3+ mean on IHC?

A

1+ negative, 2+ equivocal, 3+ positive

23
Q

What is Trastuzumab?

A

Herceptin

Monoclonal antibody against Her-2

24
Q

What is the main AE of Trastuzumab?

A

Cardiac toxicity.
Reversible
Increased risk if used with anthracyclines

25
Q

What is the approach to early breast cancer?

A
  1. WLE +RTX or Mastectomy + SLN Bx
  2. Adjuvant chemo if high risk
  3. Endocrine therapy if ER/PR +ve
  4. Trastuzumab if Her-2/neu positive
26
Q

What is the approach to locally advance breast cancer?

A

Try and down stage with neo-adjuvant therapy

27
Q

What are common sites of mets in breast cancer?

A

Bone, liver, lung, CNS

28
Q

What is the approach to Metastatic breast cancer?

A
  1. If PR/ER positive try endocrine therapy first (unless advanced visceral disease)
  2. If Her-2/neu use targeted therapy
  3. Use chemo if this fails or rapidly advancing disease
  4. Treat bone mets to prevent SRE (not survival)
29
Q

How do you treat hormone resistant metastatic breast cancer?

A

Evorolimus + exemestane - mtor pathway is often unregulated in AI resistance.

30
Q

What do you use for Her-2/neu positive metastatic breast cancer who have been off trastuzumab for > 6/12?

A

Trastuzumab + Pertuzumab + Doxetaxal

31
Q

How does Pertuzumab work ?

A

Monoclonal Ab against a different part of the Her-2/neu receptor , this often unregulated in trastuzumab resistant tumours

32
Q

What do you use for Her-2/neu positive metastatic breast cancer who relapsed on trastuzumab ie. within 6/12?

A

Trastuzumab emtansine T-DM1

33
Q

What is Trastuzumab emtansine?

A

Conjugate of trastuzumab with a microtubule inhibitor (DM1), allows targeted delivery of cytotoxic therapy to cancer cells.

Oncology G (8 decks)

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