Breast cancer Flashcards
RFs breast ca?
BRCA1 and 2 Sex age reproduction family history Post-meno HT OCPs
Prognostic factors?
LYMPH NODE INVOLVEMENT Size histo grading margins vessel invasion HER2, ER
Predictive factors?
Her 2 overexpression
ER and PrG expression
Which carcinomas in situ?
Ductal DCIS
Lobular DCIS
Which carcinoma in situ is often multifocal?
Lobular DCIS
Which breast ca does not have invasion of basement membrane?
Ductal DCIS
Which infiltrating cancers are there?
Ductal and lobular
Which breast ca is MC?
Infiltrative ductal
Which breast ca type is Paget’s disease?
Infiltrative Ductal
Where in breast is ca usually?
Upper outer quadrant
When to start mammography?
40 years old, once a year
How to diagnose breast ca?
Mammogram –> microcalcifications ==> BIOPSY!
Which tumor markers in breast ca?
NO TM
Where is metastasis MC?
Bone
Lung
Liver
Brain
Which surgical tx?
TUmorectomy
Breast conserving tx
Total mastectomy (Patey’s operation)
What is done in BC tx?
Remove tumor and sentinel lymph node
RADIOTHERAPY
How to find sentinel l n?
Blue dye
When is breast conserving tx contraindicate?
Tumor > 5 cm too large tumor in ratio to breast Previously irradiation-tx retroareolar Positive margins
Define T4A
Spread to chest wall
Define T4B
Spread to skin, swollen
Define N3
Spread to collarbone, behind sternum
Which classification is used to choose tx?
St. Galleon Consensus
What is Ki-67?
Cellular marker for proliferation
Which classes in St Galleon?
Luminal A
Luminal B
HER2+
Triple Negative
Which class har best prognosis?
Luminal A
Characteristics of Luminal A?
ER+ and PgR+
HER 2 -
Low Ki-67
Tx of Luminal A?
ONLY hormonal
Characteristics of Luminal B?
Divided into HER2 neg and positive:
HER2- : ER+, PgR+, HER2-, HIGH Ki 67
HER2+: ER+, PgR+, HER2+, ANY Ki-67
Tx in Luminal B?
HER2 neg: Hormonal and Cytotoxic therapy
HER2 positive: Hormonal, Anti-HER2 and cytotoxic tc
What defines LUMINAL classes?
ER and PgR POSITIVE
Which classes are ER and PgR NEGATIVE?
HER2 +
Triple Negative
Characteristics of HER2 positive?
HER2 overexpressed
ABSENT ER and PgR
Tx of HER2 positive?
CYtotoxic and anti-HER2 tx
Characteristics of Triple Negative?
HER2 NEGATIVE
AVSENT ER and PgR
Tx of Triple Negative?
ONLY cytotoxic
Which class has poorest prognosis?
Triple negative
Can you give Anti-HER2 tx without chemotx?
NO!!
When is neoadjuvant tx given?
Locally advanced tumors T3, N2+
(Stage III)
Which chemotx?
Doxorubicin
Docetaxel
Cyclophosphamide
5 FU
Tx given in ER+ pt?
TAMOXIFEN
LHRHA
Aromatase inhibitors
When is adjuvant HORMONAL tx given?
in all who show presence of ANY detectable estrogen receptors
Which hormonal adjuvant tx to premenopausal?
Tamoxifen
GnRHA antagonist
Which hormonal adjuvant tx to postmenopausal?
Tamoxifen
Aromatase inhibitors
Side effects of Tamoxifen?
Endometrial cancer!!!
Thromboemboli
Side effects of aromatase inhibitors?
Bone fractures!
Which tx if HER2 +?
Trastuzumab (Herceptin)
How long to give trastuzumab?
1 YEAR
Side effects of trastuzumab?
Cardiotoxicity
Follow up after tx?
Every 3 months first 3 years
–> every6-12 months
