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Cancer (mine) > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Outline the risk factors for breast cancer

A

Age
Geographical location - higher incidence in urban areas
Age of mencharce - higher risk if onset of periods is before 12
Age of menopause 0- life you have late menopause (After the age of 55)
Age a first full term pregnancy
Weight
Diet, alcohol
Radiation
Oral contraceptives - high risk if taken before the age of 25 for longer than 4 years
HRT - increased risk while taking it and up to 5 years after
Family history

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2
Q

Name two drugs that can increase your risk of breast cancer

A

COC - higher risk if taking before the age of 25 for longer than 4 years
HRT - increased risk while taking it and for up to 5 years afterward.

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3
Q

What symptoms might you have with breast cancer?

A

Lump in breast, breast pain, nipple discharge, symptoms from metastases, skin dimpling(texture like orange peel), and enlarged lymph nodes.

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4
Q

Why do we examine a patients lymph nodes?

A

Lymph nodes are the first place where the cancer spreads to.

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5
Q

Why can we not use a mammogram to diagnose breast cancer alone?

A

Does not detect 10-15% of cases, so need to use a breast ultrasound as well.

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6
Q

What can a breast ultrasound do?

A

Distinguishes whether a lump is cystic filled (benign) or a solid tumor.

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7
Q

How often are people screened for breast cancer with a mammogram?

A

Every 3 years once over the age of 50

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8
Q

Where do breast cancers develop?

A

Cancer develops from cells that line breast, lobules and draining ducts.

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9
Q

What is the difference between metastatic and invasive breast cancer?

A

Invasive means that it has spread into the basement membrane and surrounding breast tissue - 80% of breast cancers are invasive at presentation.

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10
Q

What does TNM mean?

A

TNM is a staging system.
T - tumour status
N- lymph node status
M - distant metatases

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11
Q

In terms of the TNM system what do the different T stages mean? (T0-T4)

A

T0 - no palpable tumour
T1 - tumour <2cm with no fixation to underlying muscle
T2- tumour 2-5cm with no fixation
T3- >5cm
T4- tumour of any size with fixation to chest wall

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12
Q

What is meant by early breast cancer?

A

<2cm tumours confined to breast or larger tumours with ipsilateral axillary node involvement.

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13
Q

What is meant by locally advanced breast cancer?

A

> 5cm tumour but has not spread to other parts of the body

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14
Q

What is meant by secondary/metastatic breast cancer?

A

Has spread to other parts of the body

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15
Q

Outline the adverse prognostic factors for breast cancer

A

Poorly differentiated tumours - breast cancer tissue looks very different to normal tissue under microscope. More likely to grown and spread faster.

ER/PR negative

HER2 positive

Young at diagnosis

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16
Q

What are the main treatment options for breast cancer?

A

Surgery
Radiotherapy
Hormonal therapies
Chemotherapy

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17
Q

What are the different surgery options?

A

Mastectomy - removal of the entire breast
Wide local excision ‘lumpectomy’ - remove the lump and at least 1cm of normal tissue. Commonly called breast conserving surgery.

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18
Q

When would a mastectomy be considered/

A

Very large tumours and multifocal tumors

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19
Q

When are patients offered radiotherapy?

A

Offered to patients who have had wide local excision and patients who have had mastectomy who are at high risk of recurrence.

20
Q

Tamoxifen, anastrozaole, exemestane are all what?

A

Hormonal therapies

21
Q

What patients would be offered hormonal therapy?

A

All women with ER/PR positive tumors

22
Q

What is the purpose of hormonal therapy?

A

Aim is reduce oestrogen/progesterone levels as this is driving cell growth

23
Q

How long is hormonal therapy given for?

A

Given for 5 years after surgery - there is evidence that up to 15 years is beneficial so patients may be given for longer.

24
Q

What is tamoxifen?

A

Oestrogen antagonist

25
Q

What are the side effects of tamoxifen?

A

Hot flushes, weight gain, sweats, increased risk of endometrial cancer.

Side effects related to what you experience during menopause.

26
Q

What is the hormone therapy given to PRE-menopause patients with ER positive tumors?

A

Tamoxifen

27
Q

Anastrazole is an aromatase inhibitor, what does this mean?

A

Blocks the conversion of androgens from adrenal cortex to oestrogens in peripheral tissues.

28
Q

What is the hormonal agent of choice in POST-menopaual women?

A

Anastrozole

29
Q

What side effects of Anastrozole do we need to be concerned with?

A

Decreases bone mineral density, therefore all patients must have a DEXA scan before starting treatment.

30
Q

When is chemotherapy used in breast cancer?

A

As a adjuvant therapy for patients at risk of recurrence.

31
Q

What chemotherapy regimens have been found to be the most effective?

A

Anthracycline based regimens.

32
Q

Anthracycline based chemotherapy regimens are most effective in who?

A

Pre-menopausal, lymph node positive patients.

33
Q

What is FEC100?

A

Adjuvant chemotherapy regimen.
F - flurouracil
E- epirubicin
C - cyclophosphamaide

34
Q

How is FEC given?

A

IV every 21 days for 6 cycles

Doses are based on BSA

35
Q

What are the common side effects associated with FEC100?

A

Nausea and vomiting
Bone marrow suppression
Mucositis - patients often get mouth ulcers, we can offer them mouthwashes to help with this
Alopecia
Cardiac arrythmias and cardiomyopathy
Epirubicin can cause red colouration of urine.

36
Q

Before FEC chemotherapy can be given, must do a FBC, what are the requirements for it to be safe to give treatment?

A

Neutrophils must be >1

Platelets >100

37
Q

When do antiemetics need to be taken for chemotherapy?

A

Start the day before

38
Q

What is everolimus?

A

Selective mTOR (mammalian target of rapmycin)

39
Q

When is everolimus used?

A

Licensed for treatment of ER/PR positive, HER2 negative advanced breast cancer in combination exemestane in post menopausal women after cancer progression following hormonal treatment.

40
Q

What is pertuzumab?

A

Mab that targets HER2

41
Q

When and how is pertuzumab used?

A

Used in comibination with trazutumab and chemotherapy in early HER2+ breast cancer and metastatic disease

42
Q

What IHC score confers HER2+ breast cancer?

A

3+

43
Q

What pharmaceutical care issues tare associated with Pertuzumab?

A

Cardiac dysfunction - need to assess LVEF before treatment and during treatment. Stop if <40%.

44
Q

which antiemetic(S) are known to cause headaches?

A

5HT3 antagonists such as ondansetron.

Granisetron is still a 5HT3 antagonist but has a lower incidence of headache.

45
Q

Symptoms of low Hb levels may include….

A

Dizziness, fatigue, SOB, palpitations, and angina.

46
Q

Symptoms of a reduced platelet count may include…

A

Bleeding more easily e.g. gums

Brusing

47
Q

How should patients receiving chemotherapy manage fever?

A

Should keep a thermometer at home and call chemotherapy helpline if over 38

Cancer (mine) (10 decks)

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