Breast Cancer Flashcards
Outline the risk factors for breast cancer
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
Name two drugs that can increase your risk of breast cancer
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.
What symptoms might you have with breast cancer?
Lump in breast, breast pain, nipple discharge, symptoms from metastases, skin dimpling(texture like orange peel), and enlarged lymph nodes.
Why do we examine a patients lymph nodes?
Lymph nodes are the first place where the cancer spreads to.
Why can we not use a mammogram to diagnose breast cancer alone?
Does not detect 10-15% of cases, so need to use a breast ultrasound as well.
What can a breast ultrasound do?
Distinguishes whether a lump is cystic filled (benign) or a solid tumor.
How often are people screened for breast cancer with a mammogram?
Every 3 years once over the age of 50
Where do breast cancers develop?
Cancer develops from cells that line breast, lobules and draining ducts.
What is the difference between metastatic and invasive breast cancer?
Invasive means that it has spread into the basement membrane and surrounding breast tissue - 80% of breast cancers are invasive at presentation.
What does TNM mean?
TNM is a staging system.
T - tumour status
N- lymph node status
M - distant metatases
In terms of the TNM system what do the different T stages mean? (T0-T4)
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
What is meant by early breast cancer?
<2cm tumours confined to breast or larger tumours with ipsilateral axillary node involvement.
What is meant by locally advanced breast cancer?
> 5cm tumour but has not spread to other parts of the body
What is meant by secondary/metastatic breast cancer?
Has spread to other parts of the body
Outline the adverse prognostic factors for breast cancer
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
What are the main treatment options for breast cancer?
Surgery
Radiotherapy
Hormonal therapies
Chemotherapy
What are the different surgery options?
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.
When would a mastectomy be considered/
Very large tumours and multifocal tumors
When are patients offered radiotherapy?
Offered to patients who have had wide local excision and patients who have had mastectomy who are at high risk of recurrence.
Tamoxifen, anastrozaole, exemestane are all what?
Hormonal therapies
What patients would be offered hormonal therapy?
All women with ER/PR positive tumors
What is the purpose of hormonal therapy?
Aim is reduce oestrogen/progesterone levels as this is driving cell growth
How long is hormonal therapy given for?
Given for 5 years after surgery - there is evidence that up to 15 years is beneficial so patients may be given for longer.
What is tamoxifen?
Oestrogen antagonist
What are the side effects of tamoxifen?
Hot flushes, weight gain, sweats, increased risk of endometrial cancer.
Side effects related to what you experience during menopause.
What is the hormone therapy given to PRE-menopause patients with ER positive tumors?
Tamoxifen
Anastrazole is an aromatase inhibitor, what does this mean?
Blocks the conversion of androgens from adrenal cortex to oestrogens in peripheral tissues.
What is the hormonal agent of choice in POST-menopaual women?
Anastrozole
What side effects of Anastrozole do we need to be concerned with?
Decreases bone mineral density, therefore all patients must have a DEXA scan before starting treatment.
When is chemotherapy used in breast cancer?
As a adjuvant therapy for patients at risk of recurrence.
What chemotherapy regimens have been found to be the most effective?
Anthracycline based regimens.
Anthracycline based chemotherapy regimens are most effective in who?
Pre-menopausal, lymph node positive patients.
What is FEC100?
Adjuvant chemotherapy regimen.
F - flurouracil
E- epirubicin
C - cyclophosphamaide
How is FEC given?
IV every 21 days for 6 cycles
Doses are based on BSA
What are the common side effects associated with FEC100?
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.
Before FEC chemotherapy can be given, must do a FBC, what are the requirements for it to be safe to give treatment?
Neutrophils must be >1
Platelets >100
When do antiemetics need to be taken for chemotherapy?
Start the day before
What is everolimus?
Selective mTOR (mammalian target of rapmycin)
When is everolimus used?
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.
What is pertuzumab?
Mab that targets HER2
When and how is pertuzumab used?
Used in comibination with trazutumab and chemotherapy in early HER2+ breast cancer and metastatic disease
What IHC score confers HER2+ breast cancer?
3+
What pharmaceutical care issues tare associated with Pertuzumab?
Cardiac dysfunction - need to assess LVEF before treatment and during treatment. Stop if <40%.
which antiemetic(S) are known to cause headaches?
5HT3 antagonists such as ondansetron.
Granisetron is still a 5HT3 antagonist but has a lower incidence of headache.
Symptoms of low Hb levels may include….
Dizziness, fatigue, SOB, palpitations, and angina.
Symptoms of a reduced platelet count may include…
Bleeding more easily e.g. gums
Brusing
How should patients receiving chemotherapy manage fever?
Should keep a thermometer at home and call chemotherapy helpline if over 38
