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Heme/Onco > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

Intrinsic subtypes of breast cancer

What are the 4 types

A

Luminal A
Luminal B
Basal-like
HER2-positive

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2
Q

Breast cancer

Luminal A

A 
ER+ and/or PR +, HER2-:
Most common subtypes;
Less aggressive
Lower histological grade;
Good prognosis;
Hormone responsive
Associated with increasing age
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3
Q

Breast cancer

Luminal B

A

ER+ and/or PR+, HER2+
Similar to Luminal A
More frequently ER+/PR-;
Worse outcome than Luminal A

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4
Q

Breast cancer

Basal-like

A

Triple negative, cytokeratin 5/6 + and/or EGFR+
Aggressive subtype
High grade histology and high mitotic rate
Risk at younger age (age<4-)
More likely premenopausal African American women

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5
Q

Breast cancer

HER2+ (ER-)

A

Less common, highly aggressive subtype;
High grade histology;
Risk at young age <40 greater than luminal subtypes;
African American ethnicity may be a risk factor
Outcome improved with HER2

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6
Q

Breast cancer

Incidences orders by histology

A 
Infiltrating ductal carcinoma (75%)>
Lobular carcinoma in situ>
Infiltrating lubular carcinoma (<15%)>
Medullary carcinoma (5%)>
Mucinous carcinoma (<5%)>
Tubular carcinoma (1-2%)>
Papillary carcinoma (1-2%)>
Metaplastic breast canccer (<1%)>
Paget disease
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7
Q

Breast cancer
Prevention
What is the tool to estimate woman’s 5 year and liftetime breast cancer risk?

A

Gail Model Risk Assessment Tool

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8
Q

Breast cancer
Prevention
Who should receive breast cancer prophylaxis treatment?

A

GMRAT:
If 5 year breast cancer risk>=1.7% or
with Lobular carcinoma in situ

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9
Q

Breast cancer
Prevention
What should be given for prophylaxis treatment

A

Pre-menopausal:Tamoxifen;

Post-menopausal: Tamoxifen, raloxifene or exemestane

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10
Q

Breast cancer
Prevention
Screening if BRCA1/2 mutation positive

A

Breast cancer screening with MRI at age 25 and mammography at age of 30

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11
Q

Breast cancer
Prevention
Surgical prophylaxis for BRAC1/2 mutation positive

A

Prophylactic bilateral mastectomy (decrease by 90%);

Prophylatic bilateral salpingo-oophorectomy (decrease by 80%)

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12
Q

Breast cancer

Medication- Tamoxifen

A

SERM
Breast cancer risk reduction: 49%;
SE: Vasomotor; vascular events, endometrial and uterine cancer in postmenopausal women

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13
Q

Breast cancer
Medication- Tamoxifen
Contraindication

A

If with prior thromboembolic events

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14
Q

Breast cancer
Medication- Tamoxifen
Can it be used in premenopausal women?

A

Yes

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15
Q

Breast cancer

Medication- Raloxifene

A

SERM
Breast cancer risk reduction: less than tamoxifen
SE: vasomotor; vascular events

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16
Q

Breast cancer
Medication- Raloxifene
Contraindication

A

If with prior thromboembolic events

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17
Q

Breast cancer
Medication- Raloxifene
Can it be used in premenopausal women?

A

None, not studies;

unless part of a clinical trial

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18
Q

Breast cancer
Medication- Exemestane
Mechanism of action

A

Aromatase inhibitor: prevents conversion of androgen to estrogen
Breast cancer risk reduction: 65%

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19
Q

Breast cancer
Medication- Exemestane
Side effects:

A

Vasomotor symtpoms;
Arthralgia;
Headaches
Insomnia

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20
Q

Breast cancer
Medication- Exemestane
Can it be used in premenopausal women?

A

No. Not effective

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21
Q

Breast cancer
Medication- Exemestane
Will it cause other side effects?

A

At 3 year f/u, no increase in osteoporosis, factures, endometrial cancer, vascular events or cardiac disease

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22
Q

Breast cancer

Favorable prognosis of early stage breast cancer

A

Hormone receptor-positive cancer;
Small tumor size;
Low tumor grade;
Negative lymph nodes.

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23
Q

Breast cancer

When do you need images study to eval for metastasis in stage I and II breast cancer?

A 
Hormone receptor-negative cancer;
HER2 overexpression;
Large tumor size;
High tumor burden;
Positive lymph nodes;
Presence of extensive lymphovascular invasions.
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24
Q

Breast cancer
Ductal carcinoma in Situ (DCIS)
Treatment

A

Breast-conserving therapy;

Or Mastectomy

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25
Breast cancer Ductal carcinoma in Situ (DCIS) Treatment-breast-conserving therapy
Lumpectomy + breast radiation
26
Breast cancer Ductal carcinoma in Situ (DCIS) Treatment When to do sentinel lymph node biopsy?
``` If microinvasion (<=1 mm foci of invasion); of If mastectomy is done and found invasion ```
27
Breast cancer Ductal carcinoma in Situ (DCIS) DCIS and ER positive?
DCIS: 80% ER positive
28
Breast cancer Ductal carcinoma in Situ (DCIS) Treatment Adjuvant therapy and mortality?
Tamoxifen does not affect mortality
29
Breast cancer Ductal carcinoma in Situ (DCIS) Treatment Adjuvant therapy benefit:
Decrease the risk of local recurrence of both DCIS and invasive cancer by 20% and 25% and of contralateral breast cancer by 50%
30
Breast cancer Invasive breast cancer Treatment
Breast-conserving therapy AND mastectomy
31
Breast cancer Invasive breast cancer When to do neoadjuvant therapy before surgery?
If tumor>5cm
32
Breast cancer Invasive breast cancer Treatment When to do axillary lymph node dissection?
If clinically involved lymph nodes or with 3 or more sentinel lymph nodes
33
Breast cancer Invasive breast cancer When to do chest wall radiation after mastectomy?
``` If Tumor >5 Positive tumor margins Skin or chest wall involvement Inflammatory breast cancer 4 or more positive axillary lymph nodes ```
34
Breast cancer Invasive breast cancer When to use breast-conserving therapy?
Tumors <=5 involving a single quadrant of the breast and clear margins after excision
35
Breast cancer Invasive breast cancer When to use mastectomy?
Tumors involving the skin, chest wall or more than one quadrant of the breast and for inflammatory breast cancer
36
Breast cancer Adjuvant therapy What is the goal of adjuvant therapy?
Eradicate occult microscopic foci of breat cancer to prevent or delay systemic recurrence for stage I-III breast cancer
37
Breast cancer Adjuvant therapy Endocrine therapy
If ER positive: | Tamoxifen for 10 years shows benefit
38
Breast cancer Adjuvant therapy Endocrine therapy--Premenopausal
Tamoxifen for 10 years; | Tamoxifen for 5 years and then araomatase inhibitor for 5 years once postmenopausal
39
Breast cancer | Adjuvant therapy--Postmenopausal
2 years of tamoxifen therapy followed by 3-5 years of aromatase inhibitor; Or 5 years of aromatase inhibitor
40
Breast cancer Adjuvant therapy Aromatase inhibitors
Anastrazole Letrozole Exemestane
41
Breast cancer Adjuvant therapy Chemotherapy- Who should receive?
``` ER/PR negative; HER2 positive; High-grade tumor; Extensive lymphovascular invasion; Positive lymph nodes ```
42
Breast cancer Adjuvant therapy Chemotherapy
2 or 3 agents: Anthracyclines (Doxorubicin or epirubicin); Cyclophosphamide Taxanes (Paclitaxel or docetaxel)
43
Breast cancer Adjuvant therapy Chemotherapy- SE
Anthrocyclines: cardiotoxicity Cyclophosphamide: interstitial pneumonitis Taxanes: mylelodysplasia and leukemia
44
Breast cancer Adjuvant therapy Chemotherapy for HER2 positive patients?
If tumor >=0.5cm And/Or positive lympoh nodes --> ADD trastuzumab
45
Breast cancer Adjuvant therapy Chemotherapy Trastuzumab
Mortality benefit and decrease recurrence | Given for 1 year
46
Breast cancer Adjuvant therapy Chemotherapy- Trastuzumab SE
Cardiotoxicity | High with anthrocyclines.
47
Breast cancer Adjuvant therapy Chemotherapy- How to manage Trastuzumab SE
Baseline ECHO or Multigated acquisition scan and every 3 months during treatment
48
Breast cancer Locally advanced breast cancer Definition?
Stage IIIA-IIIC | Tumor >5cm with lymph node involvement, skin or chest wall involvement, and/or extensive axillary lymph node involvement
49
Breast cancer Locally advanced breast cancer Treatment
Neoadjuvant chemotherapy then surgery and the radiation
50
Breast cancer Inflammatory breast cancer Feature
Aggressive, rapidly progressive; High grade tumor Hormone receptor negative HER2 positive
51
Breast cancer Inflammatory breast cancer Does it need images to evaluate for metastasis?
Yes
52
Breast cancer Inflammatory breast cancer Treatment
Neoadjuvant cheomtherapy + surgery and then radiation
53
Breast cancer Inflammatory breast cancer 5 year survival?
Lowest, 40%
54
Breast cancer Follow up and survivorship How often should be monitored?
Every 3-6 months in the first 2 years; Every 5 months from year 2-5 Then annually
55
Breast cancer Follow up and survivorship What images should be used to monitor?
Annual mammography
56
Breast cancer Follow up and survivorship When to use MRI for monitoring?
``` High risk (BRAC1/2 mutation); Strong family history of breast cancer; ```
57
Breast cancer Follow up and survivorship Do you do surveillance blood test and other imaging?
No. Not recommended.
58
Breast cancer Follow up and survivorship Vasomotor symptoms treatment:
SSRI: escitalopram; or SNRI: venlafaxine
59
Breast cancer Follow up and survivorship If on tamoxifen, what should be avoided
CYP2D6 inhibitors: | Bupropion, fluoxetine and praxetine: can inhibit tamoxifen activation
60
Breast cancer Follow up and survivorship Bone density monitoring.
Every 1-2 years
61
Breast cancer Follow up and survivorship Arm mobility and lymphedema
Prompt referral to PT
62
Breast cancer Metastatic breast cancer Management of metastatic lesions
Biopsy and test for hormone status and HER2 expression
63
Breast cancer Metastatic breast cancer Treatment
Systemic treatment: mainstay; | Surgery and radiation: ancillary roles
64
Breast cancer Metastatic breast cancer Hormone receptor positive: antiestrogen treatment
Aromatase inhibitors; Tamoxifen; Ovarina suppression in premenopausal women; Fulvestrant (an estrogen receptor down-regulator) Megestrol acetate Estradiol Combination of exemestene and the mTOR inhibitor (everolimus)
65
Breast cancer Metastatic breast cancer Hormone receptor negative
Chemotherapy
66
Breast cancer Metastatic breast cancer HER-2 positive
Trastuzumab plus antiestrogen therapy (if positive) or nonanthrocycline based chemotherapy
67
Breast cancer Metastatic breast cancer If lytic bone metastases
Bisphosphonates | Denosumab
68
Breast cancer Metastatic breast cancer Bispohosphonate SE
Fever, kidney injury, hypocalcemia and osteonecrosis of the jaw
69
Breast cancer Metastatic breast cancer Denosumab mechanism
Monoclonal antibody against the receptor activator of nuclear factor kB ligant (RNAKL)
70
Breast cancer Metastatic breast cancer Denusumab SE
Hypocalcemia | Osteonecrosis of the jaw
71
Breast cancer Metastatic breast cancer If on Denosumab or Bisphosphonate?
Get baseline dental evaluation | Regular dental check while on treatment
72
Paget disease of breast | Features
1. aunilateral, erythematous, intensely pruritic, ulcerative lesion confined to the nipple and areola. 2. Serous or serosanguineous discharge might occur 3. Indicate underlying malignancy 4. Require b/l mammography
73
Paget disease of breast | Dx
Biopsy

Heme/Onco (19 decks)

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