Breast Cancer

Question 1

Risk factors for breast cancer?

Answer 1

• Increasing age
• Woman
• BRCA 1/2 or Lif fraumeni syndrome
• radiation exposure
• alcohol or obesity
• Increased lifetime exposure to estrogen
• early menarche, late menopause, HRT, OCP

Question 2

According toe the NCCN and ACS, how often to get a breast exam from Ages 20-39?

Answer 2

every 1-3 years old. The USPSTF recomments agins this

Question 3

If you are > 40 yo and female, how often do the NCCN and ACS reccomend to do breast exam?

Answer 3

once a year

Question 4

according to the USPSTF, how often to do a mammogram for breast cancer?

Answer 4

from 50-74 to biennial mammogram, recommend against screening <49 yo

Question 5

should patients only screen for breast cancer through self exams?

Answer 5

no, and if they are average risk, they should clinical breast exams and mammograms

Question 6

when is an MRI indicated for breast cancer detection?

Answer 6

High risk patients

Question 7

most common symptom for breast cancer?

Answer 7

painless bump
unilateral, solid hard
irregular, non mobile
10% stable or aching pain

Question 8

what exams can you run to diagnose breast cancer?

Answer 8

clinical breast exam
mammogram
biopsy**!!
lymph node dissection / mapping

Question 9

what is the purpose of the breast biopsy?

Answer 9

to find the prescence of hormones, growth factors that determine what kind of cancer it is.

looking for : ER/PR +, HER2

Question 10

what does HER 2 stand for? ER/PR

Answer 10

human epidermal growth factor 2
estrogen receptor
progestin receptor

Question 11

what is the difference between in situ carcinoma and invasive carcinomas?

Answer 11

in situ carsinomas are inside the breast duct and have not spread outside the duct. Invasive types have spread beyond the duct

Question 12

for which stages of breast cancer the goal to cure the cancer?

Answer 12

every stage except stage IV (when the cancer has metastasized.

Question 13

what is the treatment for a carcinoma in situ?

Answer 13

lumpectovmy or consider mastectomy depending or risk

Question 14

what is the treatment for stage I, IIA, IIB?

Answer 14

lumpectomay or mastectomy

and adjuvant therapy *check this

Question 15

what is adjuvant therapy for breast cancer?

Answer 15

radiation
adjuvant chemo
+/- adjuvant endocrine therapy
+/- trastuzumab

Question 16

what is the treatemtn for invasive breast cancer stage IIIA, B, C

Answer 16

lumpectomy or mastectomy

add neuadjuvant chemoterhapy to locoregional treatments

Question 17

what is the treatment for metastatic breast cancer stage IV?

Answer 17

endocrine therapy if ER/PR +
Trastuzumabe if HER2 +
Consider chemotherapy

Question 18

when do you use neoadjuvant /preoperative chemotherapy? what does that mean?

Answer 18

it means that you use chemotherapy before the operation to make the tumor smaller

• usually when tumore >= 1cm
• only if invasive breast cancer is convfirmed (stage 3 or higher)

Question 19

what is adjuvant therapy mean in the context of breast cancer and what does it mean?

Answer 19

chemotherapy used after the operation

typically when the tumor is > = 1 cm

Question 20

what classes of chemotherapy are used in breast cancer/

Answer 20

Anthracylines: doxorubicin, epirubicin

alkylator: cyclophosphamide
taxanes: paclitaxel, coextaxel, nab-paclitael

Question 21

adriamycin

Answer 21

doxorubicin

Question 22

ellence

Answer 22

epirubicin

Question 23

cytoxan

Answer 23

cyclophosphamide

Question 24

taxol

Answer 24

paclitaxel

Question 25

taxotere

Answer 25

docetaxel

Question 26

abraxane

Answer 26

nab-paclitaxel

Question 27

what agents can be used for neoadjuvant /adjuvant therapy?

Answer 27

anthracyclines: doxorubicin, epirubicin
adding taxane (once weekly, or q 3 week docetaxel0

Question 28

preferred regimen for HER2 negative?

Answer 28

AC: adriamycin/cyclophosphamde then paclitaxel
TAC: dcetaxel, doxcoroubicin, cyclophosphamide
TC: docetaxel/ cyclophosphamide

Question 29

what is the preferred neoadjuvant treatnment t?

Answer 29

T (docetaxe) folloed bey CEF (cyclophosphamide/ eipirubicine, flurouracil+ trastuzumab

Question 30

MOA of antrhacyclines

Answer 30

intercaltating agents that are cell cycle nonspecific
inhibit topoisomerase II (doxorubicin)
creates iron mediated free oxydne redicals

Question 31

anthracyclines renal or hepatic dose adjustment?

Answer 31

heaptic dose adjustment required

Question 32

SEs of Anthracyclines?

Answer 32

Cardiotoxicity (blockage of HER2 affects signalling of heart cells)
myelosupression, alopecial
red discoloration of urine, swears, tears
moderate emetic potential
secondary malignancy: AML, Myeolodysplastic syndrome

Question 33

when do u reach nadir for neutropenia/ thrombocytopenia/ anemia for anthracycliens?

Answer 33

10-14 days

recover in ~21 days

Question 34

what is the MOA of cyclophosphamide

Answer 34

prevents DNA synthesis by crosslinking DNA-DNA or DNA to preteen, causing strand breaks and misreading of DNA
-cell cycle non-specific

Question 35

renal or hepatic adjustment for cyclophosphamide?

Answer 35

hepatic Bili 3.5-5 or AST >180 give 75% of dose, if bili > 5 do not give
Renal for severe renal impariment

Question 36

adverse effects of cyclophosphamide

Answer 36

Hemorrhagic cystitis* 
neutropenia
emetic potential is dose dependent
SIADH if Doses > 50mg/kg
secondary malignancy
alopecia
acute hemorrhageci myocarditis

Question 37

what causes the hemorragic cystitis by cyclosphosphamide?

Answer 37

metabolite acroline attaches to the bladder and leads to necrosis

Question 38

when does the nadir for neutropenia for cyclophosphamide occur?

Answer 38

in 8-14 days