Breast Cancer Flashcards
Risk factors for breast cancer?
- 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
According toe the NCCN and ACS, how often to get a breast exam from Ages 20-39?
every 1-3 years old. The USPSTF recomments agins this
If you are > 40 yo and female, how often do the NCCN and ACS reccomend to do breast exam?
once a year
according to the USPSTF, how often to do a mammogram for breast cancer?
from 50-74 to biennial mammogram, recommend against screening <49 yo
should patients only screen for breast cancer through self exams?
no, and if they are average risk, they should clinical breast exams and mammograms
when is an MRI indicated for breast cancer detection?
High risk patients
most common symptom for breast cancer?
painless bump
unilateral, solid hard
irregular, non mobile
10% stable or aching pain
what exams can you run to diagnose breast cancer?
clinical breast exam
mammogram
biopsy**!!
lymph node dissection / mapping
what is the purpose of the breast biopsy?
to find the prescence of hormones, growth factors that determine what kind of cancer it is.
looking for : ER/PR +, HER2
what does HER 2 stand for? ER/PR
human epidermal growth factor 2
estrogen receptor
progestin receptor
what is the difference between in situ carcinoma and invasive carcinomas?
in situ carsinomas are inside the breast duct and have not spread outside the duct. Invasive types have spread beyond the duct
for which stages of breast cancer the goal to cure the cancer?
every stage except stage IV (when the cancer has metastasized.
what is the treatment for a carcinoma in situ?
lumpectovmy or consider mastectomy depending or risk
what is the treatment for stage I, IIA, IIB?
lumpectomay or mastectomy
and adjuvant therapy *check this
what is adjuvant therapy for breast cancer?
radiation
adjuvant chemo
+/- adjuvant endocrine therapy
+/- trastuzumab
what is the treatemtn for invasive breast cancer stage IIIA, B, C
lumpectomy or mastectomy
add neuadjuvant chemoterhapy to locoregional treatments
what is the treatment for metastatic breast cancer stage IV?
endocrine therapy if ER/PR +
Trastuzumabe if HER2 +
Consider chemotherapy
when do you use neoadjuvant /preoperative chemotherapy? what does that mean?
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)
what is adjuvant therapy mean in the context of breast cancer and what does it mean?
chemotherapy used after the operation
typically when the tumor is > = 1 cm
what classes of chemotherapy are used in breast cancer/
Anthracylines: doxorubicin, epirubicin
alkylator: cyclophosphamide
taxanes: paclitaxel, coextaxel, nab-paclitael
adriamycin
doxorubicin
ellence
epirubicin
cytoxan
cyclophosphamide
taxol
paclitaxel
taxotere
docetaxel
abraxane
nab-paclitaxel
what agents can be used for neoadjuvant /adjuvant therapy?
anthracyclines: doxorubicin, epirubicin adding taxane (once weekly, or q 3 week docetaxel0
preferred regimen for HER2 negative?
AC: adriamycin/cyclophosphamde then paclitaxel
TAC: dcetaxel, doxcoroubicin, cyclophosphamide
TC: docetaxel/ cyclophosphamide
what is the preferred neoadjuvant treatnment t?
T (docetaxe) folloed bey CEF (cyclophosphamide/ eipirubicine, flurouracil+ trastuzumab
MOA of antrhacyclines
intercaltating agents that are cell cycle nonspecific
inhibit topoisomerase II (doxorubicin)
creates iron mediated free oxydne redicals
anthracyclines renal or hepatic dose adjustment?
heaptic dose adjustment required
SEs of Anthracyclines?
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
when do u reach nadir for neutropenia/ thrombocytopenia/ anemia for anthracycliens?
10-14 days
recover in ~21 days
what is the MOA of cyclophosphamide
prevents DNA synthesis by crosslinking DNA-DNA or DNA to preteen, causing strand breaks and misreading of DNA
-cell cycle non-specific
renal or hepatic adjustment for cyclophosphamide?
hepatic Bili 3.5-5 or AST >180 give 75% of dose, if bili > 5 do not give
Renal for severe renal impariment
adverse effects of cyclophosphamide
Hemorrhagic cystitis* neutropenia emetic potential is dose dependent SIADH if Doses > 50mg/kg secondary malignancy alopecia acute hemorrhageci myocarditis
what causes the hemorragic cystitis by cyclosphosphamide?
metabolite acroline attaches to the bladder and leads to necrosis
when does the nadir for neutropenia for cyclophosphamide occur?
in 8-14 days
