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Heme/Onc > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are the RFs for breast cancer?

A

Age/gender
Endocrine factors
Genetic factors
Environmental and lifestyle factors

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2
Q

What are the endocrine RFs for breast cancer?

A

Early menarche (< age 12) and late menopause (> age 55)
Nulliparity and late initial pregnancy (after age 30)
HRT

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3
Q

What are genetic RFs for breast cancer?

A

Benign breast disease
Personal hx
FH
BRCA1/BRCA2 mutations: Increased lifetime risk of developing breast cancer
Other genes associated with hereditary breast cancer: TP53, CHK2, PTEN, ATM

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4
Q

What are the environmental and lifestyle RFs for breast cancer?

A 
Obesity
Lack of physical activity
Alcohol use
Prior ionizing radiation (before age 20)
Long-term heavy smoking (particularly before 1st pregnancy)
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5
Q

What ages does the American cancer society make recommendations for breast cancer screening?

A

40-44 can get a yearly mammogram
45-54 should get a yearly mammogram
55+ can transition to every other year or continue annual mammograms

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6
Q

What does the USPSTF recommend for mammogram schedules?

A

Biennial for ages 50-74

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7
Q

What are considered high risk that would require more frequent screening?

A

h/o breast cancer
5-year risk 1.7+ in women > 35 yo
Lifetime risk > 20%
Known genetic predisposition

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8
Q

What is the clinical presentation of early stage breast cancer?

A 
Typically no sx
Hard painless lump
Irregular and nonmobile
Nipple discharge, pain, or inversion
Dimpling/skin irritation
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9
Q

What type of sx may be associate with metastatic breast cancer?

A

Systemic sx

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10
Q

What are lobules?

A

Glands that produce breast milk

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11
Q

What do the ducts connect in the breasts?

A

Lobules to the nipples

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12
Q

What are the types of breast cancer?

A

Ductal Carcinoma In Situ
Lobular Carcinoma In Situ
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma

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13
Q

What is the diagnosis of breast cancer?

A 
History and physical
CBC, plt, LFT, alkaline phosphatase
Mammography
Ultrasound and/or MRI
Biopsy
Pathology review
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14
Q

What is a clinical stage?

A

Determined before surgery (based on PE and imaging)

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15
Q

What is a pathological stage?

A

Determined after surgey (includes information from surgical exploration/resection)

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16
Q

What is luminal A classification?

A

HR-positive

HER-2 Negative

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17
Q

What is Luminal B classification?

A

HR-positive

HER-2 positive

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18
Q

What is the triple negative classification?

A

ER-negative

HER-2 negative (basal subtype)

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19
Q

What is the HER-2 enriched classification?

A

HR-negative

HER-2 positive

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20
Q

What are some potentially modifiable risk factors?

A

Alcohol
Diet
Exercise

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21
Q

What are the prognostic factors for breast cancer?

A 
Stage at presentation
Lifestyle
Patient characteristics
Disease characteristics
Biomarkers
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22
Q

What are the types of proliferation rates in breast cancer?

A

S-Phase fraction

Ki-67

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23
Q

What combination of hormone receptors has the best prognosis?

A

ER +

PR +

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24
Q

What combination of hormone receptors has the worse prognosis?

A

ER -

PR -

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25
Q

What biomarker is amplified/overexpressed in 25% of breast cancers?

A

HER-2 Neu

erB-2

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26
Q

What are the two testing methods under investigation?

A

Immunochemistry (IHC)

Fluorescence in-situ hybridization (FISH)

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27
Q

What stages do we use OncotypeDX?

A

Mostly Stage I or II
ER+ invasive breast cancer
ER+
HER-2 -

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28
Q

What types of surgery are available?

A 
Lumpectomy
Simple mastectomy
Radical mastectomy
Modified radical mastectomy
Axillary lymph node dissection
Sentinel lymph node biopsy
Reconstruction surgery
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29
Q

What is a lumpectomy?

A

Breast conserving

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30
Q

What is a simple mastectomy?

A

Entire breast/nipple (leaves lymph node and muscle)

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31
Q

What is a radical mastectomy?

A

Removal of breast, lymph nodes, pectoralis muscles

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32
Q

What is a modifiedradical mastectomy?

A

Removal of entire breast w/some axillary lymph nodes

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33
Q

What is axillary lymph node dissection?

A

Removal of multiple lymph nodes

34
Q

What is sentinel lymph node biopsy?

A

First lymph node that receives drainage from primary tumor

35
Q

Which type of treatment is recommended with lumpectomies?

36
Q

Which medication has an interaction with 2D6?

A

Tamoxifen

Inhibition may decrease tamoxifen active metabolite

37
Q

What are options for adjuvant endocrine therapy for women if they are premenopausal at diagnosis?

A

Tamoxifen x 10 years

If post-menopausal after 5 years = aromatase inhibitor or tamoxifen x 5 more years

38
Q

Which hormonal therapy can only be used in post-menopausal women?

A

Aromatase inhibitors (Anastrozole, letrozole, exemastane)

39
Q

What are options for adjuvant endocrine therapy for women if they are postmenopausal at diagnosis?

A

Aromatase inhibitor x 2-3 years then tamoxifen to complete 5 years
Tamoxifen x 2-3 years than aromatase inhibitor to complete 5 years
Aromatase inhibitor x 5-10 years
Tamoxifen x 5-10 years

40
Q

What is the premenopausal endocrine therapy for recurrent or stage IV breast cancer?

A

Tamoxifen or ovarian ablation/suppression, then follow postmenopausal guidelines

41
Q

What is the postmenopausal endocrine therapy for recurrent or stage IV breast cancer?

A 
Antiestrogens
Aromatase inhibitors
Palbociclib
Ribociclib
Everolimus
42
Q

What are additional therapies for breast cancer if there is bone involvement?

A

Bisphosphonates: Zoledronic/Pamidronate
RANK ligand inhibitor (Denosumab)
Calcium and Vit D

43
Q

Which hormonal agents can be used regardless of menopausal status?

A

Antiestrogens

44
Q

Which hormonal agents can only be used in post-menopausal women?

A

Aromatase inhibitors

45
Q

What are AEs for antiestrogens?

A

Flushing/hot flashes
Thromboembolic events
Endometrial cancer

46
Q

What are the AEs of aromatase inhibitors?

A

Flushing/hot flashes
Bone pain/osteoporosis
Arthralgias/myalgias

47
Q

What interactions must we watch for with tamoxifen?

A

2D6 inhibition

48
Q

What is the goal of treatment for DCIS?

49
Q

What are the potential treatment plans for DCIS?

A

Surgery

Consider risk reduction options

50
Q

What is the goal of treatment for LCIS?

51
Q

What is the potential treatment plan for LCIS?

A

Consider risk reduction options

52
Q

What is DCIS?

A

Ductal carcinoma in situ

53
Q

What is LCIS?

A

Lobular carcinoma in situ

54
Q

What is the goal of treatment for Invasive breast cancer for stages I, II or some stage III

55
Q

What are possible treatments for invasive breast cancer (Stage I-III)?

A 
Surgery
Lymph node evaluation
\+/- radiation (if lumpectomy/high risk)
\+/- adjuvant chemotherapy
\+/- adjuvant hormonal therapy
56
Q

What is the goal of treatment for invasive breast cancer with large clinical stages II, III and some circumstances where neoadjuvant therapy may shrink tumor or otherwise offer benefit?

57
Q

What are potential treatment plans for invasive breast cancer with large clinical stages II, III and some circumstances where neoadjuvant therapy may shrink tumor or otherwise offer benefit?

A

Neoadjuvant chemotherapy or endocrine therapy
Surgery
+/- Adjuvant chemotherapy
+/- Adjuvant hormonal therapy

58
Q

What is the goal of stage IV/recurrent invasive breast cancer?

A

Comfort
Prolong life
Prevent progression
Sxs

59
Q

What are the treatment options for stage IV/recurrent invasive breast cancer?

A

Surgery/radiation
Hormonal therapy
Chemotherapy
Bisphosphonate/ denosumab - if bone disease present

60
Q

When can we use endocrine therapy for neoadjuvant chemo regimens?

A

ER/PR +
AND
Postmenopausal

61
Q

Which medications are included in neoadjuvant chemo regimens if they are HER2 +?

A

Trastuzumab +/- pertuzumab

62
Q

If there is local recurrence what therapy do we consider?

63
Q

What adjuvant regimens does the NCCN prefer that do not contain trastuzumab?

A

Dose dense AC
Doxorubicin/ cyclophosphamide
TC: Docetaxel/ cyclophosphamide

64
Q

What adjuvant regimens does the NCCN prefer that do contain trastuzumab?

A

T + Trastuzumab +/- pertuzumab

TCH: Docetaxel/ carboplatin/ trastuzumab +/- pertuzumab

65
Q

What are the preferred single agents for recurrent/metastatic breast cancer?

A

Doxorubicin (regular/liposomal)
Paclitaxel
Antimetabolites: capecitabine, gemcitabine
Vinorelbine, eribulin

66
Q

Which study looked at patients with metastatic breast cancer taking trastuzumab + docetaxel + pertuzumab/placebo?

67
Q

Which medications do we use if the patient is HER-2 +?

A

Pertuzumab + Trastuzumab w/ paclitaxel/docetaxel

68
Q

What are metastatic complications of breast cancer?

A

Bone metastasis

Oncologic emergencies

69
Q

How do we follow up with a patient with breast cancer?

A

Routine follow up
Annual mammography
Endocrine therapy follow up
Lifestyle factors

70
Q

What is hematologic supportive care?

71
Q

How many months should a woman wait after receiving treatment for breast cancer?

72
Q

Does fertility correlate to menses?

A

Not really

73
Q

What causes lymphedema?

A

Consequence of surgery but may be chemotherapy as well

74
Q

What populations are appropriate candidates for breast cancer intervention?

A

Lifetime risk > 20% or genetic predisposition

Life expectancy 10+ years

75
Q

What are the types of breast cancer surgery for prevention and risk reduction?

A

Prophylactic mastectomy

Bilateral oophorectomy

76
Q

Which medication has shown to reduce breast cancer incidence in patients with ER+ tumors?

77
Q

What did the STAR trial look at?

A

Raloxifene

Tamoxifen

78
Q

Tamoxifen has an increased incidence of what?

A

Endometrial cancer
Thromboembolic events
Hot flashes

79
Q

Between tamoxifen and raloxifene, which had a reduced incidence of breast cancer compared to placebo?

80
Q

Compared to raloxifene, tamoxifen has an increased incidence of what?

81
Q

While they are category 1 recommendations for breast cancer reduction, the FDA does not recommend these?

A

Exemestane

Anastrozole

Heme/Onc (20 decks)

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