Breast cancer Flashcards
Drug of choice for ER nuclear positive invasive ductal carcinoma?
anti oestrogen therapy: tamoxifen
Drug of choice for widespread HER2 positivity in an invasive ductal carcinoma
monoclonal anti-HER2 therapy: trastuzumab (Herceptin)
monoclonal anti-HER2 therapy
Trastuzumam (Herceptin)
anti oestrogen therapy
Tamoxifen
link between oestrogen + breast ca
increased exposure to oestrogen puts you at an increased risk of breast cancer
factors resulting in an increased level of oestrogen
- early menarche
- late menopause
- nulliparity
- older age @ first birth
- use of COCP
- HRT
- no breastfeeding
- reproductive organ surgery
risk of breast Ca by 70 years in women with BRCA 1 or 2
45-65%
risk factors for breast cancer (8)
- high oestrogen exposure
- family history
- radiotherapy
- alcohol
- smoking
- low physical activity
- age
- dense breasts
where do 50% cancers occur?
upper outer quadrant of breast
1st + 2nd most common breast cancer?
1) invasive ductal carcinoma
2) invasive lobular carcinoma
85% cancers are?
INVASIVE DUCTAL CARCINOMA
what percentage of cancers are invasive lobular carcinomas?
10-15%
why are invasive lobular carcinomas difficult to detect?
cells infiltrate surrounding tissues in a single file pattern therefore the clinical presentation is a thickening rather than a discrete lump
imaging requested prior to surgery for invasive lobular carcinoma
MRI
3 factors to consider following pathological assessment of biopsies?
1) differentiation (aggressive potential of the cancer)
2) pleomorphism: how abnormal the tumour cells look
3) mitotic activity (how much the tumour cells are dividing)
what hormones can stimulate the growth of breast cancer cells
oestrogen + progesterone
what does ER +ve indicate?
presence of oestrogen receptors within the cancer
PR + ve means…
presence of progesterone receptors
HER2 is =
Human epidermal growth factor receptor 2
HER2 + ve means….
cancer cells have a higher than normal level of this protein on their surface… which stimulates them to grow
decision making aid used to estimate breast cancer survival
PREDICT
what does PREDICT take into account?
- age
- mode of detection
- tumour size + grade
- no. positive nodes
- ER + HER2 status
- chemo regimen
3 indications for mastectomy
1) Local focality: 2 or more breast cancers in the same breast
2) local recurrence
3) DCIS or Invasion > 4cm
different types of breast reconstruction offered?
1) delayed reconstruction using an implant
2) delayed recon - using flap of muscular tissue e.g. lat dorsi
3) immediate recon: implant, flap from muscle or abdomen
4) nipple: tattoo/reconstruction
side effects of tamoxifen (4)
- Cataracts
- DVT
- Endometrial thickening
- menopausal symptoms
menopausal symptoms
- hot flushes
- vaginal dryness
- nausea
- low libido
name the targeted drug therapy for HER2 positive breast cancer
monoclonal antibody: Trastuzumab/Herceptin
how does Trastuzumab/herceptin work ?
Monoclonal antibody that binds to the HER2 protein –> preventing stimulation of cancer cells –> stopping the cells dividing + growing
when is Herceptin given?
before or after chemotherapy treatment
delivery of Herceptin?
- IV infusion
- subcutaneous injection
3 weekly or weekly
1) if used to treat
frequency and duration of Herceptin treatment?
3 weekly or some have weekly
a) if using to treat primary breast cancer after surgery = 18 cycles (1 year duration)
b) if having before surgery = 4 to 6 cycles
common side effects of herceptin?
- nausea
- diarrhoea
- soreness at injection site
- flu like symptoms
less common side effects of Herceptin
- allergic reaction
- risk of infection (through lowering WCC)
- heart
signs of allergic reaction
- feeling hot
- itching
- shivering
- skin rash
- facial oedema
how does Tamoxifen work
hormonal therapy that blocks oestrogen binding to the oestrogen receptors of the cancer therefore reducing the stimulation of the cancer to grow by oestrogen stimulation
delivery of tamoxifen
tablets or syrup
common side effects of tamoxifen
menopausal symptoms -
advice for menopausal symptoms
- wear clothes made of natural fabrics: cotton
- dress inlayers that can be easily removed
- cotton bed sheets
- room temperature cool/use fan
- cold drinks
- avoid caffeine
treatment for vaginal effects from tamoxifen
- effects = discharge, bleeding, itching, dryness
- hormonal creams, gels, lubricants
components of tamoxifen which may affect your lifestyle
- alcohol
- some sugars
- lactose
what should be ruled out in a patient with non lactational breast abscess, and mastitis
inflammatory breast cancer
pathophysiology of inflammatory breast cancer
when cancer cells block the lymphatic drainage –> inflamed appearance of breast
symptoms of inflammatory breast cancer
- orange peel skin
- nipple discharge
- raised marks on skin of breast
- tender
- warmth
- erythematous
treatment
rapidly due to rapid progression of type of cancer
combination therapy
