breast cancer

Question 1

most common cancers in women

Answer 1

breast\; 1.6million cases. 450,000 deaths

lung

Question 2

histological types of breast cancer

Answer 2

in situ
- ductal
#comedo, cruciform, micropapillary, papillary, solid
-lobular

invasive carcinoma
tubular
ductal tubular 
invasive lobular
infiltrating ductal 
-poor diff, mod diff, well diff  
mucinous (colloid) 
medullary
infiltrating

Question 3

Breast cancer survival rate

Answer 3

98% early stage

27% advanced stage

Question 4

Stages of breast cancer

Answer 4

Stage 1a: 20 mm. n0 m0

Stage 1b: 20mm. N:0.2-2.0mm. M0

2a: 20-50mm. N0/N1. M0
2b: 20-50+. N0/N1 M0
3a: 50-50+. N1/2 M0
3b: invades chest wall/skin. N0-2. M0
3c. Any size. N3. M0
4. Any size. N0-3. M1

Question 5

RF for breast cancer

Answer 5

Uncontrollable 
 age
Fam history 
Reproductive history 
Genetic factors: HER2 & BRACA 
Tade 
Menstrual history 

Controllable 
- obesity 
Nulliparity 
Excercise 
Alcohol consumption 
Hormone replacement therapy

Question 6

Sx of breast cancer

Answer 6

Breast lump Most common initial sign

Lump in axilla

Breast size and shape change

Dimpled breast

Nipple discharge

Question 7

Treatment for breast cancer

Answer 7

Depends on stage

Biopsy of sentinel LN

Surgical removal: mastectomy/ breast conserving surgery

Radio therapy
Chemotherapy w/ oral drugs

Hormone therapy to block estrogen mediated tumor growth

Targeted therapy w/ drugs to ID and attack cancer cells

Question 8

Prognostic factors of breast cancer

Answer 8

Age at dg 
Lymph node invasion 
Tumor size 
Histological Grading and type of tumour 
Steroid receptor status ( ER&PR) 
HER2 status

Question 9

How does hormonal therapy treat breast cancer

Answer 9

Lowers oestrogen in body and blocks action on cancer cells

Only effective on hormone receptor positive breast cancer

Drugs blocking esteogen
1)Tamoxifen:
selective estrogen receptor modulator.
Causes fatigue, flushes, dry vagina and mood swings

2)Toremifene: Serm similar to tamoxifen

3)Fulvestrant: not a SERM
Blocks and temp ELIMINATES oestrogen

Question 10

Rx to reduce oestrogen

Answer 10

Aromatise inhibitors: Ferama, Arimidex
Block aromatise in fat tissue only not in ovaries
Taken as pills

Ovarian ablation
-Oophorectomy
Removal of ovaries where estrogen is produced forcing menopause
-LHRH drugs e.g. zoladec

Question 11

Targeted therapy in breast cancer

Answer 11

Blocks growth of cancer by interfering with specific target molecules

Examples
Hormone therapy, signal transduction inhibitors, apoptosis inducers, angiogenesis inhibitors m, immunotherapy

Side effects

• diarrhoea
• hepatitis
• imparted blood clotting and wound healing
• HTN
• gastrointestinal perforation

Question 12

Monoclonal antibodies for targeted therapy of breast cancer

Answer 12

Trastuzab/ herceptin: given IV

Pertuzimab/ perjeta:IV

Kadycla: used w: chemo IV

Lapatinib/ tykerb: non ab, pill

Question 13

Bone directed therapy in breast cancer

Answer 13

Common metastasis to Bones causes patho fractured and pain

Bisphosphonates
- strengthen bones and reduce fracture risk.
-reduce risk of osteoporosis from aromatase inhibitor use
E.g: pamidronate, zoledronic acid both IV
Side effects
-flu sx, bone pain, kidney problems, osteonecrosis

Denosumab
Prevents pathological fractures w/o kidney prob! 
Sub cut injection every 4wks 
Side effects
-low calcium and phosphate