breast cancer JH

Question 1

what can breast cancer look/ feel like?

Answer 1

thick area, dimple, nipple crust, red or hot, new fluid, skin sores,bump, growing vein, sunken nipple, new shape/ size, orange peel skin

Question 2

how does genetics influence breast cancer?

Answer 2

most of breast cancers are sporadic
family history is the strongest risk

Question 3

what are the genes associated with breast cancer?

Answer 3

BRCA1andBRCA2
* Two major high-risk genesassociated with hereditarybreast cancer
* Inheritance of mutated BRCA gene confers 45-90% lifetime risk of breast cancer

Question 4

what personal factors/ history may infleunce your chances of developing breast cancer?

Answer 4

• Age
• Previous breast cancer
• High breast density
• Previous exposure tor adiation(chest)
• Increased exposure to oestrogen
• Higher social/ economic status
• White ethnicity

Question 5

how does ones lifestyle influence their chances of developing breast cancer?

Answer 5

exercise- lower incidence
obesity- higher incidence
alcohol- increased incidence when consumed regularly.

Question 6

how is breast cancer screened?

Answer 6

mammogram is an x-ray

Question 7

how do you diagnois breast cancer?

Answer 7

• Identified by self-examination or routine screening
• Diagnosis is usually facilitated using Triple Assessment:
• Clinical Examination
• Characteristics of the lump— size,
  texture ,where it moves
• Breast Imaging
• Mammography: X-rays of the breast to allow detailed imaging of the tissue
• Ultrasound: aids diagnosis
• can differentiate between solid or fluid filled lump
• Pathological Evaluation
• Biopsy-assessment of tissue from the lump

Question 8

what is the first line treatment for breast cancer?

Answer 8

to remove the primary breast tumour via surgery

Question 9

what are the different types of surgery?

Answer 9

wide local excision- small margin
radial- breast, pectoralis and muscle
conventional- breast, skin and nipple, musle

Question 10

what is axillary surgery?

Answer 10

frequent site of lymph node metastases
to obtain lymph nodes for examination in breast cancers

Question 11

what is lympoedema?

Answer 11

after surgery cut off lymph nodes- build up of fluid and swelling

Question 12

how do you treat lymphoedema?

Answer 12

compression stockings, massage and specific exercises

Question 13

what is your aim with lymphoedema?

Answer 13

aim to take BP, readings and give injections in other arm

Question 14

when can radiotherapy be used?

Answer 14

after surgery for early BC
combined with systemic theraphy and surgery for local advanced cancer
combined with all systemic therapy for treatment of metastatic disease

Question 15

what about post mastectomy radiotherapy?

Answer 15

most patients wont require
reduces risk of chest wall reoccurrence
considered for patients with high risk of re-occurrence
axcillary radiation not recommended after axillary dissection as 30-40% risk of significant lymphoedema

Question 16

what are some adverse effects of radiotherapy?

Answer 16

early- skin in treatment areas becomes more senesitive, red and swollen, fatigue, hair loss
late- breast changes, bone damage, cardiac and respiratory toxicity

Question 17

when should someone start adjuant chemo?

Answer 17

started within 31 days of surgery or earliest clinically appropiate date

Question 18

what is taken into consieration with adjuvant chemotherapy?

Answer 18

nodal involvement
oestrogen receptor status
HER2 status

Question 19

what are the different regimens?

Answer 19

node negative patients: anthracycline regimen
node positive- taxane containing regime

Question 20

who is Neo-adjuvant chemotherapy considered for?

Answer 20

locally advanced disease and tumours where down staging may facilitate breast conserving surgery

Question 21

what should be determined prior to neo-adjuvant chemo?

Answer 21

ER, PR and HER2 status

Question 22

what are the different types of hormonal regulation

Answer 22

estrogen receptor- modulates circulation in blood stream
tamoxifen- pre- menopause
aromatase inhibitors- post menopause

Question 23

what are the side effects of hormonal therapy?

Answer 23

bone loss- monitor/ bisphosphonate
menopausal symptoms
increased risk of VTE

Question 24

what role does HER2 play in breast cancer?

Answer 24

Growth factor receptors have an essential role in proliferative and cell survival pathways

Question 25

what is amplification/ overexpression of HER2 associated with?

Answer 25

accelerated cell growth/ proliferation
increased risk of disease reucrrence
shortened overall patient survival

Question 26

what is trastuzumab- herceptin used for?

Answer 26

monoclonal antibody that blocks HER2 receotor
given with chemo and other cancer drugs

Question 27

what are the s/e of herceptin?

Answer 27

neutropenia
aneamia
thromboctopenia
hypersensitivity reactions
CV disease

Question 28

what is the treatment for hormone receptor positive patients?

Answer 28

endocrine therapy usually first- depends if pre or post menopause

Question 29

what treatment is given in HER2 positive patients?

Answer 29

targeted in conjuction with chemo

Question 30

what if the patient is tripple negative?

Answer 30

chemo
depends on patient factors
no optimal duration of treatment

Question 31

how do you treat brain metastases?

Answer 31

surgery
whole brain radiotherapy
pallative care

Question 32

what is ulcerating/ fungating disease?

Answer 32

grows in shape of a fungus
develops in untreated cancer
cancer growsupwards and breaks throughskin