Breast cancer - oncology

Question 1

How long may hormonal therapy be given prior to surgery in some patients with breast cancer?

Answer 1

For less fit patients with ER-positive tumour or patients in whom it is not certain if surgery will be performed, may be given for up to a year before surgery

Question 2

What are the main side effects of chemotherapy used in breast cancer treatment ?

Answer 2

• Anorexia, malaise, neutropenia, alopecia and peripheral neuropathy
• Taxanes induce myalgia
• gCSF injections may produce severe axial skeleton pain from marrow stimulation

Question 3

What are the side effects of Trastuzumab (Herceptin)?

Answer 3

Causes allergic reactions and reversible cardiac failure

Question 4

What routine follow up is done for patients after breast cancer ?

Answer 4

yearly mammograms for 3 years

Question 5

What is given to patients with bony metastases with breast cancer or those on anw AI if DXA scan abnormal (i.e. osteopenia or worse)?

Answer 5

Bisphosphonates (e.g. oral ibandronic acid)

Question 6

What is done if a patient develops neutropenia during chemotherapy?

Answer 6

• If the patient is well and has no fever, ignore
• If they are septic, or well but with fever, admit to oncology urgently - Piperacillin/Tazobactam given

Question 7

What common problem is experienced by patients on tamoxifen or an AI?

Answer 7

Hot flushes

Question 8

What is given for patients experiencing hot flushes on tamoxifen/AI’s?

Answer 8

No good treatment

Clonidine sometimes works, needs to be reduced and stopped slowly

Question 9

Is the Mierna coil safe to use in those with a history of breast cancer?

Answer 9

No contraindicated

Question 10

Can tamoxifen cause vaginal bleeding ?

Answer 10

Yes - Common to induce endometrial hyperplasia (it increase risk of endometrial cancer development) and/or polyps

Question 11

If there is concern about tamoxifen causing vaginal bleeding and potential endometrial hyerplasia or polyp development what can be done ?

Answer 11

• If concern, seek gynaecological opinion
• May need to change to AI (if post-menopausal)
• If pre-menopausal, perhaps goserelin

Question 12

What is a common lump which may be found following breast reconstruction surgery ?

Answer 12

Fat necrosis causing a firm localized swelling is common after trauma, particularly after reconstructive surgery