Breast Oncology

Question 1

what oncological treatment can be given for breast cancer

Answer 1

radiotherapy
chemotherapy
hormonal therapy
antibodies

Question 2

what is Neo-adjuvant treatment and what is given

Answer 2

treatment given before the main treatment

often hormonal therapy for ER positive tumours - can be given for up to a year before surgery

or can be chemotherapy

Question 3

what are the advantages of neoadjuvant chemotherapy

Answer 3

allows for wide local excision instead of mastectomy

Question 4

what is adjuvant therapy and what is given

Answer 4

treatment given after the main treatment

usually radiotherapy - routinely given after a wide local excision to reduce the recurrence risk by half

ER-blockade

chemotherapy

Question 5

how is adjuvant radiotherapy given

Answer 5

by external beam therapy using linac over 3 weeks

extra treatment can sometimes make the course longer (boosts) - usually if young, or positive margins

Question 6

what is ER-blockade adjuvant therapy

Answer 6

oestrogen receptor blocking

5 years tamoxifen
-reduces risk of relapse by 15% at 10 years

aromatase inhibitors

• letroxole, anastrozole
• no difference in survival between tamoxifen and His

Question 7

what is adjuvant chemotherapy

Answer 7

chemotherapy after the surgery

improves 10 year survival by 5-10%

anthracycline and often a taxane

lots of side effects

Question 8

what targeted antibody therapy can be used as adjuvant therapy

Answer 8

Trastuzumab (Herceptin)

given by s/c injection

an antibody against the HER2 receptor (found over expressed in 15% of Breast cancers)

one year of 3 weekly treatment

improves survival by 3%

Question 9

what are the disadvantages to trastuzumab

Answer 9

causes allergic reactions and reversible cardiac failure

Question 10

what follow up is done after discharge from breast cancer treatment

Answer 10

review at the end of adjuvant treatment

discharge

surgical review on 1 year anniversary of surgery

yearly mammograms for 3 years

Question 11

what palliative care treatments are available for breast cancer

Answer 11

systemic treatment for wide spread disease (chemo or ER blockade)

radiotherapy for fungating breast disease or bone mets

bisphosphonates for bone mets as prevention

Question 12

what is trastuzumab-emtansine

Answer 12

new drug combining chemotherapy with trastuzumab (HER2 antibody)

delivers chemo directly to the tumour

Question 13

how can you confirm the presence of bone metastasis

Answer 13

localised CT (or MRI) of the affected bone

Question 14

what is a common problem with chemotherapy in breast cancer treatment

Answer 14

Neutropenia during chemotherapy

if patient has no fever ignore, if septic or well with fever admit urgently

Question 15

what tumour markers are used for monitoring breast cancer

Answer 15

CEA (carcinoembryonic antigen)

CA15-3

dont check unless metastatic disease and its clear how result will change treatment

Question 16

what is the impact of breast cancer therapy on the marina could

Answer 16

it is contraindicated so needs taken out

Question 17

what problems can occur with tamoxifen treatment

Answer 17

hot flushes 
vaginal bleeding 
risk of endometrial cancer (1:400)
endometrial hyperplasia/polyps 
vaginal dryness

Question 18

what problems can occur with giving radiotherapy to the breast

Answer 18

greater volume of tissue - greater the reaction

lymphodedma of the arm - rare

Question 19

what can cause a new lump in the breast shortly after treatment

Answer 19

unlikely to be recurrence so soon

fat necrosis common after trauma - particularly reconstruction

Question 20

what are the risks of back pain in patients with bone metastases

Answer 20

risk of spinal cord compression

red flags:

• severe back pain
• radicular back
• non-specific difficulty walking with no signs

need urgent MRI of spine

Question 21

what anti depression should be avoided when on tamoxifen

Answer 21

paroxetine (SSRI)

Question 22

what are some complications of HER2 positive breast cancer

Answer 22

higher risk of recurrence

commonly mets to central nervous system and pleura

if headaches - head scan

blurred vision - consider retinal mets

Question 23

complications of lobular breast cancer

Answer 23

commonly mets to peritoneum and gut

presents with sub-acute bowel obstruction

more difficult to see on mammogram

Question 24

how can you reduce breast cancer risk

Answer 24

have a normal BMI
exercise
self examination
dont consume excess alcohol

Question 25

can you use vagifem for vaginal dryness with ER-blockade

Answer 25

(its an oestrogen vaginal insert)

if high risk cancer and on aromatase inhibitor avoid

if low risk cancer and on tamoxifen then okay