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Reproduction > Breast Oncology > Flashcards

Breast Oncology Flashcards

1
Q

what oncological treatments exist

A

radiotherapy
chemotherapy
hormonal therapy (oestrogen blockade)
antibodies (e.g. trastuzumab (herceptin))

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2
Q

what are the treatment options for a curative cancer

A

neo-adjuvant
adjuvant
radical (treating cancer with oncological tx alone)

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3
Q

what is the role of adjuvant therapy

A

acts as back up to oncological Tx, wont cure it on its own but improves survival

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4
Q

what neoadjuvant therapies are given for breast cancer

A

hormonal therapy- for ER +ve tumours (can be given up to a year before surgery)
chemotherapy- can allow WLE instead of mastectomy

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5
Q

what is the disadvantage of neo aduvant chemo

A

need to attend for 6 extra imaging investigations compared with adjuvant therapy

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6
Q

what adjuvant therapies are used in breast cancer

A

radiotherapy (used after WLE)

ER blockade (5 years of tamoxifen or aromatase inhibitors (letrozole, anastrozole)

chemotherapy (usually anthracycline and taxane)

trastuzumab (herceptin - antibody against HER2)

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7
Q

how is adjuvant radiotherapy given

A

external beam therapy using linac over 3 weeks

extra boost sometimes makes tx longer- indicated if young age or positive margins

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8
Q

whar are the SEs of ER blockade

A

tamoxifen- DVT, PE, (is a partial agonist, paritally oestrogenic=will cause endometrium to proliferate) bleeding, polyps, endometrial cancer, endometrial hyperplasia
(may need to switch to goserelin)
AIs- heart problems, osteoporosis

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9
Q

why are AIs given to postmenopausal women

A

cant stop ovaries making oestrogen so given to post menopausal
are more effective in post menopausal
cause less clots and endometrial cancer

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10
Q

what are the side effects of chemotherapy

A 
anorexia
malaise
neutropenia
alopecia
myalgia
peripheral neuropathy 
gCSF infections- these can cause severe axial skeletal pain from marrow stimulation
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11
Q

how is trastuzumab given

A

sc injection
one year of 3 weekly treatments
only for cancers that overexpress HER2

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12
Q

what are the risks of trastuzumab

A

allergic reactions

reversible cardiac failure

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13
Q

what happens at the end of adjuvant treatment

A

review at end
discharge
surgical review on anniversary of surgery
yearly mammograms for 3 years

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14
Q

what are the palliative options for breast cancer

A

systemic Tx for widespread disease- ER blockage or chemotherapy

radiotherapy for fungating breast disease/ bone mets

bisphosphonates for bone mets to prevent risk of #

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15
Q

how is radiotherapy delivered

A

cancer localised
beams targeted to area, avoiding heart (exposure increases risk of ischaemic heart disease)
proton or electron (better for more superficial lesions)

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16
Q

what is trastucumab-emtansine

A

combo of herceptin with chemo- delivers chemo to the tumour

used palliatively and as an adjuvant

17
Q

what increases the change of breast cancer recurrence

A

its size
its grade
the involvement of axillary lymph nodes

18
Q

is bone pain after cancer always mets

A

no - assess risk of the cancer to determine likelyhood

19
Q

what is the best way to diagnose bone mets

A

localised CT or MRI of affected bone
bone scans only helpful if there is a shower of mets affected the axial skeleton (other things can make it appear hot eg #’s)

20
Q

when should you worry about neutropenia during chemo

A

if patient septic, or well with fever admit to oncology urgently
if patient well and no fever ignore

21
Q

what treatments for hot flushes caused by tamoxifen/ AI

A

clonidine
avoid plant oestrogens
progesterones work but safety unclear
stop ER blockage if cancer not risky

22
Q

can you use the marina coil when have breast cancer

A

CI by companies
risk unclear
may be cases where it is left in

23
Q

what tumour markers for breast cancer

A

CEA

CA125

24
Q

what is the role of tumour markers in breast cancer

A

ok for monitoring, poor for diagnosis
dont check unless mets disease known to be present
dont check unless its clear of how the result will change the treatment

25
Q

when are bisphosphonates used in breast cancer

A

in metastatic disease in high dose
with AIs if DXA scan abnormal (osteopenia or worse)
do dental work needed before starting them- risk of jaw osteonecrosis
if lack of oral tolerance try IV

26
Q

what are the risks of radiotherapy

A

skin reactions
chornic swollen breast
(greater the volume of tissue, greater the reaction)
tends to come on at end of treatment, lasts a few weeks then heals

lymphoodema of arm - rare, refer to breast care nurses if starting, avoid instrumentation (CP, cannulation, venopuction)= of ipsilateral arm after axillary surgery

27
Q

what is a new lump after breast cancer treatment likely to be

A

unless cancer very aggressive unlikely to be local recurrence if shortly after Tx finishing
-fat necrosis common after surgery

if uncertain do refer for triple assessment

28
Q

what should you be worried about in patients who have bone mets and back pain

A

spinal cord compression
look out for :
-severe back pain
-radicular back
-non specific difficulty walking with no signs
URGENT MRI of spine
by time classic signs have developed too late to treat

29
Q

what is the guidance for antidepressants and tamoxifen

A 
avoid paroxetine (SSRI)
antidepressents inhibit cytochrome P450 liver enzymes which are needed to convert tamoxifen to its active form

if someone has brittle depression then risk of change of anti depressant may be greater than any effect on tamoxifen

30
Q

what are the risks of a HER-2 positive breast cancer

A

high risk of recurrence
similar distribution of mets, but esp to CNS, meninges and pleura
if headache in this group do head scan
if blurred vision condsider retinal mets

31
Q

what are the risks of lobular breast cancer

A

Similar distribution of mets, but preferential metastases to peritoneum and gut
may be invisible on scan- Often more difficult to see on mammography too
often presents with sub-acute bowel obstruction

32
Q

how can you reduce your risk of breast cancer

A

normal BMI
exercise
dont smoke or consume excessive alcohol
self examine but not too often as may miss changing area

33
Q

can use topical oestrogen (vagifen) for vaginal dryness caused by ER blockade

A

uncertain
decide on symptom severity and patient wishes
risk on tamoxifen or if low risk cancer probably less

avoid if high risk cancer and on AI

34
Q

when is back pain after breast cancer tx likely/possible to be mets

A

if high risk cancer

35
Q

when should you do a head scan after breast cancer treatment

A

if headaches or visual disturbance or inco-ordination (particularly fleeting peripheral disturbance)
especially in patients who have had HER-2-positive cancer removed

Reproduction (51 decks)

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