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Reproduction and Sexual Health > Breast Oncology and Palliative Care > Flashcards

Breast Oncology and Palliative Care Flashcards

1
Q

Who is not involved in a breast cancer patient pre-diagnosis?

A

Oncologists

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2
Q

What are the 4 different treatment methods that oncologist deal with in a breast cancer patient?

A
  • Radiotherapy
  • Chemotherapy
  • Hormonal therapy – oestrogen blockage
  • Antibodies e.g Herceptin
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3
Q

What is the main method of neoadjuvant therapy?

A

Hormone therapy

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4
Q

What patient type responds well to hormone therapy?

A

ER + patients

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5
Q

When is neoadjuvant therapy given?

A

Before the main treatment e.g surgery

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6
Q

How long can neoadjuvant therapy be given for?

A

Usually up to 1 year before main therapy

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7
Q

What, essentially, is neoadjuvant therapy?

A

This is basically an additional treatment to make the main treatment (surgery) more successful

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8
Q

For what reason is neoadjuvant chemotherapy usually done?

A

For cosmetic reasons - this means that less surgery is needed and thus less breast tissue needs to be removed

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9
Q

What is done in Tayside that is different to elsewhere in the UK?

A

In Tayside, less extensive nodal clearance is done if there is an excellent response to neoadjuvant chemotherapy

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10
Q

What is the risk to the patient with neoadjuvant chemotherapy?

A

If you do damage to a patient with neoadjuvant chemotherapy, they may not be able to get surgery

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11
Q

What does adjuvant radiotherapy do?

A

Reduces the rate of local recurrence

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12
Q

When is adjuvant radiotherapy used?

A

It is used routinely after wide local excision

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13
Q

Adjuvant radiotherapy reduces local recurrence rate by ______

A

A half

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14
Q

How is adjuvant radiotherapy given?

A

Given by external beam therapy using linac over 3 weeks

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15
Q

What patients will need extra radiotherapy treatments?

A
  • Young age

* Positive margins (that cannot be cleared by surgery)

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16
Q

Some patients need extra treatment (boosts) of ____________ which can make the treatment course longer – treat the whole breast

A

Radiotherapy

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17
Q

Name an ER blocker.

A

Tamofixen

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18
Q

What does aromatase do?

A

Converts androgen to oestrogen

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19
Q

Why are aromatase inhibitors good?

A

They make oestrogen levels drop very low as they stop the conversion of androgen to oestrogen

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20
Q

Give 2 examples of aromatase inhibitors.

A
  • Letrozole

* Anastrozole

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21
Q

Why is adjuvant chemotherapy given?

A

Given to improve 10 year survival by 5-10%

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22
Q

What does adjuvant chemotherapy essentially do?

A

Decreases the chance of the cancer coming back

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23
Q

Give 2 examples of adjuvant chemotherapy agents used.

A
  • Anthracyclie

* Taxane

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24
Q

List some side effects of chemotherapy.

A
  • Anthracyclie

* Taxane

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25
Q

Name 2 problems that taxanes cause.

A
  • Myalgia

* Peripheral neuropathy

26
Q

Name a problem that gCSF injections causes.

A
  • Severe axial skeleton pain from marrow stimulation
27
Q

How do you tell who will benefit from radiotherapy and who won’t?

A

You can’t - but use things like staging to see how bad the cancer is

e.g size, mets, lymph nodes

28
Q

How is Trastuzuma given?

A

SC or IV occasionally

29
Q

What does Trastuzuma work against?

A

Antibody against the HER2 receptor

30
Q

How often is Trastuzuma given?

A

One year of 3 weekly treatments

31
Q

What adverse reactions can Trastuzuma cause?

A

Causes allergic reactions and reversible cardiac failure

32
Q

Who does Trastuzuma work really well for?

A

This works really well for palliative patients as you can control the tumour size for slightly longer

33
Q

How many women with breast cancer have the HER2 receptor?

A

Found over-expressed in about 15% of breast cancers

34
Q

When is the surgical review following surgery?

A

Surgical review on anniversary of surgery then discharge from clinic follow-up

35
Q

How often should breast cancer patients get mammograms?

A

Yearly mammograms for 3 years – this picks up recurrences or new cancers

36
Q

What is used for patients with bone mets as prevention?

A

Bisphosphonates e.g oral ibandronic acid

37
Q

If a patient has bone pain, what is it almost certainly?

A

Bone mets

38
Q

What should you do to the bone with pain?

A

Localised CT of the bone

39
Q

When are bone scans helpful?

A

Bone scans are often only helpful if it shows an atypical distribution of mets in the axial skeleton

40
Q

How can patients reduce their risk of breast cancer?

A
  • Normal BMI
  • Exercise
  • Self-breast exam
  • Don’t consume excess alcohol
41
Q

What should be done in a patient with neutropenia?

A

NOTHING - unless they are symptomatic

42
Q

What therapy causes neutropenia?

A

Chemotherapy

43
Q

What should you do if someone post-chemo is septic or has a fever?

A

Admit to oncology urgently !!

44
Q

What therapy causes hot flushes?

A

This occurs with oestrogen blockers e.g Tamofixen

45
Q

What drug can help with hot flushes?

A

Clonidine

46
Q

What should be done if hot flushes get really bad?

A

** Stop oestrogen blockage if it gets really bad **

47
Q

What form of contraception is contraindicated in patents with breast cancer?

A

Merina coil

48
Q

In breast cancer patients, when can the marina coil be used?

A

Keep in if patient has bad periods or needs for contraception

49
Q

What are the 2 main tumour markers of breast cancer?

A
  • CEA

* CA15-3

50
Q

What are the below good for?

  • CEA
  • CA15-3
A

Good for monitoring disease

Bad for diagnosing disease

51
Q

When only should you check …?

  • CEA
  • CA15-3
A

Don’t check these unless you know that the patient has metastatic disease

52
Q

** If someone on this gets PV bleeding, always consider the risk of endometrial cancer or polys !! **

A

If on Tamofixen

53
Q

What is the link between breast size and radiotherapy?

A

The bigger the breast, the greater the damage

54
Q

When does damage from breast radiotherapy usually happen?

A

This usually happens at the end of treatment or once the treatment has stopped

55
Q

What is a new lump post treatment usually?

A

Fat necrosis

NOTE: unlikely to be recurrence unless really aggressive cancer

56
Q

What is common in cancers with multiple bone mets?

A

Spinal cord compression

57
Q

What should be done if you think someone has spinal cord compression?

A

MRI

58
Q

What are the most common cancers to cause bone mets?

A

** Prostate, lung and breast are most common cancer to cause mets **

59
Q

What should you do if a patient presents with headaches?

A

URGENT head scan

60
Q

What group of patients have a high risk of breast cancer recurrence?

A

HER2 +

61
Q

What will patients with lobular breast cancer often present with? Why?

A

Patient will often present with sub-acute bowel obstruction

Similar distribution of mets but to peritoneum and gut

62
Q

What antidepressant should you avoid in patients on Tamoxifen?

A

Paroxetine

Reproduction and Sexual Health (51 decks)

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