Breast Oncology and Palliative Care Flashcards
Who is not involved in a breast cancer patient pre-diagnosis?
Oncologists
What are the 4 different treatment methods that oncologist deal with in a breast cancer patient?
- Radiotherapy
- Chemotherapy
- Hormonal therapy – oestrogen blockage
- Antibodies e.g Herceptin
What is the main method of neoadjuvant therapy?
Hormone therapy
What patient type responds well to hormone therapy?
ER + patients
When is neoadjuvant therapy given?
Before the main treatment e.g surgery
How long can neoadjuvant therapy be given for?
Usually up to 1 year before main therapy
What, essentially, is neoadjuvant therapy?
This is basically an additional treatment to make the main treatment (surgery) more successful
For what reason is neoadjuvant chemotherapy usually done?
For cosmetic reasons - this means that less surgery is needed and thus less breast tissue needs to be removed
What is done in Tayside that is different to elsewhere in the UK?
In Tayside, less extensive nodal clearance is done if there is an excellent response to neoadjuvant chemotherapy
What is the risk to the patient with neoadjuvant chemotherapy?
If you do damage to a patient with neoadjuvant chemotherapy, they may not be able to get surgery
What does adjuvant radiotherapy do?
Reduces the rate of local recurrence
When is adjuvant radiotherapy used?
It is used routinely after wide local excision
Adjuvant radiotherapy reduces local recurrence rate by ______
A half
How is adjuvant radiotherapy given?
Given by external beam therapy using linac over 3 weeks
What patients will need extra radiotherapy treatments?
- Young age
* Positive margins (that cannot be cleared by surgery)
Some patients need extra treatment (boosts) of ____________ which can make the treatment course longer – treat the whole breast
Radiotherapy
Name an ER blocker.
Tamofixen
What does aromatase do?
Converts androgen to oestrogen
Why are aromatase inhibitors good?
They make oestrogen levels drop very low as they stop the conversion of androgen to oestrogen
Give 2 examples of aromatase inhibitors.
- Letrozole
* Anastrozole
Why is adjuvant chemotherapy given?
Given to improve 10 year survival by 5-10%
What does adjuvant chemotherapy essentially do?
Decreases the chance of the cancer coming back
Give 2 examples of adjuvant chemotherapy agents used.
- Anthracyclie
* Taxane
List some side effects of chemotherapy.
- Anthracyclie
* Taxane
Name 2 problems that taxanes cause.
- Myalgia
* Peripheral neuropathy
Name a problem that gCSF injections causes.
- Severe axial skeleton pain from marrow stimulation
How do you tell who will benefit from radiotherapy and who won’t?
You can’t - but use things like staging to see how bad the cancer is
e.g size, mets, lymph nodes
How is Trastuzuma given?
SC or IV occasionally
What does Trastuzuma work against?
Antibody against the HER2 receptor
How often is Trastuzuma given?
One year of 3 weekly treatments
What adverse reactions can Trastuzuma cause?
Causes allergic reactions and reversible cardiac failure
Who does Trastuzuma work really well for?
This works really well for palliative patients as you can control the tumour size for slightly longer
How many women with breast cancer have the HER2 receptor?
Found over-expressed in about 15% of breast cancers
When is the surgical review following surgery?
Surgical review on anniversary of surgery then discharge from clinic follow-up
How often should breast cancer patients get mammograms?
Yearly mammograms for 3 years – this picks up recurrences or new cancers
What is used for patients with bone mets as prevention?
Bisphosphonates e.g oral ibandronic acid
If a patient has bone pain, what is it almost certainly?
Bone mets
What should you do to the bone with pain?
Localised CT of the bone
When are bone scans helpful?
Bone scans are often only helpful if it shows an atypical distribution of mets in the axial skeleton
How can patients reduce their risk of breast cancer?
- Normal BMI
- Exercise
- Self-breast exam
- Don’t consume excess alcohol
What should be done in a patient with neutropenia?
NOTHING - unless they are symptomatic
What therapy causes neutropenia?
Chemotherapy
What should you do if someone post-chemo is septic or has a fever?
Admit to oncology urgently !!
What therapy causes hot flushes?
This occurs with oestrogen blockers e.g Tamofixen
What drug can help with hot flushes?
Clonidine
What should be done if hot flushes get really bad?
** Stop oestrogen blockage if it gets really bad **
What form of contraception is contraindicated in patents with breast cancer?
Merina coil
In breast cancer patients, when can the marina coil be used?
Keep in if patient has bad periods or needs for contraception
What are the 2 main tumour markers of breast cancer?
- CEA
* CA15-3
What are the below good for?
- CEA
- CA15-3
Good for monitoring disease
Bad for diagnosing disease
When only should you check …?
- CEA
- CA15-3
Don’t check these unless you know that the patient has metastatic disease
** If someone on this gets PV bleeding, always consider the risk of endometrial cancer or polys !! **
If on Tamofixen
What is the link between breast size and radiotherapy?
The bigger the breast, the greater the damage
When does damage from breast radiotherapy usually happen?
This usually happens at the end of treatment or once the treatment has stopped
What is a new lump post treatment usually?
Fat necrosis
NOTE: unlikely to be recurrence unless really aggressive cancer
What is common in cancers with multiple bone mets?
Spinal cord compression
What should be done if you think someone has spinal cord compression?
MRI
What are the most common cancers to cause bone mets?
** Prostate, lung and breast are most common cancer to cause mets **
What should you do if a patient presents with headaches?
URGENT head scan
What group of patients have a high risk of breast cancer recurrence?
HER2 +
What will patients with lobular breast cancer often present with? Why?
Patient will often present with sub-acute bowel obstruction
Similar distribution of mets but to peritoneum and gut
What antidepressant should you avoid in patients on Tamoxifen?
Paroxetine
