Breast Oncology and Palliative Care

Question 1

what does neo-adjuvant treatment mean?

Answer 1

treatment given pre-surgery eg chemo/radio

Question 2

what kind of patients would get neo-adjuvant hormonal therapy?

Answer 2

ER+ patients

less fit patients

Question 3

material is stained with what substance after FNA?

Answer 3

H + E

Question 4

what neo-adjuvant therapy has a cosmetic advantage and why?

Answer 4

chemo, can shrink tumour significantly so that less surgery is needed

Question 5

what patients would be unsuitable for neoadjuvant chemo?

Answer 5

patients with lots of comorbidities

Question 6

how is hormonal therapy given as an adjuvant therapy?

Answer 6

tamoxifen for 5yrs

Question 7

what aromatase inhibitors are given to patients who have undergone the menopause?

Answer 7

letrozole

anastrozole

Question 8

side effects of hormonal therapy?

Answer 8

vaginal dryness

hot flushes

Question 9

how are side effects of hormonal therapy managed?

Answer 9

clonidine

Question 10

what chemotherapy drugs are given as adjuvant for breast cancer?

Answer 10

toxic anthracycline

taxane

Question 11

side effects of chemo?

Answer 11

anorexia
malaise
neutropenia
alopecia
myalgia
peripheral neuropathy

Question 12

when would you admit someone with side effects from chemo?

Answer 12

if fever from neutropaenia

significantly ill

Question 13

what is trastuzomab?

Answer 13

a monoclonal antibody (used in HER2+ patients)

Question 14

side effects of trastuzomab/herceptin?

Answer 14

allergy

reversible heart failure

Question 15

how are patients with breast cancer followed up after treatment?

Answer 15

1 mammogram a year for 3 yrs

back to usual screening after that

Question 16

palliative Tx of breast cancer?

Answer 16

systemic ER blockade with hormonal therapy OR chemo
radiotherapy to breast or to bone mets
bisphoponates for bone mets

Question 17

Tx bone mets

Answer 17

ibandronic acid (A bisphosphonate)
radiotherapy

Question 18

Ix bone pain in someone with a PMH of breast cancer

Answer 18

CT or bone scan

Question 19

when cannulating what should you be wary of in someone with lymphoedema?

Answer 19

dont cannulate ipsilateral arm

Question 20

new lump presents post breast cancer surgery….

Answer 20

might be fat necrosis

Question 21

when is checking tumour markers useful in breast cancer?

Answer 21

for mets only (not original diagnosis)

Question 22

red flag symptom for bone mets? why?

Answer 22

back pain

from spinal cord compression

Question 23

what medication cannot be given with tamoxifen?

Answer 23

paroxetine (SSRI)

Question 24

HER2+ breast cancer metastasises where?

Answer 24

brain
lung
meninges
pleura

Question 25

lobular breast cancer metastasises where?

Answer 25

lung
pleura
peritoneum
gut