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Reproductive & Sexual Health > Breast Oncology and Palliative Care > Flashcards

Breast Oncology and Palliative Care Flashcards

1
Q

What are the oncological treatments available?

A
  • Chemotherapy
  • Radiotherapy
  • Hormonal therapy
  • Antibodies (TZ, Herceptin)
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2
Q

Of cancer can be cured what treatment is provided

A

Adjuvant and neoadjuvant

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3
Q

If cancer cannot be cured what treatment is provided

A

Palliation

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4
Q

What treatments are given as neo-adjuvant therapies?

A

Radiotherapy- usually no

Hormonal therapy- yes

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5
Q

Who is given hormonal therapy?

A
  • ER-positive tumours
  • less fit patients
  • patients in whom it is not certain if surgery will be performed
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6
Q

How long is neo-adjuvant hormonal treatment given?

A

Up to a year before sugery

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7
Q

What are the advantages of neo-adjuvant chemotherapy

A
  • cosmetic- WLE could be done instead of mastectomy
  • less expensive nodal clearance post chemo
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8
Q

What are the disadvantages of neo-adjuvant chemotherapy

A

Attendances for 6 extra imaging investigaitons compared with adjuvant treatment

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9
Q

When is adjuvant radiotherapy used?

A
  • routinely after WLE
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10
Q

How is adjuvant radiotherapy delivered?

A

By external beam therapy using linac over 3 weeks

Extra treatment boost makes course longer

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11
Q

What are the indications for boost adjuvant radiotherapy?

A

Young age

+ve margins

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12
Q

adjuvant radiotherapy reduces recurrence risk by about ___; probably saves ___ life for every 4 recurrences prevented

A

adjuvant radiotherapy reduces recurrence risk by about half; probably saves one life for every 4 recurrences prevented

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13
Q

Describe effect of tamoxifen adjuvant therapy?

A

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

Improvement in survival is 5-10%

10 years of tamoxifen gives a further increase in survival of 3%

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14
Q

How do tamoxifen and AI’s work?

A

Oestrogen receptor blockade

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15
Q

Aromatase inhibitors – _______, ________ – ___ _________ in overall survival between tamoxifen and AIs

A

Aromatase inhibitors – letrozole, anastrozole – no difference in overall survival between tamoxifen and AIs

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16
Q

Adjuvant chemotherapy is given to improve 10-year survival by _-__% absolute

A

Adjuvant chemotherapy is given to improve 10-year survival by 5-10% absolute

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17
Q

What do the various adjuvant chemotherapy regimens involve?

A

Anthracycline and often a taxane

18
Q

What are the side effects of adjuvant chemotherapy?

A
  • Anorexia
  • malaise
  • neutropenia
  • alopecia
  • taxanes induce myalgia
  • peripheral neuropathy
  • gCSF injections may produce severe axial skeleton pain from marrow stimulation
19
Q

Describe adjuvant hormonal therapy

A

Trastuzumab (herceptin)

given by s/c injection- sometimes IV

One year of 3-weekly treatment

Causes allergic reactions and reversible cardiac failure

20
Q

What is the survival advantage from adjuvant hormonal therapy

A

3%

21
Q

After treatment surgical review on …….. then discharge from clinic follow up but …… mammograms for …. ……

A

After treatment surgical review on the anniversary of surgery then discharge from clinic follow up but yearly mammograms for three years

22
Q

What can be given as palliative treatment for breast cancer?

A
  • systemic blockade for widespread disease (e.g. ER blockade or chemotherapy)
  • Radiotherapy for fungating breast disease or bone metastases
  • bisphosphonates (e.g. oral ibandronic acid) for those with bone metastases as prevention
23
Q

What is trastuzamab-emtansine

A

New drug combining chemotherapy moiety with trastuzumab

Delivers chemotherapy moiety directly to the tumour

24
Q

What is the only way to be sure of bony mets?

A

localised CT or MRI

Bone scan often only helpful if it shows shower of mets on axial skeleton

25
Q

What should be done about neutropenia during chemotherapy?

A

If patient well and has no fever, ignore

If they are septic, or well but with fever, admit to oncology urgently

26
Q

What should be done about hot flashes on tamoxifen?

A
  • no good treatment
  • clonidine 50ug-75ug bd sometimes works, needs to be reduced and stopped slowly
  • phyto-oestrogens should be avoided
  • progestogens work, but safety unclear
  • stop the ER blockade
27
Q

What is the issue with merina coil in breast cancer?

A

Contraindicated by the company if breast cancer diagnosed depsite no obvious risk, may leave it in

28
Q

What tumour markers are there?

A

CEA

CA15-3

29
Q

How should tumour markers be interpreted

A

OK for monitoring, poor for diagnosis

Don’t check them unless metastatic disease known to be present

Don’t check them unless it’s clear how the result will change treatment

30
Q

When are bisphosphonates used?

A

In metastatic disease in high dose with AIs if DXA scan abnormal

31
Q

Why should dental work be done before starting bisphosphonates?

A

Can cause osteonecrosis of the jaw

32
Q

What is the risk with tamoxifen?

A

Vaginal bleeding

Endometrial cancer (1:400)

Endometrial hyperplasia/polyps

33
Q

What can be used as opposed to tamoxifen?

A

Post-menopausal: aromatase inhibitor

Pre-menopausal: goserelin

34
Q

When does radiotherapy reaction come on?

A

When there is a greater volume of tissue the greater the reaction

Tends to come on at end of treatment/once treatment stopped and lasts a few weeks

35
Q

What is a common cause of a new lump after treatment?

A

Fat necrosis causing a firm localized swelling

36
Q

What should be looked out for in back pain with bone mets

A
  • severe back pain
  • radicular back
  • non-specific difficulty walking with no signs
37
Q

Which anti-depressants should be avoided if on tamoxifen?

A

Paroxetine

38
Q

Where does HER-2 +ve breast cancer preferentially metastasise to?

A

CNS and pleura

39
Q

What should be looked out for in HER-2 +ve breast cancer?

A
  • headaches- seek head scan
  • blurred vision- consider retinal mets
40
Q

Where does lobular breast cancer metastasise to preferentially?

A

Peritoneum and gut

Can present with sub-acute bowel obstruction

41
Q

How can risk of breast cancer be reduced?

A
  • normal BMI
  • exercise
  • self-examination
  • don’t drink to excess
42
Q

What can be done for vaginal dryness with ER blockade?

A

UNCERTAIN

If cancer low risk (e.g. low grade, small, <1cm, node-negative) then might consider vagifem

NOT if high risk cancer and on AI

Reproductive & Sexual Health (54 decks)

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