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Reproduction > Breast Oncology and Palliative Care > Flashcards

Breast Oncology and Palliative Care Flashcards

1
Q

Are oncologists involved pre-diagnosis?

A

No

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2
Q

What is the diagnostic process for suspected metastatic disease in someone with no previous diagnosis?

A

Investigation undertaken by medical and surgical specialty and biopsy taken = surgical/oncological referral then made

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3
Q

How are most breast lumps diagnosed?

A

More are diagnosed by CT than by physical examination

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4
Q

What oncological treatment options are available?

A

Radiotherapy and chemotherapy
Hormonal therapy = oestrogen blockade
Antibodies = herceptin

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5
Q

What is the oncological management of cancer?

A 
Curable = neo-adjuvant and adjuvant 
Non-curative = palliative therapy
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6
Q

Is radiotherapy commonly offered as neo-adjuvant therapy?

A

No = not usually used

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7
Q

What patients receive hormonal neo-adjuvant therapy?

A

Oestrogen-positive tumours, less fit patients, patients in whom it isn’t certain if surgery will be performed

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8
Q

How long can neo-adjuvant hormonal therapy be given for?

A

Can be given for up to 1 year before surgery

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9
Q

What are some advantages of neo-adjuvant therapy?

A

Cosmetic = sometimes wide local excision can be done instead of mastectomy
Less extensive nodal clearance done if excellent treatment response (Tayside only)

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10
Q

What is a disadvantage of neo-adjuvant therapy?

A

Attendance for 6 extra imaging investigations compared to adjuvant treatment

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11
Q

What are some options for adjuvant therapy?

A

Radiotherapy, oestrogen blockade, chemotherapy, herceptin

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12
Q

What are some indications for using radiotherapy as adjuvant treatment?

A

Used routinely after wide local excision = reduces recurrence risk by about half
Used in young patients and those with positive margins

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13
Q

How can an oestrogen blockade be achieved?

A

5 years tamoxifen or use aromatase inhibitors

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14
Q

How effective is adjuvant treatment by tamoxifen oestrogen blockade for 5 years?

A

Reduces relapse risk by 15% at 10 years and improves 5 year survival by 10%

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15
Q

What are some features of aromatase inhibitors?

A

Examples = letrozole and anastrozole

Offer no difference in overall survival when compared to tamoxifen

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16
Q

How is chemotherapy given as adjuvant therapy?

A

Given to improve 10 year survival by 5-10%

Usually includes anthracycline and a taxane

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17
Q

What are some side effects of chemotherapy?

A

Anorexia, malaise, neutropenia, alopecia, myalgia (taxane), peripheral neuropathy

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18
Q

What is a side effect of gCSF chemotherapy injections?

A

Severe axial skeleton pain = due to marrow stimulation

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19
Q

How is herceptin therapy given?

A

Subcutaneous injection = sometimes given by IV

One year of three weekly treatment

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20
Q

What is herceptin?

A

Antibody against HER2 receptor = HER-2 receptor overexpression seen in about 15% of breast cancers

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21
Q

How effective is herceptin?

A

Improves overall survival by a further 3%

Side effects = allergic reactions, reversible cardiac failure

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22
Q

What happens to patients after their treatment?

A

Review at end of adjuvant treatment and discharge from oncology clinic = surgical review on anniversary of surgery then discharge from clinic follow up

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23
Q

How long do patients have to present for yearly mammograms following adjuvant treatment completion?

A

Have yearly mammograms for 3 years

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24
Q

What are some palliative systemic treatment options for widespread disease?

A

Oestrogen blockade or chemotherapy

25
Q

When is radiotherapy used palliatively?

A

To treat fungating breast disease or bone metastases

26
Q

What is used to palliatively treat bone metastases as prevention?

A

Bisphosphonates = oral ibandronic acid

27
Q

How has chemotherapy developed?

A

Multiple therapies for metastatic disease
Benefits often minimal or non-existent
Can distract from good palliation in terminal phase

28
Q

How has radiotherapy developed?

A

Treatment set up more complicated and time consuming

Techniques to reduce lung/heart treatment becoming more common

29
Q

What imaging modality is routinely used for image acquisition before radiotherapy treatment?

A

CT scans

30
Q

What is intra-operative radiotherapy (IORT)?

A

Radiotherapy that is delivered in one fraction during surgery

31
Q

What is trastuzumab-emtansine?

A

New drug combining chemotherapy moiety with trastuzumab = delivers chemotherapy moiety directly to tumour

32
Q

What are some features of bone pain following breast cancer?

A

Recurrence depends on grade, tumour size and amount of axillary lymph nodes involved
Usually request localised CT of affected bone
Ribs are especially problematic to diagnose

33
Q

What are some features of bone scans for bone pain following breast cancer?

A

Bone scan may appear positive = only helpful if it shows shower of metastases affecting axial skeleton

34
Q

How should neutropenia following chemotherapy be managed?

A

Ignore if patient is well and has no fever

Urgent admittance to oncology if fever or sepsis

35
Q

How are hot flushes caused by tamoxifen managed?

A

No good treatment = clonidine 50-70ug 2x daily sometimes works (needs to be reduced/stopped slow)
Phyto-oestrogens best avoided
Progestogens work but their safety is unclear

36
Q

Can the Mirena coil be used in patients with breast cancer?

A

No = contraindicated in breast cancer

37
Q

What are some tumour markers for breast cancer?

A

CEA and CA15-3

38
Q

How are tumour markers used to monitor disease?

A

Okay for monitoring but poor for diagnosis

Don’t check unless known metastatic disease

39
Q

When are bisphosphonates indicated?

A

Metastatic disease in high dose and with aromatase inhibitors if DEXA scan abnormal

40
Q

What are some issues with bisphosphonates?

A

Lack of oral tolerance = may try IV

Risk of osteonecrosis of jaw = issue if dental work required

41
Q

What are the risk associated with vaginal bleeding due to tamoxifen?

A

Risk of endometrial cancer = common to induce endometrial hyperplasia and/or polyps

42
Q

What can tamoxifen be switched to if it’s causing vaginal bleeding?

A

Aromatase inhibitor if postmenopausal

Goserelin if premenopausal

43
Q

When can lymphoedema of the arm occur?

A

Associated with greater volumes of radiotherapy

Tends to occur at the end of treatment

44
Q

What are some features of lymphoedema of the arm?

A

Rare = lasts few weeks then spontaneously heals

Avoid instrumentation of ipsilateral arm after axillary surgery

45
Q

Is it likely that local recurrence will happen shortly after or during treatment?

A

No = not unless the cancer is extremely aggressive

46
Q

What is a cause of a new breast lump following treatment for cancer?

A

Fat necrosis = causes firm localised swelling and can occur after reconstructive surgery

47
Q

Why do patients suffering from back pain with bone metastases need urgent MRI of spine?

A

There is risk of spinal cord compression

48
Q

What are the signs of spinal cord compression due to bone metastases?

A

Too late to treat by time symptoms develop = severe and radicular back pain, non-specific difficulty walking with no signs

49
Q

What antidepressant should you avoid using when taking tamoxifen?

A

Paroxetine

50
Q

What are some features of HER-2 positive breast cancers?

A

Higher risk of recurrence
Preferential metastases to CNS and pleura
Consider retinal metastases if blurred vision

51
Q

What are some investigations that may need to be done in a patient with HER-2 positive breast cancer?

A

Head scan if suffering headaches

52
Q

Why are lobular breast cancers hard to detect?

A

May be invisible on scan and more difficult to see on mammography
Often presents with sub-acute bowel obstruction

53
Q

Where do lobular breast cancer metastases tend to occur?

A

The peritoneum and gut

54
Q

How can you reduce the risk of developing breast cancer?

A

Normal BMI and regular exercise
Avoid excessive alcohol intake
Self examination helps awareness

55
Q

What treatment can cause vaginal dryness?

A

Oestrogen blockade

56
Q

Can vagifem be used to treat vaginal dryness caused by oestrogen blockade?

A

Depends on symptom severity = lower risk if low risk cancer or if on tamoxifen
Avoid if high risk cancer and taking aromatase inhibitor

57
Q

What would make back pain after treatment more likely to be due to metastases?

A

If the cancer was high risk

58
Q

In what patients should you consider doing a head scan?

A

Especially if HER-2 positive = headaches, visual disturbances or uncoordination (especially fleeting peripheral disturbances)

Reproduction (62 decks)

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