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Oncology > Breast/Ovarian Cancer > Flashcards

Breast/Ovarian Cancer Flashcards

1
Q

Survivors of Hodgkin lymphoma who received mantle radiotherapy have an increase risk of what cancer?

A

25% increased lifetime risk for developing breast cancer

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2
Q

What percentage of all breast cancers are due to germ line missions (BRCA1, BRCA2 or p53)?

A

5-10%

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3
Q

What is the management if primary breast DCIS?

A

Breast conserving treatment (lumpectomy +RTx) or mastectomy
Tamoxifen for 5 years

No role for LN evaluation, adj chemo, Trastuzumab or Raloxifene

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4
Q

In invasive breast cancer, if the sentinel lymph node is negative for malignancy, what is the chance that other axillary lymph nodes are involved?

A

5-10%

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5
Q

By what percentage does endocrine therapy reduce the relative risk of cancer recurrence in oestrogen or progesterone-positive tumours?

A

Approx 50%

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6
Q

What are the side effect profiles of Tamoxifen (SERM) vs Aromatase inhibitors?

A

Tamoxifen: increased thromboembolic events, endometrial Ca, hot flushes, cataracts

Aromatase inhibitors: osteoporosis, fragility fractures, MSK/arthralgia syndrome

**Aromatase inhibitors do not increase the risk of endometrial Ca or thromboembolic disease

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7
Q

What is 1st line treatment for HER-2 receptor positive breast cancer?

A

Trastuzumab - monoclonal antibody to HER-2/neu receptor

1 year of Trastuzumab therapy reduces breast cancer recurrence by 50% and improved overall survival

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8
Q

What is the main side effect of HER-2 receptor monoclonal antibody (Trastuzumab)?

A

Trastuzumab-induced cardiotoxicity

  • > causes impaired systolic function and heart failure. Usually reversible with Trastuzumab ceased
  • > risk factors: age >50yo, HTN, previous/current use of anthracyclines, in-field RTx
  • > avoid using with anthracycline (Doxorubicin) due to anthracycline-induced cardiotoxicity (which is irreversible and progressive)
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9
Q

What are the features of inflammatory breast cancer?

A

Inflammatory breast cancer is a clinical diagnosis characterised by:

  1. Erythema
  2. Skin thickening
  3. Peau d’ orange (dimpling of the skin typically due to obstruction of dermal lymphatics)

Poor prognosis
30% cure rate with systemic chemotherapy, mastectomy and RTx

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10
Q

How do you monitor women after treatment of early stage breast cancer?

A
  1. Clinical evaluation (history and physical exam) 6/12 for 5 years, then annual thereafter
  2. Annual mammogram
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11
Q

What is 2nd line therapy for HER-2 positive breast cancer once disease progresses on Trastuzumab?

A

Lapatinib - HER1/HER2 tyrosine kinase inhibitor

Side effects:
Dermatitis
Diarrhoea
Liver disease
Cardiotoxicity
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12
Q

What class of medications is contraindicated when taking Tamoxifen and why?

A

Antidepressants that are potent inhibitors of the CYP2D6 enzyme, such as Bupropion, Fluoxetine and Paroxetine, are contraindicated whilst on Tamoxifen because the metabolism of Tamoxifen requires adequate CYP2D6 enzyme activity

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13
Q

What are the protective factors against ovarian cancer?

A

OCP -> decreases risk by up to 50%, with protective effect lasting up to 20 years after

Multiparity
Breast feeding
Tubal ligation

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14
Q

What follow up is needed after treatment of ovarian cancer?

A

Clinical exam & CA-125

2-4/12 for 2 years, then 3-6/12 for 3 years, then annually

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15
Q

What are the common histological types of cervical cancer?

A

Squamous cell carcinoma - 70-80%
Adenocarcinoma - 20%
Adenosquamous cell carcinoma - 3-5%

Adenosquamous has the poorest prognosis

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16
Q

What is the most common cause of leptomeningeal disease?

A

Breast cancer

Leptomeningeal metastases, also know as carcinomatous meningitis, refers to the spread of malignant cells through the CSF space.

17
Q

What are the risk factors for ovarian cancer?

A 
Age >50yo
Familial factors:
 - FHx or PHx breast/ovarian/CRC
 - BRCA gene mutation
 - HNPCC gene mutation
Early menarche (52yo)
HRT/fertility drugs
1st pregnancy >30yo
Infertility
18
Q

Endometrial cancer is the most common gynae malignancy in developed countries, and typically presents with abnormal uterine bleeding or a thickened endometrial strip on pelvic USS. What are the risk factors for endometrial cancer?

A 
Excess of endogenous (obesity) or exogenous oestrogen (HRT using oestrogen, without a progestin)
Tamoxifen
Obesity
Nulliparity
Diabetes
Hypertension
19
Q

What are the 2 main strains of Human Papilloma virus (HPV) associated with cervical cancer?

A

HPV 16 and 18

20
Q

What are the 2 most common histological types of breast cancer?

A

Ductal & Lobular (ductal&raquo_space; lobular)

21
Q

What percentage of breast cancers are HER-2 positive and what implications does this have on prognosis?

A

20% of all breast cancers are HER-2 positive.
HER-2 is a constituently active transmembrane protein activated by dimerisation

They typically have higher recurrence rates and are more aggressive (now improved with HER-2 directed therapies)

22
Q

BRCA 1 and 2 mutations are associated with multiple cancers. What cancers are associated with each?

A

BRCA 1

  • Breast cancer (risk 40%)
  • Ovarian cancer (risk 20-40%)
  • Prostate cancer (1.5-2x increased risk)

BRCA 2

  • Breast cancer (risk 40-60%)
  • Ovarian cancer (risk 10-20%)
  • Male breast cancer (risk 6%)
  • Pancreatic cancer (risk 3.5%)
  • Prostate cancer (4x increased risk)
  • Melanoma (increased risk)
23
Q

What ‘risk reducing medications’ can be used in women at high risk of breast cancer?

A

Tamoxifen or Raloxifene

- both reduce risk of hormone + breast cancer by 30-40%, but no proven survival benefit

24
Q

Patients with PALB2 mutations have an increased risk of what cancer?

A

PALB2 = Partner and Localiser of BRCA-2

Increased risk of breast cancer

  • risk 14-50% of developing breast cancer
  • risk 35% to age 70yo
25
Q

Li Fraumeni syndrome results from autosomal dominant inheritence of a germline p53 mutation on chromosome 17. What are the features of Li Fraumeni syndrome?

A

90% cancer risk by age 60, often with multiple primary tumours

  • Premenopausal breast cancer (often HER2 +)
  • Non-Ewing sarcoma
  • Brain tumours (GBM)
  • Leukaemia
  • Adrenocortical & other paediatric cancers

*** Breast-sarcoma syndrome

26
Q

Cowden syndrome results from autosomal dominant inheritence of a germline PTEN mutation on chromosome 10q. What are the features of Cowden syndrome?

A
  • Breast cancer (25-50% risk) & fibrocystic disease
  • Thyroid cancer (10%) & benign thyroid disease
  • Cutaneous lesions
    e. g. oral papillomas, skin keratoses, macrocephaly

Cowden is an overgrowth syndrome

Oncology (8 decks)

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