Day 4- Breast and Ovarian Cancer Flashcards
What is the lifetime risk for women to get breast cancer?
What are breast cancer risk factors?
When are mammograms recommended?
1 in 8, most commonly diagnosed cancer in women. #1 killer is lung but #2 is breast.
Female, increased age(>40), increased breast density. Family history and genetic mutations BRCA1 or BRCA2. Early menarche(<12), Late menopause(>55), nulliparity, older age at first child birth(>30), long term use of postmenopausal replacement therapy, oral contraceptives(controversial), exposure to radiation, obesity/low physical activity/ diet high in fat and alcohol.
Recommend for patients older than 40.
How much of a risk reduction is a mammogram and a bilateral oophorectomy and a SERM’s?
What is Tamoxifen and it’s dose?
What special things to know about Tamoxifen?
90%, 50%, 50%.
A SERM, 20 mg PO QD for 5 years.
Antagonistic effects on breast on vaginal, agonistic effect on endometrium, bones, and lipids. Take with or without food. Watch for CYP2C9 stuff(grapefruit juice).
What is Raloxifene and things to know about it?
What things to know about Toremifene?
What things to know about Anastrozole
Used for prophylaxis, interacts with levothyroxine and bile acid sequestarants, better side effect profile than Tamoxifen. 60 mg PO QD.
60mg PO QD, Alternative to tamoxifen.
Aromatase inhibitor, 1 mg PO QD for 5 years if adjuvant or until disease progression. With or without food, CYP interactions. Menopausal side effects(Arthritis is big one). Lower risk of VTE’s and endometrial cancer compared to SERM.
What is Letrozole’s dose and other things to know?
What is Exemestane and things to know?
What are the signs and symptoms of breast cancer?
2.5 PO QD for 5 years with or without food. Same side effects as Anastrozole. Aromatase Inhibitor.
25 mg PO QD for 5 years, Take after meal, Major CYP3A4 inhibitor. Steroidal AI. Less bone turnover than other AI.
Asymptomatic, painless breast lump, skin thickening/discoloration/dimpling, nipple inversion or crusting or unilateral discharge, new onset pain.
How do you diagnose breast cancer?
What does TNM stand for in staging?
What is staging you need to know?
History and physical–> Imaging–> Core needle biopsy–> Labs(ER/PR/HER2).
Tumor, Node, Metastisis.
Stage 0 is increased risk, stage 1 is less than 1 inch, stage 2 is less than 2 inches and may have spread to some lymph nodes, stage 3 larger than 2 inches and possible dimpling, stage 4 is metastisis to other places..
How to give a prognosis?
When do you start radiation in breast cancer?
What is LCIS vs DCIS?
If more than >1 cm it is poor prognosis. If ER/PR is positive that’s good, if HER2 positive it’s poor, if inflammatory it’s poor.
All patients require local radiation therapy unless negative lymph nodes, tumor size is <5cm, and clear margins(>1 mm).
Take out LCIS and may consider preventative endocrine therapy, DCIS will do surgery and radiation therapy(reduces recurrence by 50%) If ER/PR positive will do preventative endocrine therapy.
How do you treat someone who is ER/PR positive and HER-2 positive how do you treat them?
What about if ER/PR- and no HER-2?
What is AC–>T + trastuzumab and pertuzumab?
They will get Chemotherapy + trastuzumab + endocrine therapy
No endocrine therapy and no trastuzumab.
Doxorubicin, Cyclophosphamide–> Paclitaxel.
What is TCH + pertuzumab?
If HER-2 negative what are your treatment regimens?
What is dose-density?
Docetaxel, Carboplatin, Trastuzumab.
Dose-dense AC–>T, Dose dense AC–> weekly T, TC.
Decreases the time between treatment cycles, increases dose intensity.
When is Pertuzumab used and what is it’s dose?
How long do you want to use adjuvant endocrine therapy?
If a patient has metastatic disease and is HER-2 positive what do you do?
Neoadjuvant therapy and metastatic therapy.
5 years after, anastrozole, letrozole, and exemstane have similar efficacy.
Pertuzumab + Trastuzumab + Docetaxel(category 1)( can swap paclitaxel next) or can add Ado-trastuzumab emtansine.
If a patient has metastatic disease and has prior exporuse to HER-2 agents what do you do?
What is Ado-trastuzumab emtansine and what to know?
What things to know about Lapatinib?
Lapatinib + capecitabine or Lapatinib + trastuzumab or trastuzumab + capeticitabine.
Used for metastatic disease, 3.6 mg/kg IV q3 weeks until progression or can’t handle toxicity. HER-2 antibody and microtubule inhibitor conjugate, binds to HER-2 and injects emtansine.
take on empty stomach, acts on EGFR and HER-2
What is ovarian cancer?
Where do over 90% of inherited cancers come from?
What increases your risk?
Little cancer bombs that disrupt your epithelium that are pretty aggressive.
BRCA1 and BRCA2
Nulliparty,Early menarch, late menopause, fatty foods
What decreases your risk?
Is screening recommended for ovarian cancer?
What are signs and symptoms of ovarian cancer?
oral contraceptives, pregnancy/multiparty. Fruits and vegetables.
NO
Abdominal discomfort, bloating, early satiety, urinary frequency.
How do you stage ovarian cancer?
What is primary ovarian cancer treatment?
Is neoadjuvant chemotherapy recommended in ovarian cancer?
Stage 1 is confined to ovaries, Stage 2 is pelvic extension/fallopian tubes, Stage 3 is peritoneal mass, Stage 4 is distant mass.
Surgery by a gynecologic oncologist to watch for risk of tumor seeding, goal is to debulk tumor to <1Cm of disease.
NO. It’s benefit is controversial. Considered in stage 3 or 4.
What is adjuvant therapy mainstay?
What is intraperitoneal chemotherapy?
What are requirements for IP chemotherapy?
Platinum agent plus taxane AFTER surgical resection.
Prepare chemotherapy in one liter bag(will warm saline first), reposition patient 1/4 turn every 15 minutes for one hour, allows fluid to reach every inch of peritoneal cavity, patient may leave once ambulatory.
Preferred over IV only if they can tolerate it, must be educated about increased toxicities, must have normal renal function and performance status, must be adequately hydrated to protect kidneys.
What are your main stay treatments for ovarian cancer?
What is the cut off for platinum sensitivity?
Paclitaxel and Carboplatin.
> 6 months.
