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PHRM 864 > E2 Breast Cancer > Flashcards

E2 Breast Cancer Flashcards

1
Q

some risk factors for breast cancer

A

age
family hx
radiation (prior tx for lymphoma)
estrogen exposure
alcohol
high BMI
diet

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2
Q

2 tumor suppressor genes in breast cancer

A

BRCA 1
BRCA 2

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3
Q

risk assessment tool to determine relative risk in % of developing breast cancer

A

gail risk model

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4
Q

4 types of breast cancer

A

invasive carcinoma
ductal carcinoma in situ
lobular carcinoma in situ
inflammatory

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5
Q

Has invaded beyond the basement membrane of duct or lobule
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

A

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6
Q

More common:
A. invasive ductal carcinoma
B. invasive lobular carcinoma

A

A

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7
Q

Normal cells have undergone pre-malignant genetic transformation
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

B

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8
Q

Usually an incidental finding on biopsy
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

C

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9
Q

T or F:
Ductal and lobular in situ cancers are considered invasive

A

false, thats why they arent called invasive breast cancer sherlock

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10
Q

aggressive form of breast cancer with rapid onset and poor prognosis
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

D

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11
Q

pt presents with edema, redness, warmth
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

D no fuckin shit

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12
Q

delayed in diagnosis because docs think its probably something else
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

D. (they think its cellulitis)

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13
Q

2 different ways you can test for HER2 status *

A

1) Immunohistochemistry (IHC): detects protein overexpression
2) Fluorescence In-Situ Hybridization (FISH): detects gene amplification

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14
Q

Genetic test for expression of 21 genes which gives a recurrence score
can determine likelihood that breast cancer will return and whether pt will benefit from chemo

A

Oncotype Dx

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15
Q

what stages of breast cancer can you use oncotype dx in?

A

stage I or II

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16
Q

T or F: Oncotype Dx is used in ER negative and HER2 positive cancers

A

false, other way around. ER pos and HER2 neg

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17
Q

Oncotype Dx: TAILORx:
Low risk (<__) = ________ therapy only

A

26, hormone

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18
Q

Oncotype Dx: TAILORx:
High risk (>/=__) = ______ and hormonal therapy

A

26, chemo

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19
Q

Oncotype Dx in LN(+) Disease:
both _________ and __________ patients with LN+ disease

A

pre and post menopausal

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20
Q

T or F:
Breast cancer can metastasize anywhere

A

true

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21
Q

for what stages of breast cancer is the goal curing it?

A

I, II, and IIIA, IIIB, IIIC

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22
Q

Stage I, II, IIIA guidelines

A

lumpectomy + radiation
OR
modified radical mastectomy +/- radiation

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23
Q

T or F:
Most women will receive adjuvant therapy after surgery) in stages I, II, IIA

A

True

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24
Q

Stage IIIB and IIIC guidelines

A

same as I, II, and IIIA but with neoadjuvant chemo before MRM or lumpectomy

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25
Stage IV guidelines
basically whichever combo makes most sense for patient (chemo, hormonal, biologics, immunotherapy) AND Surgery is only for symptomatic relief
26
when you see XRT what is it
radiation therapy
27
what stage is breast cancer metastatic?
IV
28
does radiation fall under neoadjuvant or adjuvant?
adjuvant
29
before surgery A. neoadjuvant B. adjuvant
A
30
In stages I, IIA, IIB, and III when do you choose to give neoadjuvant therapy?
pts with tumors >1 cm
31
what are the 2 benefits of neoadjuvant therapy (she made this sound important)
- allows less extensive surgery - allows you to see response to chemo while tumor is in tact
32
HER2 negative ,tumor < or = to 0.5 cm -> consider what therapy?
adjuvant endocrine
33
HER2 positive ,tumor < or = to 0.5 cm -> consider what therapy?
adjuvant endocrine +/- chemo with HER2 targeted therapy
34
T or F: SERMS and LNRH analogs are considered neoadjuvant therapies
false, adjuvant
35
adjuvant chemo regimen HER2 negative (2 preferred options)
DOSE dense AC -> paclitaxel (NCCN preferred), doxo, cyclo TC -> docetaxel, cyclo
36
what does dose dense mean?
pts got same amount of chemo but in less time than usual
37
if pt is HER2 negative and has cardiac issues what should you consider>
using docetaxel and cyclo instead of the doxorubicin onee
38
drug to include every time if her2 positive
trastuzumab, (or combo with pertuzumab)
39
adjuvant her2 positive regimens
APT -> paciltaxel, trast TCH -> docetaxel, carboplatin, trast
40
what does residual disease mean in breast cancer
that the cancer is still there after some level of treatment
41
what is ado-trastuzumab
trast with emtansine (TDM-1)
42
if you see keynote trial what do you think of
triple negative breast cancer
43
triplle negative regimen
pembro+ chemo, paclitaxel, carboplat
44
ER+/PR+ means what kind of therapy
hormone
45
ER/PR- means what kind of therapy
chemo and HER2 depending on her2+ or -
46
if there is something that says "bone only disease" what kind of therapy do you choose
hormone
47
recommended 1st line option for her2 positive metastatic
trast pert docetaxel
48
2nd line her2 + metastatic
fam-trast deruxtecan-nxki
49
when do you use the fam-trast deruxtecan thing
in her2 low patients
50
what class has shown benefit in triple negative
platinum agnets
51
two first line options for triple negativee
carboplatin cisplatin
52
pembro is also approved in triple negative, what is something you check for to determine if this is appropriate
combined positive score, assess number of pd-L1 staining cells, max is 100 and usually use it with score 10 or above
53
1st line hormonal therapy metastatic
aromatase inhibitor + cdk4/6 inhibitor
54
2nd line hormonal therapy metastatic
fulvestrant + cdk4/6 inhibitor or everolimus + endocrine therapy (exemestane, fulvestrant, tamoxifen)
55
T or F: CDK 4/6 inhibitors are activated in ER+ breast cancer
true
56
3 cdk4/6 inhibitors
abemaciclib palbociclib ribociclib
57
what is the main monitoring parameter for cdl4/6 inhibitors
complete blood count
58
which cdl 4/6 inhibitor can cause qtc prolongation **
ribociclib
59
what age are mammograms cant think of the verb
40-44 and above
60
T or F: pts with BRCA mutations are at risk for breast cancer
no fuckin shit
61
what 3 agents have been studied in preventative setting
tamoxifen raloxifene exemestane
62
T or F: tamoxifen is used more often than raloxifene in prevention because it is more effective
false, same effectiveness
63
what two ae's did pts taking raloxifene have less of than tamoxifen
uterine cancer and blood clots

PHRM 864 (29 decks)

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