Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PY367 Breast cancer > Intro to Case > Flashcards

Intro to Case Flashcards

1
Q

outline the risk factors of developing breast cancer

A
  1. age >60 years
  2. oestrogen exposure- early menarche, late menopause, oral contraceptive use, HRT
    3.lifestyle factors such as obesity, alcohol
  3. family history of breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what can protect against breast cancer

A

breastfeeding and physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe the presentation of breast cancer

A
  1. lump in the breast
  2. a change in size or shape of the breast
  3. dimpling of the skin or thickening in breast tissue
  4. presence of inverted nipple
  5. rash or discharge from the nipple
  6. swelling or a lump in the armpit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe the screening of breast cancer

A
  1. breast self examination
  2. mammography- UK national breast screening programme screens all women aged 50-70 every 3 years
    - facilitates detection of early breast cancer, reducing mortality by 20-30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

outline the basic treatment options of breast cancer

A
  1. surgery
  2. endocrine therapy
  3. radiotherapy
  4. chemotherapy
  5. MAbs and other target treatments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does TNM staging stand for

A
  1. T- tumour size
  2. N- lymph nodes
  3. M- metastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe the tumour size in TNM staging

A
  1. T1- <2cm
  2. T2- 2-5cm
  3. T3- >5cm
  4. T4- direct extension to chest wall or skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe the lymph nodes in TNM staging

A
  1. N1- mobile ipsilateral lymph nodes
  2. N2- fixed to one another or other structures
  3. N3- intraclavicular or ipsilateral internal mammary and axillary nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe metastasis in tNM staging

A
  1. M0- no distant metastasis
  2. M1- contralateral lymph nodes or any distant metastases
  3. Mx- distant metastasis can’t be assessed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

outline the grading pathology

A
  1. Grade I- well differentiated/low grade
    - cancer cells look similar to normal cells and grow very slowly
  2. Grade II- moderately differentiated
    - cancer cells look more abnormal and are slightly faster growing
  3. grade III- poorly differentiated/high grade
    - cancer cells look very different from normal cells and grow quickly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe the pathological classification

A
  1. 70-80% ductal
  2. 5-10% lobular
  3. 10-20% tubular
  4. 5-10% medullary
  5. 1-2% mucinous/colloid
  6. 2% inflammatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the 2 categories in the immunohistochemistry receptor status

A
  1. ER- oestrogen receptor and PR- progesterone receptor
  2. HER2 positive
    - human epidermal growth factor receptor type 2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the role of the oestrogen and progesterone receptor and describe prognosis

A
  1. hormone dependent tumour
  2. more likely to respond to hormonal treatments
    - aromatase inhibitors
    - tamoxifen
  3. more favourable prognosis and more common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is HER2 and describe the prognosis of this receptor status

A
  1. a transmembrane tyrosine kinase which regulates growth, survival and migration
  2. may respond to trastuzumab (herceptin)
  3. more aggressive and less favourable prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what factors should be considered when considering chemotherapy

A
  1. gender, age
  2. personal and family history
  3. pathological stage of tumour
  4. biological characteristics of tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe how molecular assays are used

A
  1. uses real time PCR to assess expression of a panel of 21 genes related to tumour proliferation
  2. gives a validated recurrence score indicating the patients 10 year recurrence risk
  3. gives a validated prediction as to whether the patient will have additional benefit from chemotherapy compared to tamoxifen alone
  4. NICE approved for early stage node -ve, ER +, HER2-ve breast cancer
17
Q

what is the difference between adjuvants and Neo-adjuvant

A
  1. adjuvant- after primary surgery
  2. Neo-adjuvant starts before surgery
    - locally advanced tumours
    - inflammatory tumours
    - to preserve tissue, facilitate less invasive surgery
18
Q

describe the treatment for early stage, HER+ breast cancer

A
  1. surgery- lumpectomy and lymph nodes
  2. adjuvant chemotherapy including HER2 targeted treatment
  3. radiotherapy
  4. endocrine therapy
19
Q

what does adjuvant chemotherapy consist of

A
  1. cyclophosphamide
  2. an anthracycline- doxorubicin
  3. a taxane- docetaxel, paclitaxel
  4. for HER2+, should contain trastuzumab +/- pertuzumab
20
Q

describe the properties of cyclophosphamide

A
  1. alkylating agent- crosslinks DNA strands and inhibits DNA synthesis, transcription and replication
  2. non cell cycle specific
  3. a pro drug- activated in liver to phosphoramide mustard
21
Q

describe the properties of anthracyclines

A
  1. creation of free radicals- oxidative damage
  2. intercalates between base pairs in DNA
  3. inhibit action of topoisomerase II by stabilising the DNA topoisomerase II complex, preventing re-ligation of the double helix
  4. non cell cycle specific
22
Q

describe the properties of taxanes

A
  1. enhance the polymerisation of tubulin
  2. stabilise the microtubule polymer, preventing disassembly of the mitotic spindle
  3. blocks progression of mitosis, leading to apoptosis
  4. cell cycle specific- M phase
23
Q

what is involved in combination chemotherapy

A
  1. choose drugs which act at different stages of the cell cycle, with different MOAs to maximise cytotoxic effect and minimise resistance
  2. lots of different regimes- eg. EC-T
    - epirubicin, cyclophosphamide and docetaxel
24
Q

describe the MOA of trastuzumab

A
  1. the only approved HER2 therapy that binds to HER2+ tumour cells and flag them for destruction by immune system
  2. blocks downstream HER2 signalling to inhibit proliferation of cells
25
Q

describe the health economics related to the sue of trastuzumab

A
  1. hazard ratio= 0.54- trastuzumab halves the risk of relapse
  2. cost per patient- 25k
  3. NNT=12= £300k
  4. originally rejected by NICE but reviewed after public pressure
  5. biosimilars have reduced the price
26
Q

how is pertuzumab used

A

can be used in combination with trastuzumab to provide a more comprehensive block

27
Q

describe the results of the intention to treat population category in the APHINITY trial

A
  1. pertuzumab vs placebo
  2. 19% risk reduction
  3. overall 1.7% reduction in percentage of patients relapsing after 4 years
28
Q

describe the results of the population with node negative disease category in the APHINITY trial

A
  • little differences between the 2 groups
29
Q

describe the results of the population with node positive disease category in the APHINITY trial

A
  1. 3.2% Absolute reduction in relapses over 4 years
  2. 23% risk reduction
  3. Cost per QALY <£20k
  4. NICE approved for lymph node positive disease only
30
Q

outline the dosage regime of EC100T and T and P

A
  1. Epirubicin 100mg/m2 IV bolus
  2. cyclophosphamide 500mg/m2 IV bolus
    - on day 1 of a 21 day cycle for 3 cycles, then
  3. docetaxel (taxotere) 100mg/m2 iV infusion in 250ml 0.9% sodium chloride over 1 hour
    - on day 1 of a 21 day cycle for 3 cycles
  4. Trastuzumab and pertuzumab 1200/600mg LD SC over 8 mins (cycle 1) then 600/600mg SC over 5 mins (cycle 2+)
    - on day 1 of a 21 day cycle for 18 cycles

PY367 Breast cancer (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions