Lecture 3-4 Flashcards by Eunice Kouadio

Breast Cancer can happen in :

Ducts ***
Lobules
Other areas

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What action has proven to be reducing the risk of cancer ?

Breastfeeding

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What are the risks factors for breast cancer ?

Age
Sex
History
Estrogen exposure
Radiation at a young age
Alcohol
Obesity
Dense breast tissue

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Can contraceptives have a high risk of cancer ?

No currently low

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What age has a high risk of breast cancer ?

45 - 65 yo

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What type of estrogen exposure can increase the risk ok breast cancer ?

Endogenous : early puberty, late menopause, first pregnancy > 30 yo

Exogenous: HRT after menopause , HRT > 5 yo

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What is BRCA gene and relation to breast cancer ?

Breast cancer susceptibility genes
Tumour suppressor gene that increases the risk of breast cancer
Most common in Ashkenazi Jewish

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What is Li Fraumeni Syndrome ?

Rare germ line mutation to TP53 gene , tumor suppressor gene that increases the risk of breast cancer .

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How does radiation works as oncology Tx ?

Rays cause DNA damage … which accumulates and causes the cells to no longer divide —> DEATH

Only cancer cells cannot repair DNA but normal cells can effectively repair it

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What is the main difference between **external beam RT ** and Brachytherapy ?

External is the most common , the higher the energy beam and the deeper the radiation

Brachytherapy requires an implant directly to the tumor and body cavity . This limits the absorption of other healthy cells

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How often is RT usually given ?

Daily

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Which of the cancer is palliative when RT is involved ?

Lung
Head/ Neck Cancer

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What are radiosensitizers ?

Chemicals that increase the biological effects of RT
Some chemo agents are radiosensitizers

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Which of the chemotherapy agents or radio sensitizers?

5FU and cisplatin

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What percentage of RT is given with palliative intent?

About 50%

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What are indications for palliative RT?

Bone metastases, spinal cord compression brain metastases, advance lung cancer, superior vena cava syndrome

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Give an example of RT emergencies

Spinal cord compression

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What are one of the generalized side effects of radiation therapy?

fatigue

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What is Gene TP 53? What happens when it’s mutated?

TP 53 is it true or surface one mutated it increases the risk of breast cancer

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At what age would you recommend screening for breast cancer through mammograms?

Asymptomatic women, transgender, gender, diverse, and non-binary people excluded risk 45 to 74 years old is recommended for screening mammograms

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From the LGBTQ community , who can we screen ?

breast tissue
>5 years of feminizing hormone
maybe top surgery ( decided by the doctor)

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What are the predictive markers of breast cancer ?

Hormone receptors, HER2

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What are the prognostic markers for bresat cancer ?

Ki67

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BAsed on the breast type, which has the worsr prognosis ?

Invasive Ductal carcinoma

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what is stage IV breast cancer ?

metastatic

What is stage 1 breast cnacer ?

early stage disease ( resectable) <2 and no nodes

What is stage 0 breast cancer ?

insitu only

What is stage 2 breast cancer ?

Stage 3 : > 5 and lots of nodes early stage - resectable

What is HIGH grade ?

less differiential cells poor prognosis and better response to therapy

What is Ki67 ?

marker of proliferation

What is an oncogene in breast cnacer ?

hER2/neu

What are the genomic test for cancer ?

OncotypeDx Prosigna

Which genomic test will provide onformation about which tx would work for breast cancer ( chemo, endocrine, HER ) ?

OncotypeDx

What is the goal of tx at stage 0 ?

prevention of the invasice cancer

When would you consider adding endocrine tx in cancer breast ?

Stage 0 and down

When would you consider adding chemo adjuvant in breast cancer ?

Stage 1 and down

When would you consider adding HER2 target for breast cancer ?

stage 2 and down

What is the main diff in modified and radical masectomy ?

modified : entire breast and some auxillary nodes radical : entire breast and more axillary nodes

What is the use of sentinnel nodes in breast cancer ?

hypothetical first affected nodes free of cancer, don't spread the infected radioactive agent

what is a possible consequence of blocked or removed axillary nodes ?

lymphedema

What does it mean grade 1 breast cancer ?

Low grae, well differentiate and growing slow and well organized

What is the suffix of anthracycline ?

"rubicin"

What are the drug combination for stage 1-3 breast cancer ?

"3 aunties can talk feeding" 3 : carboplatin, cyclophosphamide , ALONE - capecitabine AC, TC , FECD, CT

What is the difference in chemo tx for stage 1-3 to 4 ?

4 : now includes vinca alkoid or NAB-Pacitaxel

What are the MOA of doxorubicin ?

Intercalated base pairs inhibits topoisomerase 2 Chelates with iron → radicals

Which of the anthracyclines stays longer in the body ?

Doxorubicin is longer because fastter metabolism of epirubicin

What are your f/u measures for anthracyclines ?

Rubicin red urine cardio ( ECG , LVEF) blister N/V

What is the MOA of cyclophosphamide ?

alkylatin agent --> nitrohen mustard breaks DNA

What is the ADR or cyclophosphamide ?

Hemorrhagic cystitis ( acrolein) nausea ( ** if with the anthracyclines) fertility suppression

a patient is taking cyclophosphamide , what can you counsel them ?

Drink lots of water and pee often * help with cystitis Fertility is suppressed

What is the MOA or taxanes ?

"tangles vines " disrupts the microtbules

What are the main ADR of taxanes?

hypersensitivity rxn Acute intoxications fluid retention fatigue neuropathy and nail changes

What is the role of dexamethasone with taxanes and with which agent ?

Dexa + doctaxel ( double D's) helps with fluid retention, hypersensitivity and ??? antiemetic

How is carboplatin vs cisplatin ?

Less oto/nephrotoxic N/V (

What is HER receptors ?

Transmembrane protein that stimulates intracellular signaling to proliferate . HER2 is activated by COUPLING

Name the breast cancer HER2 tx ?

Trastuzumab : Trastuzumab + DM1: emtansine Trastuzumab + Dxd : Deruxetecan Pertuzumab Tucutinib Lapatinib

What is the MOA of trastuzumab ?

mABs of HER2 --> ligand dependent leading to NK cells to kill it

What is MOA of pertuzumab ?

inhibits the dimerization of HER2 - HER1/3/4

Which hormonal Tx for breast cancer is best after menopause ?

Tamoxifen aromatase inhibitors ( anastrozole/letrozole/exemestane) Fulvestrant CDK4/6 ( palbociclib,ribociclib,abemaciclib)

Where does tamoxifen bind ?

agonist on the endometrium/bone/lipids antagonist on the breast / breast cancer cells

What is the DDI between tamoxifen and Fluoxetine vs venlafaxine ?

Fluoxtine --> CYP2D6 inhibitors ( not activation of tamoxifen) venlafaxine --> not a CYP2D6 inhibitors

What is exemestane ?

Aromatase inhibitors used in the breast cancer ER+/PR+

What are tamoxifen side effects ?

Side effects : Menopause like Flare-ups Myalgias ?! DVT/PE

What are the MOA of anstrozole ?

Aromatase inhibitors for breast cancer Stops the production of estrogen from the adipose tissue

What are the Side effects of letrozole ?

Aromatase inhibitors : Myalgia Edema Vaginal dry Bone loss Hypercholesterol

What is the fulvestrant ?

FULL estrogen antagonist

Which of the CDK4 /6 inhibitors is used in early disease ?

abemaciclib

What is palociclib ?

CDK 4/6 inhibitors - breast cancer : metastatic

What should we monitor for pt on ribociclib ?

CDK4/6 inhibitors --> metastatic CYP3A4 --> not grapefruit fatigue bone marrow suppression Watch for Qtc

what are the side effects for fulvestrant ?

Injection site rxn Hypersensitivity Hepatoxic Hot flashes

What is Olaparib ?

PARP inhibitors in BRCA mutations

What are the immune checkpoint therapies for breast cancer ?

Pembrolizumab Olaparib Natural health ( vitamib D)