Management of Breast Cancer

Question 1

what staging is used in breast Ca

Answer 1

TNM

Question 2

what defines T1, T2 and T3 from each other

Answer 2

T1 = <2cm
T2 = 2-5cm
T3 = >5cm

Question 3

what stage is a tumour invading locally

Answer 3

T4

Question 4

what differentiates N1 and N2

Answer 4

whether the lymph nodes are mobile or fixed

Question 5

what investigations are done to stage breast Ca

Answer 5

sentinel node biopsy
ER and PR status
HER2 status
FBC and LFTs
CXR
CT
bone scintigraphy 
PET

Question 6

name 5 members of the MDT for breast cancer

Answer 6

radiologist, cytologist, clinical oncologist, medical oncologist and breast surgeon

Question 7

5 modes of breast cancer treatment

Answer 7

surgery
radiotherapy
chemotherapy
hormonal thera[y
specific therapies

Question 8

surgery offered

Answer 8

breast conservation or mastectomy +/- lymph nodes

Question 9

what treatment must also be given if patient wishes breast conservation

Answer 9

radiotherapy

Question 10

how long is radiotherapy given for

Answer 10

3 weeks

Question 11

complications from lymph node removal/Rx

Answer 11

lymphoedema, nerve damage, radiation induced sarcoma and decreased ROM

Question 12

2 antihormonal agenta

Answer 12

tamoxifen and aromatase inhibitors

Question 13

indications for tamoxifen

Answer 13

ER+ tumour (block oestrogen)

Question 14

main risk in tamoxifen

Answer 14

VTE

Question 15

how do aromatase inhibitors work

Answer 15

block oestrogen receptor synthesis

Question 16

who should aromatase inhibitors be given to

Answer 16

post-menopausal women

Question 17

risk of aromatase inhibitors

Answer 17

osteoporosis

Question 18

who is chemotherapy best in

Answer 18

women <50 y/o with poor prognostic factors

Question 19

3 chemo options

Answer 19

CMF, anthracycline and taxane combinations

Question 20

what is Herceptin

Answer 20

aka trastuzumab - a monoclonal antibody against HER2 receptor

Question 21

what therapy should be given in before herceptin

Answer 21

chemotherapy

Question 22

3 things that make up the nottingham prognostic index

Answer 22

lymph node involvement
tumour grade
tumour size

Question 23

poor prognostic factors for recurrence

Answer 23

-ve ER or PR
+ve HER2
high grade
lymph node involvement

Question 24

which molecular subtypes are ER+ve

Answer 24

luminal A and B

Question 25

true/false - tamoxifen works on the same pathway as aromatase inhibitors

Answer 25

false - tamoxifen is a receptor antagonist wherease aromatase inhibitors inhibit oestrogen production

Question 26

what gene assay can be done to determine whether chemotherapy is likely to be effective

Answer 26

oncotype DX

Question 27

4 poor prognostic factors

Answer 27

grade 3, HER2 +ve, ER -ve and

Question 28

why are mammograms less sensitive in women <35

Answer 28

increased glanular tissue makes tumour less obvious