Medical Treatments for Breast Cancer

Question 1

What are the 4 main medical treatment options for breast cancer?

Answer 1

Radiotherapy, chemotherapy, hormone therapy and targeted therapy

Question 2

What are the two main points to consider before starting treatment for breast cancer?

Answer 2

Is the patient fit enough for treatment? Can the cancer be cured?

Question 3

What is neoadjuvant therapy?

Answer 3

A treatment given in advance of the main treatment (i.e. surgery)

Question 4

What is usually the main goal of neoadjuvant treatment?

Answer 4

To shrink the tumour before surgery

Question 5

How long can neoadjuvant treatment be given for?

Answer 5

Months - a year

Question 6

Which types of medical therapies can be used for neoadjuvant treatment?

Answer 6

Chemotherapy and hormone therapies

Question 7

When is hormone therapy used as a neoadjuvant treatment?

Answer 7

In ER+ cancers, and in less fit patients/those who you are unsure if they surgery will go ahead or not

Question 8

Why is neoadjuvant chemotherapy better than adjuvant chemotherapy?

Answer 8

They both have the same survival outcome, but neoadjuvant chemotherapy has better cosmetic outcome

Question 9

How does neoadjuvant therapy provide a better cosmetic outcome?

Answer 9

It sometimes allows wide local incision to be done instead of mastectomy

Question 10

In Tayside, what is different about breast surgery if the patient has an excellent response to neoadjuvant chemotherapy?

Answer 10

Less extensive axillary nodal clearance is done - lymph nodes only get sampled, not taken out

Question 11

What is the disadvantage of neoadjuvant chemotherapy?

Answer 11

Have to attend for a lot more imaging investigations

Question 12

Which group of people tend not to cope well with neoadjuvant chemotherapy?

Answer 12

Those with chronic co-morbid conditions

Question 13

What is adjuvant therapy?

Answer 13

Back up therapy, given after the main treatment (i.e. surgery)

Question 14

What is the main goal of adjuvant treatment?

Answer 14

To reduce the risk of systemic relapse

Question 15

What are the three factors which increase the risk of future systemic relapse?

Answer 15

Nodal involvement, high grade tumour, large sized tumour

Question 16

Which types of medical therapies can be used for adjuvant therapy?

Answer 16

Radiotherapy, chemotherapy, hormone therapy, targeted therapy

Question 17

Which type of medical therapy is an essential component of breast conserving surgery?

Answer 17

Radiotherapy

Question 18

When is adjuvant radiotherapy always used? What is the reason for this?

Answer 18

After WLE - reduces the risk of systemic relapse by 50%

Question 19

What are the 3 indications for post-mastectomy radiotherapy?

Answer 19

Involvement of more than 3 lymph nodes, positive surgical margins, tumour larger than 5cm

Question 20

How is adjuvant radiotherapy usually given?

Answer 20

By external beam radiotherapy using LINAC

Question 21

How long is adjuvant radiotherapy usually given for?

Answer 21

5 days a week for 3 weeks

Question 22

Adjuvant radiotherapy can be given for longer to certain patient groups, this is known as ‘boost’. Who would get this?

Answer 22

Younger patients and those with positive surgical margins

Question 23

What is used to minimise the effects of radiation in radiotherapy?

Answer 23

Carefully individualised radiation therapy planning and modern equipment

Question 24

What is the major disadvantage of using radiotherapy?

Answer 24

Can result in the formation of another cancer

Question 25

Give some examples of non-invasive hormone therapy?

Answer 25

Tamoxifen, aromatase inhibitors (e.g. letrozole/anastrozole) and GnRH

Question 26

Give an example of an invasive hormone therapy?

Answer 26

Oophorectomy

Question 27

How long is Tamoxifen used for as adjuvant therapy? What is the purpose of this?

Answer 27

5 years - reduces the risk of systemic relapse by 15%

Question 28

What type of drug is Tamoxifen?

Answer 28

Oestrogen receptor antagonist

Question 29

What type of side effects can Tamoxifen cause? Give examples?

Answer 29

Oestrogeneric side effects e.g. vaginal bleeding, vaginal dryness, hot flushes

Question 30

Is there a difference in survival benefit between Tamoxifen and aromatase inhibitors?

Answer 30

No

Question 31

There are various adjuvant chemotherapy regimes, but what do they usually include?

Answer 31

Anthracycline and a taxane

Question 32

What are some general side effects of adjuvant chemotherapy?

Answer 32

Anorexia, malaise, neutropenia, alopecia

Question 33

What are some side effects of adjuvant chemotherapy specifically caused by taxanes?

Answer 33

Myalgia and peripheral neuropathy

Question 34

gCSF injections given during adjuvant chemotherapy may cause what side effect?

Answer 34

Axial skeleton pain due to marrow stimulation

Question 35

Why is adjuvant chemotherapy not given to everyone with breast cancer?

Answer 35

It is a tough treatment and should only be given to people who it is really going to benefit

Question 36

What is the main targeted treatment used in breast cancer?

Answer 36

Herceptin

Question 37

What is Herceptin?

Answer 37

Monoclonal antibody against the HER2 receptors

Question 38

How is Herceptin given?

Answer 38

SC injection

Question 39

Who has HER2 receptors? Herceptin is a particularly useful treatment in people who have what?

Answer 39

Most people will have HER2 receptors, about 15% of breast cancers will show HER2 overexpression

Question 40

How often is Herceptin given and how long for?

Answer 40

3 weekly for a year

Question 41

What are some side effects of Herceptin?

Answer 41

Allergic reactions and reversible cardiac failure

Question 42

What monitoring is required for patients taking Herceptin?

Answer 42

4 monthly scans to assess for reversible cardiac failure

Question 43

When are breast cancer patients reviewed and discharged from the oncology clinic?

Answer 43

At the end of adjuvant treatment

Question 44

When do breast cancer patients get a surgical review and are discharged from clinic follow-up?

Answer 44

A year after their surgery

Question 45

What follow-up do breast cancer patients get after adjuvant treatment has ended?

Answer 45

Yearly mammograms for 3 years and back into usual screening thereafter

Question 46

What is palliative treatment?

Answer 46

Non-curative treatment, systemic treatment for widespread disease

Question 47

Which medical therapies for breast cancer are most commonly used as palliative treatment?

Answer 47

Chemotherapy or hormonal therapy

Question 48

When would radiotherapy be used as a palliative treatment?

Answer 48

For fungating breast disease or bony metastases

Question 49

What medication is used as palliative treatment for bony metastases? What does this reduce the risk of?

Answer 49

Bisphosphonates, reduce the risk of crush and pathological fractures

Question 50

Which imaging modality is now used for image acquisition before radiotherapy?

Answer 50

CT