Onco 2: cancer of breasticles Flashcards

1
Q

non-modifiable risk factors for breast cancer

A
  • Female
  • Older age
  • Family hx
  • Personal hx
  • Genetics: BRCA 1 and 2 (tumor suppresor gene that repairs DNA)
  • Breast changes found on biopsy
  • Ionizing radiation hx, esp before age of 30 (?)
  • Breast density (=/= size): makes it hard to discern tumors
  • Early menarche (< 12 yrs)/late menopause (> 55yrs)
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2
Q

what are breast changes foud on biopsy

A
  • atypical hyperplasia: non-cancerous condition where breast cncer cells have abnormal features and are increased in number
  • lobular carcinoma in situ
    • in situ: abnormla cells found in lobules and ducts
    • ductal caarcinoma in situ
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3
Q

modifiable risk factors for bresat cancer

A
  • Nulliparity - no full term nirhts
  • Older age (35+) at first child birth
  • Postmenopausal HRT
  • Postmenopaussal obestiy
  • Physial inactivit
  • EtOH abuse
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4
Q

breast cancer prognosis factors

A
  • Tumor size
  • Lymph node status: lymph node involvemnt also bad pronosis, esp if 4+
  • Tmor grade (differentiation): how different it looks form a normal cell
    • Grade 1: kinda look normal, kinda still have some normal activity
    • Grade 3: alien goop
  • Ki67 index: information on cell proliferation, higher grade = more active replicaation
  • Lymphovascular invasion: tumor emboli is found in lymphatic and vascular spaces
    • Helpful in identifying node (-) pts who are at risk for recurrence
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5
Q

non invasive breast cancer treatment

A
  • DCIS
    • lumpectomy + radiation
    • mastectomy
    • if hormone (+), may cosider +/- endocrine therapy
  • LCIS
    • regular monitoring
    • no treatment
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6
Q

invasive treatment for breast cancer

A
  • Lumpectomy + radiation
    • Goal: breast consveration
  • Mastectomy +/- radiation
    • Based on nodal involvement, size and tumor margin at time of surgery
    • removal of breast AND associated lymph
  • Post-surgery systemic therapy
    • Cytotoxi chemotherapy
    • Targeted therapy
    • Endocrine therapy
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7
Q

adjuvvnt chemo treatment for breast cancer pt: HER (-)

pt may or may not be hormone (+)

A
  • Dose-dense doxorubicin/cyclophosphamide 4x → paclitaxel Q2W 4x OR paclitaxel QW 12x → endocrine therapy (if pt qualifies) 5-10yrs
  • Docetaxel and cyclophosphamide Q3W 4-6x
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8
Q

adjuvant chemo treatment for breast cancer pt: HER (-), hormone (+), and high risk

A
  • high risk: 4+ lymph nodes OR 1-3 lymph nodes with grade 3 tumor OR tumor size > 5 cm
  • can consider adding abemaciclib PO BID for 2 years; given in combo with endocrie thearpy
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9
Q

adjuvant chemo treatment for breast cancer: pt HER (-), BRCA mutation, and high risk

A
  • can add olaparib PO BID for 1 year
    • can be lethal in pts with BRCA 1/2 deficient tumors
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10
Q

neoadjuvant chemo treatment for breast cancer pt: triple neg

A

Pembrolizumab Q3W 4x + weekly paclitaxel/carboplatin 12x → pembrolizumab + doxorubicin/cyclophosphamde Q3W 4x

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11
Q

adjuvant chemo treatment for breast cancer pt: triple neg and did NOT achieve pathologic complete response with chemo

A

try capecitabine: BID 14D, off 7D for 6-8 cycles

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12
Q

adjuvant chemo treatment for breast cancer pt: HER (+)

A
  • TCH+/-P (trastuzumab/carboplatin/Docetaxel+/- pertuzumab Q3W 6x → continue the mAbs to complete a year → endocrine therapy (if pt qualifies) 5-10yrs
  • ALT: Paclitaxel + trastuzumab QW 12x

All: → trastuzmab continued to complete a year → endocrine therapy (if pt qualifies) 5-10yrs

pertuzumab criteria for use
- HER (+) and either T > 2 OR > N1 (these pts are at high risk for recurrence

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13
Q

adjuvant chemo treatment for breast cancer pt: HER (+) and did NOT acheive pathologic complete response with chemo

A

try ado-trastuzumab emtansine IV Q21D 14x

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14
Q

adjuvant chemo treatment for breast cancer pt: HER (+) and very high risk for recurrence

A
  • can consider adding neratinib after pt has completed the year of trastuzumab
    • 6T PO QD for 1 year
    • ppx loperamide
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15
Q

difference between neoadjuvant and adjuvant chemo for breast cancer treatment

A

no diffference - EXCEPT: ER/PR (-) and HER (-): same as adjuvant → surgery → pembrolizumab Q3W 9x

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16
Q

what pt might you consider zoledronic acid in in breast canccer pts

A

postmenopausal: can add zoledronic acid IV Q6mo for 2 years

17
Q

endocrine therapy in premenopausal women

A

estrogen from ovaries →
- tamoxifen OR
- ovarian suppression with an aromatase inhibitor

ovarian suppression
- oophrectomy OR
- LHRH agonist
- reversible, continouss suppression of pituitary → decrease FSH, LH, estrgen production fro ovaries
- goserelin
- leuprolide

18
Q

endocrine therapy nin postmenopausal women

A
  • Aromatase enzyme: androgens from adrenal gland converted by aromatase in final step of estrogen iosynthesis
  • if unable to tolerate aromatase inhibitor or CI, can receive tamoxifen