Oncology and Palliative Care

Question 1

Post op, who should be treated with radiotherapy?

Answer 1

treat all conservation patients, but only higher risk mastectomy patients

Question 2

What are the acute side effects of post op radiotherapy?

Answer 2

Skin erythema to moist desquamation
Tiredness
Possible mild dysphagia if irradiating supraclavicular fossa

Question 3

What are the late side effects of post op radiotherapy?

Answer 3

Local fibrosis and telangectasia
Lung fibrosis (rarely symptomatic)
Cardiac damage (ischaemic heart disease) – rarer now treatment better ‘planned’

Question 4

What is the median survival period for a patient with mets?

Answer 4

2 years

Question 5

Treatment for mets?

Answer 5

Hormone therapy (aromatase inhibitors
Tamoxifen,
Progestagens)
Chemotherapy
Bisphosphonates for bony mets
Trastuzumab if HER2 +ve

Question 6

When is chemotherapy used for a more rapid response?

Answer 6

If there are there are liver metastases or lymphangitis carcinomatosa

Question 7

What is the absolute benefit in survival of adjuvant chemotherapy in breast cancer?

Answer 7

Between 0% and 15%

Question 8

What is the major difference between aromatase inhibitors and tamoxifen?

Answer 8

AIs lower circulating oestrogen in post-menopausal women; tamoxifen is partial agonist at receptor

Question 9

What is the benefit of neo-adjuvant chemotherapy in breast cancer?

Answer 9

It decreases the number of people who need mastectomy

Question 10

Is there a proven overall survival advantage for AIs over tamoxifen in the adjuvant setting?

Answer 10

No, the overall survival advantage for both drugs is the same, but 10y of TAM is 3% better than 5y

Question 11

What is the standard sequence of treatment for early breast cancer?

Answer 11

Surgery; radiotherapy; (chemo); adjuvant hormonal treatment (if applicable)