Oncology with Breast Cancer Flashcards
What is involved in the oncological rx of breast cancer ?
Radiotherapy
Chemotherapy
Hormone Therapy
Antibodies (Herceptin) - trastuzumab
If the cancer can be CURED; which rx is given?
- Neoadjuvant
- Adjuvant
If the cancer is NOT curable?
- palliative treatment is offered
WHat is included in neoadjuvant rx?
- Hormone Therapy
2. Chemotherapy
In which conditions may hormone therapy be given?
- ER+ tumors
- less fit patients
- pts in whom it is not certain when surgery can be done (or LONG waiting list)
What are the advs of neo-adjuvant chemotherapy?
- COSMETIC; wide local excision is enough (as opposed to mastectomy)
- — less extensive nodal clearance is done, if GOOD response to rx (in TAYSIDE)
What are the disadv. of neoadjuvant chemotherapy?
- attendance for 6 extra imaging ivx (compared to adjuvant rx)
What is the difference between adjuvant and neoadjuvant therapy?
- Neoadjuvant= rx done BEFORE the surgery
- Adjuvant= rx done AFTER the surgery
What occurs in adjuvant therapy?
- RADIOTHERAPY
- –used routinely after wide local excision
- ER-blockade
- Chemotherapt
What occurs during radiotherapy?
- external beam therapy using LINAC over 3 weeks
- boost (extra rx) may be needed
What are the indications for BOOST rx?
- young age
- (+)ve margins
How effective is radiotherapy?
(reduces recurrence by 1/2) —–one life saved for every 4 recurrences
How effective and how long must one take ER blockade during Adjuvant therapy?
- 5 years of TAMOXIFEN
- reduces risk of RELAPSE by 15% at 10 years
—-same with Aromatase inhibitors (LETROZOLE and ANASTROZOLE)
What drug is used for chemo adjuvant therapy?
- anthracycline
- Taxane
What are the side effects of adjuvant chemo-therapy?
- anorexia
- malaise
- neutropenia
- alopecia
- myalgia
- peripheral neuropathy
- —-axial skeleton pain (gCSF injections)
What adjuvant therapy is given to a patient with tumors that are HER2 +?
- Trastuzumab (HERCEPTIN)
- —by s/c injection (IV)
What is trastuzumab?
- antibody against HER2 receptor (seen in 15%V of breast cancer)
- —given for one YEAR thrice a week
How effective is herceptin?
- improves overal survival by 3% absolute
What are the side effects of trastuzumab?
- allergic rxns and cardiac failure
What occurs after adjuvant rx is complete?
- surgical review on anniversary of surgery
- discharge from clinic
- follow-up YEARLY mammograms (for 3 years)
What occurs with palliative rx?
- systemic rx for widespread disease (ER- block/ Chemotherapy)
- radiotherapy for BONE metastases or FUNGATING breast disease
- bisphosphonates
Name a bisphosphonate and what is its use?
- Oral ibandronic acid
- those with high levels of calcium (d.t bone metastasis) —-reduces calcium loss from bone (to strengthen it)
- those with BONE PAIN (from bone metastasis)
What is done routinely?
CT
What is a new development with radiotherapy?
IORT
- intraoperative radiotherapy
What is trastuzumab-emtansine?
- new drug combining chemotherapy moiety with trastuzumab
Main concern post therapy?
- metastasis to the bone
—-bone pain? (confirm with CT/ MRI of affected bone) —usually ribs
Recurrence?
What should be made aware to the patient about fever during chemo?
- if pt is well and NO fever, IGNORE
- if pt is SEPTIC or well WITH fever==> ADMIT to oncology
IS mirena coil c.i in cancer survivors?
yes
- by the company
How reliable are tumor markers ?
- OK for monitoring
- poor for dx
- NOT to be checked unless metastatic disease is KNOWN to be present
What is a side effect seen with tamoxifen ? How to treat ?
- hot flushes
- —-give CLONIDINE (to be reduced and stopped slowly)
- —progestogens work (tho maybe unsafe)
What risk is there with the use of bisphosphonates>
- osteonecrosis of the jaw
What are side effects seen with tamoxifen?
- vaginal bleeding
- endometrial cancer risk
- ## endometril polyps and hyperplasia
What alternative for tamoxifen if the pt is post-menopausal?
- Aromatase inhibitors
What alternate drug is the pt is pre-menopausal?
- goserelin
Greater reaction with radiotherapy occurs if the breast has ______
greater volume
lasts a few weeks and then heals spontaneously
Can a lump appear after surgery?
- yes
- UNLIKELY to be recurrence shortly after rx
- —common for fat necrosis to occur after trauma
How may bone metastasis present as?
- severe back pain
- radicular back
- difficulty walking
- —d.t compression of spine
- —-urgent MRI of spine needed
