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REPRO > Oncology with Breast Cancer > Flashcards

Oncology with Breast Cancer Flashcards

1
Q

What is involved in the oncological rx of breast cancer ?

A

Radiotherapy
Chemotherapy
Hormone Therapy
Antibodies (Herceptin) - trastuzumab

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2
Q

If the cancer can be CURED; which rx is given?

A
  • Neoadjuvant

- Adjuvant

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3
Q

If the cancer is NOT curable?

A
  • palliative treatment is offered
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4
Q

WHat is included in neoadjuvant rx?

A
  1. Hormone Therapy

2. Chemotherapy

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5
Q

In which conditions may hormone therapy be given?

A
  • ER+ tumors
  • less fit patients
  • pts in whom it is not certain when surgery can be done (or LONG waiting list)
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6
Q

What are the advs of neo-adjuvant chemotherapy?

A
  • COSMETIC; wide local excision is enough (as opposed to mastectomy)
  • — less extensive nodal clearance is done, if GOOD response to rx (in TAYSIDE)
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7
Q

What are the disadv. of neoadjuvant chemotherapy?

A
  • attendance for 6 extra imaging ivx (compared to adjuvant rx)
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8
Q

What is the difference between adjuvant and neoadjuvant therapy?

A
  • Neoadjuvant= rx done BEFORE the surgery

- Adjuvant= rx done AFTER the surgery

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9
Q

What occurs in adjuvant therapy?

A
  • RADIOTHERAPY
  • –used routinely after wide local excision
  • ER-blockade
  • Chemotherapt
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10
Q

What occurs during radiotherapy?

A
  • external beam therapy using LINAC over 3 weeks

- boost (extra rx) may be needed

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11
Q

What are the indications for BOOST rx?

A
  • young age

- (+)ve margins

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12
Q

How effective is radiotherapy?

A

(reduces recurrence by 1/2) —–one life saved for every 4 recurrences

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13
Q

How effective and how long must one take ER blockade during Adjuvant therapy?

A
  • 5 years of TAMOXIFEN
  • reduces risk of RELAPSE by 15% at 10 years

—-same with Aromatase inhibitors (LETROZOLE and ANASTROZOLE)

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14
Q

What drug is used for chemo adjuvant therapy?

A
  • anthracycline

- Taxane

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15
Q

What are the side effects of adjuvant chemo-therapy?

A
  • anorexia
  • malaise
  • neutropenia
  • alopecia
  • myalgia
  • peripheral neuropathy
  • —-axial skeleton pain (gCSF injections)
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16
Q

What adjuvant therapy is given to a patient with tumors that are HER2 +?

A
  • Trastuzumab (HERCEPTIN)

- —by s/c injection (IV)

17
Q

What is trastuzumab?

A
  • antibody against HER2 receptor (seen in 15%V of breast cancer)
  • —given for one YEAR thrice a week
18
Q

How effective is herceptin?

A
  • improves overal survival by 3% absolute
19
Q

What are the side effects of trastuzumab?

A
  • allergic rxns and cardiac failure
20
Q

What occurs after adjuvant rx is complete?

A
  • surgical review on anniversary of surgery
  • discharge from clinic
  • follow-up YEARLY mammograms (for 3 years)
21
Q

What occurs with palliative rx?

A
  • systemic rx for widespread disease (ER- block/ Chemotherapy)
  • radiotherapy for BONE metastases or FUNGATING breast disease
  • bisphosphonates
22
Q

Name a bisphosphonate and what is its use?

A
  • 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)
23
Q

What is done routinely?

A

CT

24
Q

What is a new development with radiotherapy?

A

IORT

- intraoperative radiotherapy

25
Q

What is trastuzumab-emtansine?

A
  • new drug combining chemotherapy moiety with trastuzumab
26
Q

Main concern post therapy?

A
  • metastasis to the bone
    —-bone pain? (confirm with CT/ MRI of affected bone) —usually ribs
    Recurrence?
27
Q

What should be made aware to the patient about fever during chemo?

A
  • if pt is well and NO fever, IGNORE

- if pt is SEPTIC or well WITH fever==> ADMIT to oncology

28
Q

IS mirena coil c.i in cancer survivors?

A

yes

- by the company

29
Q

How reliable are tumor markers ?

A
  • OK for monitoring
  • poor for dx
  • NOT to be checked unless metastatic disease is KNOWN to be present
30
Q

What is a side effect seen with tamoxifen ? How to treat ?

A
  • hot flushes
  • —-give CLONIDINE (to be reduced and stopped slowly)
  • —progestogens work (tho maybe unsafe)
31
Q

What risk is there with the use of bisphosphonates>

A
  • osteonecrosis of the jaw
32
Q

What are side effects seen with tamoxifen?

A
  • vaginal bleeding
  • endometrial cancer risk
  • ## endometril polyps and hyperplasia
33
Q

What alternative for tamoxifen if the pt is post-menopausal?

A
  • Aromatase inhibitors
34
Q

What alternate drug is the pt is pre-menopausal?

A
  • goserelin
35
Q

Greater reaction with radiotherapy occurs if the breast has ______

A

greater volume

lasts a few weeks and then heals spontaneously

36
Q

Can a lump appear after surgery?

A
  • yes
  • UNLIKELY to be recurrence shortly after rx
  • —common for fat necrosis to occur after trauma
37
Q

How may bone metastasis present as?

A
  • severe back pain
  • radicular back
  • difficulty walking
  • —d.t compression of spine
  • —-urgent MRI of spine needed

REPRO (55 decks)

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