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MRCOG MedExamExpert > Pregnancy and Breast Cancer > Flashcards

Pregnancy and Breast Cancer Flashcards

1
Q

What is the most common cancer in females?

A. Cervical cancer
B. Breast cancer
C. Colon cancer
D. Melanoma

A

B. Breast cancer

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2
Q

What is the lifetime risk of developing breast cancer in the UK?

A. 1/3
B. 1/9
C. 1/12
D. 1/20

A

B. 1/9

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3
Q

What is the leading cause of death in females aged 35-54 in the UK?

A. Cervical cancer
B. Breast cancer
C. Colon cancer
D. Melanoma

A

B. Breast cancer

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4
Q

What is the percentage of breast cancer diagnosed before age of 45yo?

A

15%

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5
Q

In women under the age of 30, what is the rate of breast cancer associated with pregnancy/up to 1 yr PP?

A. <10%
B. 10-20%
C. 25%
D. 30%

A

B. 10-20%

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6
Q

What is the 5-year survival rate of for <50’s age group?

A. 60%
B. 70%
C. 80%
D. 90%

A

C. 80%

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7
Q

How does pregnancy affect the prognosis of breast cancer?

A. Doesn’t worsen
B. Worsen then improve
C. Improve
D. Worse

A

A. Doesn’t worsen

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8
Q

Breast cancer occurring in younger population may carry a higher risk of metastases due to what factors, leading to an inferior prognosis.

A

High grade tumours

Estrogen receptor negative tumours

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9
Q

Prognosis factors are:

A 
Tumour size
Grade
Nodal status
Estrogen and Progesteron receptor
HER2 status
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10
Q

How is breast lump in pregnancy managed?

A. ObGyn consultant-led
B. Breast specialist team + MDT
C. Radiotherapy unit
D. Breast-endocrine surgical team

A

B. Breast specialist team + MDT

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11
Q

First line to asses a breast lump in pregnancy:

A

USG

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12
Q

When is mammography (with fetal shield) indicated in pregnancy?

A. Abnormal discharge from nipple
B. When cancer is confirmed and the extent of disease needs assessment.
C. History treated breast cancer
D. To assess a discrete breast lumo

A

B. When cancer is confirmed and the extent of disease needs assessment.

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13
Q

When is mammography (with fetal shield) indicated in pregnancy?

A. Abnormal discharge from nipple
B. When cancer is confirmed and the contralateral breast needs assessment.
C. History treated breast cancer
D. To assess a discrete breast lumo

A

B. When cancer is confirmed and the contralateral breast needs assessment.

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14
Q

In pregnancy, which is preferred: Biopsy or cytology?

A

Biopsy for histology. Pregnancy changes make cytology inconclusive.

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15
Q

When is staging for breast cancer in pregnancy undertaken?

A

When there is high clinical suspicion

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16
Q

How is staging for breast cancer in pregnancy undertaken?

A

CXR, liver scan

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17
Q

Does staging for breast cancer in pregnancy include bone scan and pelvic CT?

A

Not recommended d/t fetal radiation

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18
Q

When does staging for breast cancer in pregnancy require a gadolinium enhanced MRI?

A

When there is a need to investigate a clinical problem.

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19
Q

What are the roles of CA-125, CEA, CA 15-3 in breast cancer during pregnancy?

A

They are misleading in pregnancy.

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20
Q

When to consider TOP and the discussion points?

A

Discuss: cancer prognosis, treatment, future fertility between the woman, partner & MDT.

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21
Q

What treatment is available for breast cancer during pregnancy?

A. WLE in all trimesters
B. Chemo in all trimesters
C. Loco-regional clearance in all trimesters
D. Radiotherapy in all trimesters

A

C. Loco-regional clearance in all trimesters

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22
Q

When is breast conserving surgery or mastectomy considered?

A

Based on tumour characteristic and breast size

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23
Q

When is breast reconstruction considered?

A

Delayed, to avoid prolonged aneasthesia and allow for symmetrisation

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24
Q

When is sentinel node biopsy indicated?

A

In women with negative result from preOP axillary USG and needle biopsy

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25
Q

What surgery is indicated if axilla is positive?

A

Axillary clearance

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26
Q

When is radiotherapy indicated in the management of breast cancer in pregnancy

A. Brain mets
B. Pain due to spinal cord compression
C. Large tumour size
D. High grade histology.

A

B. Pain due to spinal cord compression

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27
Q

When is routine breast/chestwall radiotherapy done in the management of breast cancer in pregnancy?

A

Deferred until after dleivery

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28
Q

When is systemic chemotherapy contraindicated in the treatment of breast cancer in pregnancy?

A

First trimester, due to high rates of fetal anomalies

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29
Q

Which systemic chemotherapy is safe in the treatment of breast cancer in pregnancy?

A. Cisplatin
B. Anthracycline
C. Taxanes
D. Methotraxate

A

B. Anthracycline

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30
Q

Which systemic chemotherapy is safe in the treatment of breast cancer in pregnancy which is node positive?

A. Cisplatin
B. Anthracycline
C. Taxanes
D. Methotraxate

A

C. Taxanes

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31
Q

Which systemic chemotherapy is safe in the treatment of breast cancer in pregnancy which is metastatic?

A. Cisplatin
B. Anthracycline
C. Taxanes
D. Methotraxate

A

C. Taxanes

32
Q

What antiemetic treatment is used during chemotherapy treatment of breast cancer in pregnancy?

A

5HT3 serotonin antagonists & dexamethasone

33
Q

What is the relation between breast cancer in pregnancy and T2 losses or FGR?

A

No evidence for an increased rate.

34
Q

When is there a role for chemotherapy pre surgery?

A

In the event of neoadjuvent chemotherapy (NACT) to shrink the tumour preOp

35
Q

What is tamoxifen and trastuzumab?

A

Monoclonal antibody targeted against HER2

36
Q

When is tamoxifen and trastuzumab treatment indicated in breast cancer during pregnancy?

A

It isnt. It is contraindicated due to adverse fetal outcome.

37
Q

With regards to breast cancer during pregnancy and early delivery are corticosteroids considered?

A

Yes

38
Q

With regards to chemotherapy for breast cancer during pregnancy, when is delivery timed?

A

2-3 weeks from last chemotherapy session.

39
Q

A woman who completed a session of chemotherapy last for breast cancer during pregnancy, presents in labour. What investigation is necessary?

A

FBC, TRO neutropenia

40
Q

When is tamoxifen and trastuzumab treatment safe for treatment of breast cancer during breastfeeding?

A

Transmission is unknown and therefore contraindicated for breastfeeding.

41
Q

What can tamoxifen and trastuzumab treatment cause in neonates?

A

Neonatal neutropenia.

42
Q

When is can breastfeeding resume after tamoxifen and trastuzumab treatment?

A. 10 days
B. 1-2 weeks
C. 2-3weeks
D. >4weeks

A

C. 2-3weeks

43
Q

When is can breastfeeding resume on tamoxifen and trastuzumab treatment?

A. Stop immediately
B. 1-2 weeks
C. 2-3weeks
D. >4weeks

A

A. Stop immediately

44
Q

What contraception is recommended to avoid pregnancy after treatment of breast cancer?

A

Non-hormonal contraceptive methods

45
Q

Hormonal contraception in women with current or recents breast cancer is classified as?

A

UKMEK-4

46
Q

When can you initiate hormonal contraception in women with history of breast cancer?

A

At least 5 years BRCA free

47
Q

What is the role of LNG-IUS in tamoxifen therapy?

A

May reduce endometrial abnormalities during tamoxifen therapy however, further evidence is require on its safety in breast cancer. NO overall increase recurrence was found.

48
Q

What is the duration of tamoxifen cessation before trying to conceive?

A

3 months

49
Q

How should women with metastatic breast cancer be advised with regards to pregnancy?

A

Advised against as life expectancy is limited and treatment of mets will be compromised.

50
Q

How is long-term survival after breast cancer affected by pregnancy?

A

NOT adversely affected.

51
Q

With regards to pregnancy after breast cancer, when is recurrence highest?

A. 2 years
B. 3 years
C. 5 years
D. 10 years

A

A. 2 years

52
Q

With regards to pregnancy after breast cancer with estrogen receptor positive, how long is tamoxifen treatment?

A. 2 years
B. 3 years
C. 5 years
D. 10 years

A

C. 5 years

53
Q

What is the outcome of pregnancies after completion of treatment of breast cancer?

A. Infertility
B. Increased IUD
C. May be an increased miscarriage rate
D. Increased congenital malformations

A

C. May be an increased miscarriage rate

54
Q

What is the outcome of pregnancies after completion of treatment of breast cancer?

A. Infertility
B. Majority proceed with live birth
C. No change in miscarriage rate
D. Increased congenital malformations

A

B. Majority proceed with live birth

55
Q

What is the outcome of pregnancies after completion of treatment of breast cancer?

A. Infertility
B. Increased IUD
C. No change in miscarriage rate
D. No increase in congenital malformations

A

D. No increase in congenital malformations

56
Q

With regards to pregnancy after treatment of breast cancer, who takes charge?

A

MDT

57
Q

With regards to pregnancy after treatment of breast cancer, what investigation needs to be performed?

A

Echo for cardiomyopathy

58
Q

With regards to pregnancy after treatment of breast cancer, how does radiotherapy affect breastfeeding?

A

Fibrosis may make lactation unlikely.

59
Q

With regards to pregnancy after treatment of breast cancer, how does chemotherapy affect breastfeeding?

A

No evidence of previous affecting BF.

60
Q

With regards to pregnancy after treatment of breast cancer, how should a woman wishing to breast feed be managed?

A

The woman should be supported.

61
Q

Chemo-induced Gonadotoxicity may cause: (4)

A

Permanent amenorrhea and complete loss of germ cells
Transient amenorrhea
Menstrual irregularities
Subfertility

62
Q

What is an alkylating agent used?

A

Cyclophosphamide

63
Q

Between CMF regimen and anthracycline regimes, which is more gonadotoxic?

A

CMF more than FEC

64
Q

What is CMF?

A

Cyclophosphamide, methotraxate, 5-FU

65
Q

What is FEC?

A

5-FU, Epiribicin, cyclophosphamide.

66
Q

Are newer taxanes less gonadotoxic?

A

Yes.

67
Q

Does NACT cause long term effects on infertility?

A

Not in themselves

68
Q

What does Tamoxifen cause?

A

Menstrual irregularities and increased risk of endometrial pathology

69
Q

What is the washout period for tamoxifen?

A

2-3 months

70
Q

Is the amenorrhea and estrogen deficiency in GnRH analogue treatment reversible?

A

Yes, entirely.

71
Q

What is the role of GnRH analogues for ovarian protection in HERpos breast Ca?

A

Insufficient level 1 data to support routine use

72
Q

How does GnRH affect tumour response with concomitant chemotherapy

A

May lessen the response

73
Q

What is the finding of co-treatment with GnRH during chemotherapy for breast cancer?

A

Lessens the risk of ovarian damage.

74
Q

What are the guidelines with regards to gamete storage for persons undergoing gonadotoxic treatment?

A

NICE recommends universal access to sperm, egg and embryo storage.

75
Q

After chemotherapy, what is the time interval before the next pregnancy?

A

2 years

76
Q

After chemotherapy, when is breast feeding commenced after?

A

14 days

MRCOG MedExamExpert (4 decks)

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