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Heme / Onc > SM_275b: Breast Cancer > Flashcards

SM_275b: Breast Cancer Flashcards

1
Q

___ is most commonly diagnosed cancer worldwide

A

Breast cancer is most commonly diagnosed cancer worldwide

  • Mortality decreasing
  • Incidence stays largely the same
  • Risk of developing breast cancer and of dying from breast cancer increase with age
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2
Q

Describe general risk factors for breast cancer

A

General risk factors for breast cancer

  • Increasing age
  • Female gener
  • Ionizing radiation (i.e. chest radiation for Hodgkin lymphoma)
  • Lifestyle: obesity, decreased physical activity, and alcohol
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3
Q

Describe hormonal risk factors for breast cancer

A

Hormonal risk factors for breast cancer

  • Reproductive factors: early menarche (< 12 years), late menopause, late age of first pregnancy (> 30 years), nulliparity
  • Hormone intake: hormone replacement therapy, oral contraceptive therapy
  • Increased breast density
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4
Q

Majority of hereditary breast cancer is due to germ line mutations in ___ and ___

A

Majority of hereditary breast cancer is due to germ line mutations in BRCA1 and BRCA2

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5
Q

Describe pathological risk factors for breast cancer

A

Pathological risk factors for breast cancer

  • Proliferative lesions without atypia: usual ductal hyperplasia, intraductal papillomas, radial scars, simple fibroadenoma
  • Atypical hyperplasias: atypical ductal hyperplasia, atypical lobular hyperplasia
  • In situ pathology, ductal carcinoma in situ (pre-malignant), lobular carcinoma in situ (not pre-malignant)
  • Hx of invaisve breast cancer
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6
Q

Describe risk-reducing strategies for breast cancer

A

Risk-reducing strategies for breast cancer

  • Bilateral prophylactic mastectomies
  • Enhanced screening MRI
  • Chemoprevention: premenopausal (tamoxifen) or postmenopausal (tamoxifen, raloxifene, aromatase inhibitor)
  • Lifestyle modifications: limit alcohol to < 1 drink/day, exercise, weight control, smoking cessation
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7
Q

Describe breast cancer screening

A

Breast cancer screening

  • Mammogram: low dose x-ray procedure
  • Ultrasound: to further evaluate abnormalities on mammogram or exam, may be useful with dense breasts
  • MRI: used for women at higher risk of breast cancer
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8
Q

___ reduce the risk of dying from breast cancer and facilitate early treatment

A

Screening mammograms reduce the risk of dying from breast cancer and facilitate early treatment

  • Advances in adjuvant therapies also help
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9
Q
A
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10
Q

___ is the most common type of breast cancer

A

Invasive ductal carcinoma is the most common type of breast cancer

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11
Q

Describe types of breast cancer

A

Types of breast cancer

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma: high risk of bilateral and multicentric disease, tend to be estrogen responsive with favorable prognosis
  • Metaplastic: typically aggressive with less favorable prognosis
  • Mucinous: favorable prognosis
  • Tubular: favorable prognosis, metastases rare
  • Medullary
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12
Q

Describe hormone positive breast cancer

A

Hormone positive breast cancer

  • Most common subtype
  • Overexpress estrogen receptor or progesterone receptor
  • Anti-estrogen therapy: tamoxifen, aromatase inhibitors
  • Overall favorable prognosis
  • Gene expression similar to luminal epithelial
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13
Q

Hormone positive breast cancer is molecularly subclassified into ___ and ___

A

Hormone positive breast cancer is molecularly subclassified into luminal A and B

  • Luminal A has better prognosis
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14
Q

Describe HER2 positive breast cancer

A

HER2 positive breast cancer

  • 20% of all
  • Now has excellent outcomes with combos of chemo and HER2 targeted therapy
  • Diagnosed by IHC and FISH
  • Defines therapeutic options
  • Triple positive: ER, PR, and HER2 positive
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15
Q

Describe triple negative breast cancer

A

Triple negative breast cancer

  • Does not express ER/PR/HER2
  • 15-20% of breast cancers
  • Gene expression similar to basal epithelial cells
  • Tend to be aggressive and prognosis inferior
  • Novel immunotherapies including immunotherapy and PARP inhibitors
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16
Q

Describe staging breast cancer

A

Staging breast cancer

  • Stage 1 and 2: only if symptoms
  • Stage 3: irrespective of symptoms
17
Q

Early stage cancer is treated with ___

A

Early stage cancer is treated with combos of surgery, radiation, and systemic (medical) therapy

18
Q

Describe current breast cancer surgery

A

Breast cancer surgery

  • Mastectomy: radical is almost never used, routine contralateral prophylactic mastectomy
  • Partial mastectomy (lumpectomy): radiation required
  • Sentinel lymph node biopsy / dissection: limited to avoid morbidity
  • Axillary lymph node dissection: only required if lymph nodes clinically involved or in some situations where sentinel lymph nodes are involved
19
Q

Radiation therapy for breast cancer works by ___

A

Radiation therapy for breast cancer works by eliciting double strand breaks in DNA (DNA repair mechanisms usually aberrant in cancer)

  • May target breast ± regional lymph nodes
  • Usually required in context of lumpectomy
  • Often recommended after mastectomy for node positive disease
  • Axillary radiation can increase risk of lymphedema
20
Q

Describe systemic therapy for breast cancer

A

Systemic therapy for breast cancer

  • Aimed at elimination of micrometastatic disease
    • Endocrine therapy: after surgery for ER/PR early stage breast cancer
    • Chemotherapy
    • Targeted (i.e. HER-2 targeted therapy)
    • Other novel therapies
21
Q

Tamoxifen is used for ____ women with breast cancer and is a ____

A

Tamoxifen is used for pre-menopausal women with breast cancer and is a SERM

  • Antagonist in breast, agonist in uterus
22
Q

Aromatase inhibitors are used for ____ women with breast cancer and ____

A

Aromatase inhibitors are used for post-menopausal women with breast cancer and inhibits enzymatic conversion of androgen to estrogen

23
Q

Describe endocrine therapy toxicity

A

Endocrine therapy toxicity

  • Estrogen deprivation: hot flashes, decreased libido, vaginal dryness
  • Uterine cancer (tamoxifen)
  • Thromboembolic disease (tamoxifen)
  • Arthralgias (aromatase inhibitors)
  • Decreases in bone density (aromatase inhibitors)
24
Q

Describe adjuvant chemo for breast cancer

A

Adjuvant chemo for breast cancer

  • Triple negative and HER2 positive: almost always receive chemotherapy
  • Node positive: almost always receive
  • ER+: not really
  • Anthracyclines ± taxanes
  • Pre or postop
  • Neoadjuvant: shrink tumor to convert to breast conserving therapy, inflammatory breast cancer, inoperable
25
Q

Anti-HER2 therapy involves ___ and ___

A

Anti-HER2 therapy involves trastuzumab and pertuzumab

26
Q

Trastuzumab is a ___ that comprises ___

A

Trastuzumab is a monoclonal antibody against HER2 and HER4 that comprises anti-HER2 therapy

27
Q

Pertuzumab is a ___ that comprises ___

A

Pertuzumab is a monoclonal antibody against HER2 and HER3 that comprises anti-HER2 therapy

28
Q

Describe chemo toxicities

A

Chemo toxicities

  • Anthracyclines: cardiac toxicity
  • Taxanes: neurotoxicity / neuropathy, pulmonary toxicity (pneumonitis), hepatotoxicity, myalgias / arthralgias
  • HER2 targeted
    • Trastuzumab: cardiac toxicity
    • Pertuzumab: diarrhea
29
Q

___ is mainstay of treatment for metastatic breast cancer

A

Systemic therapy is mainstay of treatment for metastatic breast cancer

  • Not curable but treatable

Heme / Onc (41 decks)

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