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Breast > Systemic Rx Breast Cancer > Flashcards

Systemic Rx Breast Cancer Flashcards

1
Q

Neoadjuvant

A

Before

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2
Q

Adjuvant

A

After

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3
Q

What is goal of neodjuvant Rx

A 
Reduce tumour size before surgery
Inoperable disease operable 
Mastectomy - WLE
Easier WLE 
Clear nodal disease
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4
Q

What is goal of adjuvant

A

Clear micro disease not detected
Adjuvant chemo increases survival
Neoadjuvant chemo shows no increase in survival but may allow breast conserving surgery

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5
Q

What are options for neoadjuvant

A

Hormone

Chemo

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6
Q

What is hormone therapy given or

A

ER / PR +ve
Neoadjuvant
Adjuvant
Unfit elderly

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7
Q

What do you give if pre-menopausal

A

Tamoxifen

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8
Q

What is tamoxifen

A

SERM

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9
Q

If don’t respond to tamoxifen what can you do

A

Ovarian ablation (surgery / RT) or GnRH analogue (gorselin)
Make menopause
Can give AI

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10
Q

What do you do if post menopausal

A 
Aromatase inhibitor (Lebrazole) 
Tamoxifen if excellent prognosis / or AI CI
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11
Q

What does AI do

A

Inhibit oestrogen synthesis from androgens in fat

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12
Q

How long on hormonal and when do you give

A

5-10 years
Usually adjuvant
If having chemo usually start after
If having RT / Tratuzumab can be started during

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13
Q

When is chemotherapy beneficial

A 
ER -ve
HER2 +ve
Young <50 
Increasing with advancing risk
LN involvement
Grade 3 
Lymphovascular invasion
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14
Q

When is chemo not beneficial

A

ER+Ve HER2-ve post menopause

The most common type

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15
Q

What can you do to determine benefit

A

Gene assay

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16
Q

When do you do chemo

A

Before surgery to shrink
Reduce recurrence
Adjuvant if axillary node or high stage
For Rx of metastatic

17
Q

What targeted therapy is there

A

Tratuzumab (Hercepdin)

Anti-HER2

18
Q

What does tratuzumab do

A

Monoclonal Ab blocking growth factor from going to HER2 and proliferating
Given every 3 weeks for 1 year

19
Q

What do you always use with Tratuzuman

A

Combination with chemo

20
Q

When is it CI

A

Heart disorder

21
Q

What adjuvant Rx is there

A 
Hormone
Chemo
Tratuzumab
RT
Biphosphonates
Add aspirin
22
Q

What do biphosphonates do

A

Prevent bony met

Increase survival

23
Q

When do you use

A

Post menopause

Post chemo

24
Q

What are SE of tamoxifen

A

Similar to menopause

  • Hot flush / night sweats
  • Loss of libido
  • Amenorrhoea / eratic bleeding/. discharge
  • Vaginal dry
  • Weight gain
Less common 
Vaginal bleeding 
Endometrial cancer 
VTE
Osteoporosis if post-menopausal
25
Q

What do GnRH cause

A

Menopause

Osteoporosis

26
Q

SE of AI

A 
Menopause sx
- Hot flush / night sweas
- Joint pains 
- Loss sex dry
- Vaginal dry 
Osteoporosis / loss of BMD
27
Q

What should you get if on AI / other

A

DEXA at start
Supplement - Ca / vit D
Biphosphonates
Vaginal lubricants

28
Q

SE of Tratuzumab

A

Flu
Allergy
Cardiac

29
Q

SE of chemo

A 
Neutropenia
Fatigue
Alopecia
N+V
Loss of ovarian function
Infection
Mucositis
Diarrhoea
Weight gain
30
Q

What is used to assess the response to chemo

A

MRI

Breast (6 decks)

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