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Cancer CE & VP > VP L1 Breast cancer > Flashcards

VP L1 Breast cancer Flashcards

1
Q

5 main methods of treating cancer

A 
Surgery
Radiotherapy
Hormonal therapies
Chemotherapy
Monoclonal antibodies
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2
Q

Risk factors for developing breast cancer (10)

A

Age
Age of menarche & menopause
Age at first full term pregnancy

Lactiation
Oral contraceptives

Weight
Diet
Alcohol

Geographical location
Radiation

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3
Q

Presenting BC (breast cancer) symptoms: (4)

A

lump
pain
nipple discharge
symptoms from metastisis

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4
Q

Examination of suspected breast cancer might show (2)

A

skin dimpling

swollen lymphnodes

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5
Q

3 investigations to confirm BC?

A

Mammography
Ultrasound
Fine needle aspiration/biopsy

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6
Q

What are the limitations of mammogrphy

A

doesnt show all breast cancers (only 90%)

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7
Q

What is the purpose of ultrasound of breast?

A

To see if lump is cancerous or cystic

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8
Q

At what age are benefits shown from BC screening?

A

50

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9
Q

How often are people screened?

A

3 years - experts say not enough but cost!

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10
Q

What is non-invasive BC?

A

Confined to ducts and lobules

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11
Q

What is invasive BC?

A

Spread to basement membrane and surrounding breast tissue (this is not the same as metastasis)

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12
Q

How is breast cancer staged?

A

Using TNM system - that looks at size/ ulceration of skin/ fixation to chest wall

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13
Q

How is breast cancer staged?

A

TNM rating
Tumour status (size)
Lymph node status
Metastases

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14
Q

3 main stages of breast cancer

A

Early (

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15
Q

3 main stages of breast cancer

A

Early (

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16
Q

Adverse prognostic factors in BC (6)

A
  • high TNM stage
  • poorly differentiated tumours
  • lymph/vascular invasion
  • ER or PR -ve
  • HER2 +ve
  • young at diagnosis
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17
Q

Why measure ER (oestrogen receptor) conc?

A

Predicts response to hormonal therapy

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18
Q

e.g of hormonal therapy (4)

A

tamoxifen
anaztrazole
letrozole
exemestane

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19
Q

ER and (progesterone receptor) PR +ve cancers give better or worse prognosis?

A

better

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20
Q

What is the action of oestrogen binding to the ER?

A

Bound receptor sends signals to stimulate cell division adn growth

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21
Q

e.g. of new agent

A

Everolimus

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22
Q

2 main surgery types

A

masectomy

breast conserving surgery (lumpectomy)

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23
Q

What might also be given post surgery?

A

adjuvant therapy - radio, chemo, hormonal, trastuzamab

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24
Q

Who is given radiotherapy?

A

All surgery patients at high right of recurrance (tumour >5cm, 4 positive lymph nodes)

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25
Q

How often is radio administered?

A

5 days a week for 3-5 weeks

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26
Q

Who are hormonal therapies given to?

A

All women with ER/PR positive tumours

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27
Q

When is hormonal therapy given

A

5 days after surgery

or

to shrink tumours before surgery

28
Q

How does hormonal therapy work?

A

Sensitive cells need oestrogen to stay alive so removing oestrogen is effective at controlling/killing

29
Q

What is tamoxifen

A

a oestrogen antagonist

30
Q

Side effects of tamoxifen

A

hot flush
weight gain
sweats
increased risk of endometrial cancer

31
Q

How does tamoxifen work?

A

binds to ER in the cell

ER can no longer bind co factors needed for gene transcription

32
Q

What is letrozole

A

aromatase inhibitor

33
Q

What is anastrazole

A

aromatase inhibitor

34
Q

What is exemestane

A

aromatase inhibitor

35
Q

How do aromatase inhibitors work?

A

block conversion of androgens from the adrenal cortex —> oestrogen in peripheral tissues

36
Q

Who do aromatase inhibitors work in?

A

post menopausal women

37
Q

What is the treatment of choice in postmenopausal women?

A

Anastrazole

38
Q

s/e of anasztrazole

A

reduced bone mineral density - therefore have bone density scan when started

39
Q

When is chemo given?

A

Before/after surgery

- there is no optimum regime and many variations are used

40
Q

What are the most effective chemo regimes?

A

anthracycline based ones

41
Q

Who is chemo most effective in?

A

Premenopausal women

Node +ve patients

42
Q

s/e of chemo (6)

A 
nausea
vom
bone marrow supression
mucositis
cardiac arrhythmias/myopathy
alopecia
43
Q

FEC 100 regieme consits of

A

Flurouracil 500mg/m2
Eipirubicin 100mg/m2
Cyclophosphamide 500mg/m2

44
Q

How is FEC 100 adiministerd?

A

IV

45
Q

How often do we give FEC100

A

every 21 days for 6 cycles

46
Q

What should you check before next FEC100 dose

A

FBC (neuts >1 platelets >100)
Renal funciton
LFT
cumulatibe dose of epirubucin

47
Q

What do you change in FEC100 if LFTs are derranged?

A

reduce E and F doses

48
Q

What should always be dispensed with FEC100

A

antiemetics

49
Q

what might older patients need before chemo?

A

ECHO - to check the heart

50
Q

What should patients be aware of before chemo (2)

A
  1. How to take antiemetic - start the day before chemo start

2. Be vigilant for signs of infection (risk of neurtopenic sepsis)

51
Q

What is Capecitabine?

what is given in combo for breast cancer?

A

oral chemo

docetaxel

52
Q

Trastuzamab is also called

A

Herceptin

53
Q

What is trastuzamab?

A

MAB targetting HER2

54
Q

Who benefits from trastuzumab?

A

patients with HER 2 expression of 3+ or higher

55
Q

How does trastuzumab work?

A

prevents EGF binging to the HER2 receptor.

This prevents HER2 oncogene being amplified

56
Q

s/e of trastuzumab? (5)

A 
cardiotox
nausea and vom
diarrhoea
joint/muscle pain
rash
57
Q

Duration of treatments

A 
Surgery
Chemo - 5 months
radio - 4 weeks
trastuzumab - 1 year
hormonal therapy - 5 years
58
Q

What is everolimus

A

oral Selective mTOR ihibitor

  • mTOR is a key serine kinase upregulated in breast cancer
59
Q

Who is everolimus licensed for

A

treatment of ER/PR +ve, HER2/neu -ve advanced BC

postmenopasual women

60
Q

s/e of everolimus

A 
stomatatis
rash
fatigue
diarrhoea
infections
nausea
decreased appetie
61
Q

What is Eribulin

A

IV chemo agent

62
Q

s/e of Eribulin

A 
myelosupression
peripheral neuropathy
headache
alopecia
muscle and joint pain
infertility
63
Q

Eribulin works by…

A

inhibiting microtubule dynamics

64
Q

before starting Eribulin….

A

correct low mag and sodium levels

65
Q

Eribulin dose should be reduced if

A

low neutrophil count

Cancer CE & VP (15 decks)

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