VP L1 Breast cancer Flashcards
5 main methods of treating cancer
Surgery Radiotherapy Hormonal therapies Chemotherapy Monoclonal antibodies
Risk factors for developing breast cancer (10)
Age
Age of menarche & menopause
Age at first full term pregnancy
Lactiation
Oral contraceptives
Weight
Diet
Alcohol
Geographical location
Radiation
Presenting BC (breast cancer) symptoms: (4)
lump
pain
nipple discharge
symptoms from metastisis
Examination of suspected breast cancer might show (2)
skin dimpling
swollen lymphnodes
3 investigations to confirm BC?
Mammography
Ultrasound
Fine needle aspiration/biopsy
What are the limitations of mammogrphy
doesnt show all breast cancers (only 90%)
What is the purpose of ultrasound of breast?
To see if lump is cancerous or cystic
At what age are benefits shown from BC screening?
50
How often are people screened?
3 years - experts say not enough but cost!
What is non-invasive BC?
Confined to ducts and lobules
What is invasive BC?
Spread to basement membrane and surrounding breast tissue (this is not the same as metastasis)
How is breast cancer staged?
Using TNM system - that looks at size/ ulceration of skin/ fixation to chest wall
How is breast cancer staged?
TNM rating
Tumour status (size)
Lymph node status
Metastases
3 main stages of breast cancer
Early (
3 main stages of breast cancer
Early (
Adverse prognostic factors in BC (6)
- high TNM stage
- poorly differentiated tumours
- lymph/vascular invasion
- ER or PR -ve
- HER2 +ve
- young at diagnosis
Why measure ER (oestrogen receptor) conc?
Predicts response to hormonal therapy
e.g of hormonal therapy (4)
tamoxifen
anaztrazole
letrozole
exemestane
ER and (progesterone receptor) PR +ve cancers give better or worse prognosis?
better
What is the action of oestrogen binding to the ER?
Bound receptor sends signals to stimulate cell division adn growth
e.g. of new agent
Everolimus
2 main surgery types
masectomy
breast conserving surgery (lumpectomy)
What might also be given post surgery?
adjuvant therapy - radio, chemo, hormonal, trastuzamab
Who is given radiotherapy?
All surgery patients at high right of recurrance (tumour >5cm, 4 positive lymph nodes)
How often is radio administered?
5 days a week for 3-5 weeks
Who are hormonal therapies given to?
All women with ER/PR positive tumours
When is hormonal therapy given
5 days after surgery
or
to shrink tumours before surgery
How does hormonal therapy work?
Sensitive cells need oestrogen to stay alive so removing oestrogen is effective at controlling/killing
What is tamoxifen
a oestrogen antagonist
Side effects of tamoxifen
hot flush
weight gain
sweats
increased risk of endometrial cancer
How does tamoxifen work?
binds to ER in the cell
ER can no longer bind co factors needed for gene transcription
What is letrozole
aromatase inhibitor
What is anastrazole
aromatase inhibitor
What is exemestane
aromatase inhibitor
How do aromatase inhibitors work?
block conversion of androgens from the adrenal cortex —> oestrogen in peripheral tissues
Who do aromatase inhibitors work in?
post menopausal women
What is the treatment of choice in postmenopausal women?
Anastrazole
s/e of anasztrazole
reduced bone mineral density - therefore have bone density scan when started
When is chemo given?
Before/after surgery
- there is no optimum regime and many variations are used
What are the most effective chemo regimes?
anthracycline based ones
Who is chemo most effective in?
Premenopausal women
Node +ve patients
s/e of chemo (6)
nausea vom bone marrow supression mucositis cardiac arrhythmias/myopathy alopecia
FEC 100 regieme consits of
Flurouracil 500mg/m2
Eipirubicin 100mg/m2
Cyclophosphamide 500mg/m2
How is FEC 100 adiministerd?
IV
How often do we give FEC100
every 21 days for 6 cycles
What should you check before next FEC100 dose
FBC (neuts >1 platelets >100)
Renal funciton
LFT
cumulatibe dose of epirubucin
What do you change in FEC100 if LFTs are derranged?
reduce E and F doses
What should always be dispensed with FEC100
antiemetics
what might older patients need before chemo?
ECHO - to check the heart
What should patients be aware of before chemo (2)
- How to take antiemetic - start the day before chemo start
2. Be vigilant for signs of infection (risk of neurtopenic sepsis)
What is Capecitabine?
what is given in combo for breast cancer?
oral chemo
docetaxel
Trastuzamab is also called
Herceptin
What is trastuzamab?
MAB targetting HER2
Who benefits from trastuzumab?
patients with HER 2 expression of 3+ or higher
How does trastuzumab work?
prevents EGF binging to the HER2 receptor.
This prevents HER2 oncogene being amplified
s/e of trastuzumab? (5)
cardiotox nausea and vom diarrhoea joint/muscle pain rash
Duration of treatments
Surgery Chemo - 5 months radio - 4 weeks trastuzumab - 1 year hormonal therapy - 5 years
What is everolimus
oral Selective mTOR ihibitor
- mTOR is a key serine kinase upregulated in breast cancer
Who is everolimus licensed for
treatment of ER/PR +ve, HER2/neu -ve advanced BC
postmenopasual women
s/e of everolimus
stomatatis rash fatigue diarrhoea infections nausea decreased appetie
What is Eribulin
IV chemo agent
s/e of Eribulin
myelosupression peripheral neuropathy headache alopecia muscle and joint pain infertility
Eribulin works by…
inhibiting microtubule dynamics
before starting Eribulin….
correct low mag and sodium levels
Eribulin dose should be reduced if
low neutrophil count
