7: Breast oncology and palliative care Flashcards

1
Q

What are the treatment options for breast cancer in oncology?

A

Radiotherapy

Chemotherapy

Hormonal therapies e.g tamoxifen, aromatase inhibitors, GnRH agonist

Herceptin

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2
Q

What is offered to breast cancer patients who are not suitable for curative treatment?

A

Palliative care

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3
Q

What is meant by

a) adjuvant
b) neo-adjuvant treatment?

A

a) Adjuvant treatments are given alongside curative treatments i.e surgery

b) Neo-adjuvant treatments are given BEFORE curative treatments

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4
Q

Is radiotherapy a neo-adjuvant treatment for breast cancer?

A

No

Adjuvant - given ALONGSIDE or AFTER curative surgery

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5
Q

What therapies are given as neo-adjuvants in breast cancer?

A

Chemotherapy

Hormonal therapies

(Herceptin for HER2 positive cancers)

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6
Q

Why are neo-adjuvant therapies given before breast cancer surgery?

A

To reduce the size of the tumour

To improve cosmesis

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7
Q

What is adjuvant therapy?

A

Treatments given AFTER curative breast surgery

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8
Q

What is the most commonly given adjuvant therapy for breast cancer?

A

Radiotherapy

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9
Q

What are four adjuvant therapies given for breast cancer?

A

Radiotherapy

Chemotherapy

Hormonal therapy (tamoxifen, aromatase inhibitors)

Herceptin

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10
Q

Tamoxifen (an oestrogen receptor blocker) increases a patient’s chances of developing which cancer?

A

Endometrial cancer

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11
Q

What pathological features increase the risk of a cancer relapsing?

A

Lymph node invasion

High grade (i.e how well differentiated it is)

High stage (i.e size, local invasion)

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12
Q

What specific chemotherapy drugs are used in breast cancer?

A

Anthracycline

Taxanes

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13
Q

What are some side effects of chemotherapy?

A

Hair loss

Fatigue

Nausea and vomiting

Susceptibility to infection

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14
Q

Which receptor does herceptin act on?

A

HER2 receptor

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15
Q

Out of every 100 people treated with herceptin, how many more survive?

A

3 out of 100

so an absolute benefit of 3%

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16
Q

How are breast cancer patients followed up surgically?

A

Surgical review one year following procedure

Then breast screening every 3 years

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17
Q

What are some palliative treatments for breast cancer?

A

Radio/chemo/hormonal therapy

Bisphosphonates

18
Q

Why are bisphosphonates given to some palliative breast cancer patients?

A

1. Drugs affecting oestrogen metabolism e.g tamoxifen can cause osteoporosis

2. Bone destruction in metastatic disease

bisphosphonates reduce bone turnover

19
Q

The beneficial effects of chemotherapy must be weighed up against the ___ of the patient.

A

QOL

quality of life

20
Q

Trastuzumab (Herceptin) is effective for which type of breast cancer?

A

HER2+ cancers

21
Q

Transtuzumab can be combined with what to increase its effectiveness?

A

Chemotherapy

22
Q

What are the three factors influencing the chance of breast cancer recurrence?

A

Local invasion (stage)

Degree of differentiation (grade)

Lymph node involvement

23
Q

What are the chances that a low grade tumour will spread to the bones?

A

Little to none

24
Q

Which imaging modalities are used to check the bones of patients complaining of bony pain?

A

Bone scan

MRI/CT scan

25
Q

What is a sinister complaint of patients with breast cancer?

A

Bony pain

26
Q

What is an important immunological side effect of chemotherapy?

A

Neutropenia

27
Q

Neutropenia caused by chemotherapy can cause which complication?

A

Infection

so admit if patient on chemo has a fever

28
Q

What is a common side effect of tamoxifen and aromatase inhibitors in women with breast cancer?

Why?

A

Menopausal symptoms e.g hot flushes, pain on intercourse, vaginal dryness

Reduces oestrogen effects by blocking receptors

29
Q

Which type of contaception contains oestrogen?

A

IUS (i.e Merina coil)

there’s more

30
Q

Why are Merina coils contraindicated in breast cancer?

What’s the problem with this?

A

Release oestrogen, theoretically increasing the growth of ER positive cancers

Not all breast cancers are ER positive

31
Q

What is a tumour marker for breast cancer?

A

CA125

32
Q

CA125 is for ___, not ___ of breast cancer.

A

monitoring, not diagnosis

33
Q

A breast cancer patient complains of a sore jaw.

Which type of drug can cause this?

A

Bisphosphonates

Jaw osteonecrosis

34
Q

Fat necrosis is an inflammatory response caused by breast trauma.

What are some traumas which can cause it?

A

Seatbelt injuries

Dogs jumping up on women (really)

Reconstructive surgery (uncommon cause of breast lump immediately following surgery)

35
Q

What is an urgent neurological complication of bony metastasis?

A

Spinal cord compression

36
Q

Which class of drug influences the circulating levels of tamoxifen?

A

Antidepressants

37
Q

common metastasis sites: bones, lungs, liver, brain

HER2 positive cancers PREFERENTIALLY go for the brain

A
38
Q

Where does lobular breast cancer preferentially spread to?

A

Peritoneum

Causing GI symptoms e.g obstruction

39
Q

What are lifestyle factors which increase your risk of developing breast cancer?

A

Obesity

Lack of physical activity

Excessive alcohol consumption

40
Q

Which organs do

a) HER2+ breast cancers
b) lobular breast cancers

commonly invade?

A

a) Brain

b) GI organs