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88 Cards in this Set

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What is the number 1 risk factor for the development of BC?
Age > 50yrs
What are 4 major risk factors for BC?
Age, Endocrine factors, Genetics, Environmental factors
What are some endocrine factors that predispose WOMEN to BC?
Menarche <12yo, Late menopause, 1st Prego @ >30yo, Nullparity, HRT (Progestins), possibly OC's
What genetic factors predispose women to BC?
Family history of BRCA1/BRCA2 gene.. also associated with ovarian cancer.
What dietary factors may contribute to development of BC?
High fat intake, alcohol consumption
What lifestyle factor may contribute to the development of BC?
Obesity
When should self-breast exams be done and started?
Age 20, monthly. Or let Curt do it (if you're hot...)
When should CBE (clinicial breast exams) start being done and how often?
At age 40 then q 1-2 years until age of 50, then q 1 year
For high risk patients, when should mammograms be started?
Starting 5 years of age before youngest affeced relative's diagnosis age.
What is the clinical presentation of BC?
ASx, painless lump (solitary, unilateral, solid, hard, irregular/nonmobile), stabbing/aching pain, nipple discharge retraction or dimpling, skin edema, redness, warmth, induration of underlying tissue.
What would characterize advanced metastatic BC?
Bone pain, dyspnea, abdominal enlargement, jaundice, mental status changes, NV
How is BC staged?
Based on that TMN thing...
Age <35, poor or good prognosis?
Poor
HR- poor or good prognosis?
Poor
Black person: poor or good prognosis?
Poor
Tumor > 2cm poor or good prognosis?
poor
Positive nodes, poor or good prognosis?
poor
High s-phase fraction: poor or good prognosis?
Poor
Aneuploid: poor or good prognosis?
Poor
Her2/neu overexpression: poor or good prognosis?
Poor
Age > 70: poor or good prognosis?
Good
HR+ : poor or good prognosis?
Good
Tumor <2cm: poor or good prognosis?
Good
No nodal involvement: poor or good prognosis?
Good
Low s-phase fraction: poor or good prognosis?
Good
Diploid: poor or good prognosis?
Good
Her2/neu negative: poor or good prognosis?
Good
Her2/neu oncogene positive typically indicates (Aggressive/non-aggressive)?
Aggressive
Describe Infiltrating Ductal BC
Invasive, most common, spreads to axillary nodes, poor prognosis, metastasize to bone, liver, lungs and CNS
Which is the most common type of BC?
Infiltrating ductal
Which type of BC has a 50% chance of opposite breast involvment?
Lobular carcinoma in situ (LCIS)... patients may consider bilateral mastectomy.
Can BC be cured?
Yes, if caught early enough.
Which surgery results in breast conservation?
Lumpectomy
Which surgery has the highest morbidity?
Radical mastectomy
When CAN adjuvant radiation be used?
In all stages.
For which grade of BC is radiation always warranted?
Locally advanced
Purpose of Adjuvant radiation therapy with BC?
Minimize local recurrence.
Why would radiation therapy be used for metastatic BC?
Typically for Sx management (i.e. bone mets, CNS disease and spinal cord lesions)
Chronologically, when is Hormone therapy done vs. chemotherapy?
Afterwards
When should hormonal therapy be used always?
ER/PR+ patients
Gold standard of endocrine therapy
Tamoxifen
Tamoxifen/Nolvadex MOA in breast tissue
Antiestrogen (SERM, selective estrogen receptor modulator)
Non-carcinoma related positive effects of Tamoxifen
Beneficial lipid/bone density effects
MOA of Tamoxifen toxicity
Acts as an estrogen agonist in non-breast tissues
ADR's associated with Tamoxifen
Hot flashes, NV, edema, thrombembolism, endometrial cancer
Goserelin CLASS
LH/RH agonist
Leuprolide CLASS
LH/RH agonist
What do LHRH agonists do?
Induce menopause (ovarian oblation)
LHRH agonists can only be used in ____-menopausal women.
PRE
LHRH Agonist ADR
Amenorrhea, hot flashes, nausea
Anastrozole/Arimidex Class
Aromatase inhibitor
Letrozole/Femara CLASS
Aromtase inhibitor
Exemestane/Aromasin CLASS
Aromatase inhibitor
Do Aromatase inhibitors inhibit this enzyme in the ovary?
No, thus cannot be used in premenopausal women (no point)
Aromatase inhibitors can only be used in ____-menopausal women
POST
Compare the efficacy of Aromatase inhibitors in post-menopausal women vs. tamoxifen
Shown to be more efficacious
Describe the benefit of using Tamoxifen and Aromatase inhibitors concurrently.
There is no advantage.
Aromatase inhibitor ADR
Lethargy, rash, postural dizziness, nystagmus, nausea
Describe Adjuvant Tx for Breast cancer in the following case:
PreMen ER/PR+ Node-
LHRH+Tamoxifen or LHRH or TMX alone or after chemo
Describe Adjuvant Tx for Breast cancer in the following case:
PreMen ER/PR- Node-
No hormonal, Chemotherapy only
Describe Adjuvant Tx for Breast cancer in the following case:
PostMen ER/RP+ Node-
TMX or TMX after chemo
Describe Adjuvant Tx for Breast cancer in the following case:
PostMen ER/PR- Node-
No hormonal, Chemotherapy a must
Describe Adjuvant Tx for Breast cancer in the following case:
PreMEN ER/PR+ Node+
Tamoxifen +/- LHRH +/- Chemo
Describe Adjuvant Tx for Breast cancer in the following case:
PreMEN ER/PR- Node+
No hormonal, Chemo a must
Describe Adjuvant Tx for Breast cancer in the following case:
PostMEN ER/PR+ Node+
Tamoxifen +/- Chemo
Describe Adjuvant Tx for Breast cancer in the following case:
PostMEN ER/PR- Node+
No hormonal, chemo a must
Gold standard of BC Chemo Regimen
Taxane + Anthracycline
Indication for Neoadjuvant chemotherapy
Locally advanced breast cancer
Advantages of Neoadjuvant chemotherapy
Early initiation of chemo, intact vasculature, in vivo assessment of response, study of biologic effects
Disadvantages of Neoadjuvant chemotherapy
Loss of pathologic prognostic factors
What do you do with ER/PR+ patientts with unresectable tumors that cannot receive chemo?
Hormonal therapy
What are the most active agents against BC?
Anthracyclines
Indication for Anthracyclines regarding Node status
Node+ or Node- use
Patients with HER2/neu may benefit especially from which CHEMOtherapy?
Anthracyclines
Taxanes should be used (sequentially or concurrently) with anthracyclines?
Concurrently
How would decreasing the time between treatment cycles affect dose density?
It would increase
What are the units of dose intensity?
mg/M2/week
How does concurrent therapy affect side effect profile?
Worsens it
Hypersensitivity reactions would be attributed to ____________
Taxane (Paclitaxel)
DVT's could be attributed to _______________.
Tamoxifen
Cardiomyopathy could be attributed to __________________.
Doxurubicin (Anthracyclines)
Immunohistochemistry wise, what requirement exists for the use of Trastuzumab/Herceptin?
Must be 3+
What can herceptin NOT be used with Chemo wise?
Anthracyclines, due to cardiotoxicity
Is concurrent therapy with paclitaxel and Trastuzumab ok?
Yes, actually much more efficacious
How does Bevacizumab/Avastin work?
Binds to VEGF that prevents angiogensis
BEvacizumab/Avastin ADR
Thrombosis, hypertension
If recurrence occurs within one year, what do you do?
Pick agents that work differently.
Patient is prescribed Paclitaxel, what do you add the order?
Benadryl, APAP and Dex