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