Pt 4 Breast Cancer

Front 1

Hereditary breast cancer represents ___ - ___ % of all breast cancers?

Name some genes involved

Back 1

5-10%

- BRCA1 and 2; p53, HER2

Front 2

___ - ___ fold risk if mother or sister has/had breast cancer

Back 2

1.5 - 3

Front 3

Risk Factor: Estrogen Exposure
- early age of _____
- late age of natural _____
- age at birth of first child > ___

Back 3

- menarche (<12)
- menopause
- 30

Front 4

True or False:
The Gail model is an effective assessment tool for all women with limited family Hx to assist with decisions regarding cancer prevention?

Back 4

False, only useful for caucasian women

Front 5

Ductal Carcinoma in situ (DCIS): is this malignant?

Lobular carcinoma in situ (LCIS): is this malignant?

Back 5

- No, its premalignant is is usually cureable with resection alone

- Yes, risk factor for breast cancer

Front 6

Invasive lobular carcinoma (ILC): ___ most common type of breast cancer and is (MORE/LESS?) likely to metastasize to serosal surfaces?

Invasive ductal carcinoma (IDC): ___ common type of breast cancer and is the (Best/Worst) prognosis

Back 6

- 2nd most common (15%); more

- Most (70%); worst

Front 7

True or False: self breast examination is a clinically proven method of detecting breast cancers?

Back 7

- False

Front 8

Clinical Breast Exam should be performed at least every ___ years for women aged ___- ___ and annualy for women > ____ (according to ACS)

Back 8

q 3 years for 20-39; q yearly for over 40

Front 9

Mammography: there is proven evidence that screening reduces mortality in women > ___

Breast MRI: appropriate as ____ to mammography

Back 9

age 50; 40-49 is still under investigation

- adjunct
(if BRCA mutation carrier, FDR of BRCA, lifetime risk of 20-25%)

Front 10

In clinical trials (STAR2) comparing tamoxifene and raloxefine, which showed more adverse events?

Back 10

Tamoxifene:
- more endometrial hyperplasia and cataracts; more endometrial cancers; more PE/DVT, MI

Front 11

What might be one of the first symptoms a woman would experience?

What are some less common sx?

Back 11

Stabbing or aching pain (10%)

- nipple discharge, retraction, dimpling

Front 12

True or false: a fine needle aspiration (FNA) can distinguish between invasive and noninvasive cancer?

True or false: core-needle biopsy can distinguish between invasive and non-invasive cancer?

Back 12

- false

- true

Front 13

True or false: a PET/CT scan is recommended for diagnosis for stage I-III breast cancer?

Back 13

false

Front 14

- primary resistance to systemic therapy is a _____ prognostic indicator?

- Estrogen Receptor + tumors are generally MORE/LESS aggressive than ER - tumors?

- Progesterone receptor + tumors are generally MORE/LESS aggressive than PR -?

Back 14

- VERY POOR

- less

- less

Front 15

____ amplification indicates more aggressive tumors in both node + and -

Back 15

- HER2

Front 16

Oncotype Dx
- screens expression of ___ genes
- validated with ____ and ___ (drugs)

- used for?

Back 16

- 21 genes

- tamoxifen and anastrazole

- used to determine risk of recurrence or death in women with HR+, HER2 normal, node-negative and invasive breast cancer

Front 17

Mammaprint
- screens for ____ genes resulting in good or poor prognostic

- more or less reliable than other standard systems?

Back 17

- 70 genes

- more reliable

Front 18

Most common sites of metastases?

Back 18

Bone
Liver
Lung
Brain
Distant lymph nodes/skin

Front 19

NCCN Guidelines recommend (TAMOXIFEN/RALOXIFINE?) for pre-menopausal women and (TAMOXIFEN/RALOXIFINE?) for post-menopausal women?

Back 19

pre-menopausal - tamoxifen

post- menopausal- either one

Front 20

True or false: if a patient elects to have bilateral mastectomies, the patient should still be treated with tamoxifen/raloxifene for risk reduction?

Back 20

- false, no breast tissue remaining to protect.

Front 21

NCNN Guidelines for DCIS (ductal carcinoma in situ)

1. Local Management
2. SERM
3. Other drug type

Back 21

1. lumpectomy w/o lymph node surgery + radiation, OR,
- total mastectomy
- lumpectomy

2. Tamxoifen
- for pts following breast conservation surgery (BCS)
- consider for 5 years for: BCS + XRT or excision alone

3. Aromatase inhibitors being compared to tamoxifen

Front 22

For stage I, IIA, IIB invasive breast cancers, the goals of therapy are to _____

Back 22

Cure

Front 23

Choice of Adjuvant Systemic Therapy: Endocrine therapy

_____ for pre and post-menopausal women. ____mg daily for ____ years reduces odds of recurrence by ____%

Back 23

- Tamoxifen
- 20 mg
- 5 years
- 40%

Front 24

True or False: tamoxifen is the preferred adjuvant therapy compared to aromatase inhibitors

Back 24

FALSE!

Front 25

Name some Risks associated with anthracycline regimens

Back 25

-cardiotoxicity
- mucosistis/diarrhea
- leukemia
- amenorrhea (cyclophosphamide)
- myelosupppression

Front 26

Name some risks associated with taxane regimens

Back 26

- myelosuppression
- hypersensitivity
- peripheral neuropathy
- myalgias/arthralgias
- fluid retention
- skin/nail changes
- total body alopecia

Front 27

Operable stage of breast cancer is the combo of what number and letters?

IC
IIA
IIIB
IIIA

Back 27

IIIA (T3, N1, M0)

Front 28

Bevacizumab:

- studied in combo with ____
- First line for ____ or ____ breast cancer
- no ____ or ____ allowed

Back 28

- capecitabine and docetaxel
- locally recurrent or metastatic
- CNS mets or anticoagulation

Front 29

Lapatinib

MOA: dual ____ inhibitor (hits what 2 receptors?)

- may cross ____ and have activity against ___ mets

Back 29

- tyrosine kinase (HER2 and EGFR)

- may cross BBB and have activity against brain mets