Repro - 2-9 - Breast Ca (Arrick)

Front 1

Risk factors

Back 1

Early life events.

AGE!!!

Fam hx (incl paternal)

Early preg is protective.

Prior biopsy with atypical hperplasia or carcinoma in situ

Front 2

Things that are NOT risk factors

Back 2

Smoking

Fibrocystic disease (note that this is not atypical hyperplasia...which is bad)

Breast size

Front 3

Best time to do a breast exam

Back 3

Day 5-7. Or the early-mid follicular phase.

Front 4

Value of a negative mammogram

Back 4

Not too much. There are often false negative.

Front 5

TNM staging (T0, Tis, T1-4)

Back 5

T0 - no evidence of tumor
Tis - Carcinoma in situ (basement membrane intact)
T1 - Greatest diam is <=2cm
T2 - 2-5
T3 - >5
T4 - Extension to chest wall of inflammatory (regardless of size)

Front 6

Neoadjuvant or upfront chemo

Back 6

This is when chemo or hormonal therapy is admin before surgical removal of the tumor.
This is done with very large tumors.

Front 7

3 categories of systemic adjuvant therapy

Back 7

Endocrine - Interfere with prod or func of estrogen in women who have CA expressing estrogen and/or progesterone receptors.
Can also use aromatase inhibitors in postmenopausal women along with tamoxifen

Chemo

Antibody therapy - Herceptin (anti-HER2) for tumors overexpressing HER2

Front 8

Tamoxifen

Back 8

Antagonist of estrogen receptor at breast and agonist at bone and endometrium.

Front 9

Prognostic factors

Back 9

Molec and histo features of the tumor that influence the ultimate outcome regardless of treatment.

So there is the same benefit or risk regardless of whether the pt receives tx or not.

Front 10

Predictive factor

Back 10

Predicts responsiveness to specific therapies.

ER or HER2 are examples.

So there is a relative benefit in terms of improved response to a specific treatment.

Front 11

HER2 with predictive and prognostic facotrs

Back 11

It is both a predictive and prognostic one.

Front 12

Late complications of local therapy

Back 12

Pain/numbness in breast/chest wall/axilla. Arm swelling/lymphedema.

Front 13

Late complications of chemo

Back 13

Premature amenorrhea with risk of osteoporosis, myelodysplasia, myeloid leukemia.

Front 14

HER2

Back 14

A tyrosine kinase receptor.

Front 15

Lobular carcinoma in situ (LCIS)

Back 15

Not a premalignant lesion - is not destined to progress to invasive lobular CA

It is just a marker for inc risk for subsequent invasive CA of either histology in either breast.

(that is why you don't have to surgically remove it)

Front 16

Ductal carcinoma in situ (DCIS)

Back 16

Is considered to undergo a malignant progression to an invasive CA.

Surg management is similar to that of invasive CA except you don't need to do axillary dissection.

Front 17

For this lec...

Back 17

there are two practice questiosn at the end of the ppt. make sure you get those answers.

Front 18

Fam hx - what is best and worst to have?

Back 18

Best - a relative who had a unilateral CA post-menopausal

Worst - bilateral and pre-menopausal.