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34 Cards in this Set
- Front
- Back
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What are 3 major risk factors for breast cancer? underlying cause?
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Early menarche (before age 12)
Late menopause (after age 55) No pregnancies / 1st pregnancy after 30 yo Uninterrupted menstrual cycles: ESTROGEN note: years of studies have tried to link smoking to breast cancer...it probably doesn't help |
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What genes can lead to a higher risk for breast cancer?
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For BRCA1, 50% risk by age 70
For BRCA2, 37% risk by age 70 |
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which is a bigger risk factor for breast cancer, a mother or sister?
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SISTER-more genes in common
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why are the self breast exam and clinical breast exam not effective in reducing morbidity/mortality?
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Once you find a nodule, the prognosis is already bad..likely mets
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American Cancer Society recommends annual mammography for all women...
What are some of the indications for earlier mammography? |
>40
Family hx of bilateral or premenopausal breast cancer (10yrs earlier than age at dx or age 25, whichever older) Hx of high dose mantle radiation (eg Hodgkins’s lymphoma); start 8 years after treatment |
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what is the risk of taking mammograms in younger females
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high rate of false positives
might biopsy something you didnt need to |
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in Pts who get a mammogram, how many will have to come back for additional views? why is this a big deal?
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10%
pts think they have breast cancer, but they really just need more views only 1% will even need biopsy only 25% of those with biopsy will have cancer |
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What is the best use for ultrasound of the breast?
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compares cystic and solid
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when you have an abnormal breast exam, what do you have to do next?
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biopsy
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What are some of the CLASSIC signs of breast cancer? There are a bunch, but try your best young padawan!
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Irregular in contour
Firm to hard consistency Not well delineated from surrounding tissue Nontender Fixation Retraction Dimpling Some or all of these may be present and their absence does not exclude cancer! |
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prognosis for ductal carcinoma in situ (DCIS)
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--earliest stage of breast cancer; confined to ducts
--nearly 100% curable |
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80% of all breast cancers are what type?
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Infiltrating (invasive) ductal carcinoma (IDC
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either a palpable mass and/or an abnormal mammogram brings the patient to
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BIOPSY
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describe Lobular Carcinoma in situ (LCIS)
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not a true cancer but increases risk
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What should be your first step when a pt says they have a lump
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get imaging first
then biopsy |
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Atypical ductal hyperplasia (ADH) has many cytologic similarities to low grade ductal carcinoma in situ...what can happen after surgical excision?
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may lead to malignant upgrade
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what is the classic way to analyze lymph nodes assoc w breast cancer?
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Axillary lymph node dissection (ALND)
basically cutting out all the nodes benefit on axillary recurrence and survival and prognostic value can have lots of side effects: lymphedema, nerve injury, shoulder dysfunciton |
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What is a sentinel lymph node biopsy?
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for pts with clinically negative lymph nodes (who still have cancer), less morbid method of staging
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If a pt has to undergo mastectomy, what is one of the best methods?
benefits/disadvantages? |
Modified Radical Mastectomy
Benefit = one surgery done as inpatient, with usual recovery period of 1 week or so. Usually no radiation is needed, although that is changing today Disadvantages = long recovery in some women. Sexual implications of loss of breast. Cosmetically less acceptable for some |
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advantage/disadvantage of Lumpectomy?
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Benefits = breast is preserved. Quicker recovery period with the more limited surgery.Cosmesis is generally good
Disadvantages = all women with this have to get radiation which is inconvenient(6 to 7 weeks daily). Radiation may be far away. |
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what difference in survival is there if a pt gets a lumpectomy vs mastectomy?
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Women live the same regardless of which surgery they get(lumpectomy or mastectomy).
DOES NOT AFFECT SURVIVAL |
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how does radiation help tx breast cancer (method)
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target cell DNA to destroy
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when is chemotherpy recommended in breast cancer?
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if there is evidence of metastisis
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Use of Tamoxifen?
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Typically administer for five years after surgery
It is not a primary/sole treatment Also has use prophylactically to prevent first and second breast cancers May use both pre- and post- menopause Serious risk of endometrial cancer, thrombotic events (do not use if h/o PE,DVT) + bone/endometrium - breast |
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which is better in prophylaxis of invasive breast cancer? Raloxifene or Tamoxifen?
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Raloxifene
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What type of drug is Arimedex (anastrazole)? use
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Prevent the production of estradiol by blocking enzyme aromatase
For post-menopausal women with estrogen receptor positive breast cancers |
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What type of drug is Aromasin (exemestane)? use?
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Prevent the production of estradiol by blocking enzyme aromatase
For post-menopausal women with estrogen receptor positive breast cancers |
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What type of drug is Femara (letrozole)? use?
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Prevent the production of estradiol by blocking enzyme aromatase
For post-menopausal women with estrogen receptor positive breast cancers |
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What kind of drug is Fadozole? use?
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Prevent the production of estradiol by blocking enzyme aromatase
For post-menopausal women with estrogen receptor positive breast cancers |
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MOA of Herceptin (trastuzumab)
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Now for early and late stage tx
Antibody targets HER2/neu protein |
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use/MOA of Avastin (bevacizumab)
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Used in tx of metastatic disease
Binds a substance required for growth of new blood vessels in tumor |
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use/MOA of Tykerb (lapatinib)
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To tx advanced cancer, usually with chemo
Disrupts HER2/neu protein and interferes with growth signal on the tumor Often used when herceptin becomes ineffective |
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After a pt has been successfully treated for breast cancer, what is important to remember?
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IT CAN COME BACK
no matter how long they have been cancer free |
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What does the Gail Model Assessment Tool do?
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gives you RISK of cancer
No h/o DCIS of LCIS Age: 42 Menarch: 12 Age at first born child: 29 Number of first degree relatives dx with breast cancer: 1 Number of breast biopsies: 1 Any biopsy reporting atypia: 0 Race: C |
