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11 Cards in this Set
- Front
- Back
Define prognostic versus predictive
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Prognostic: Determines populations at risk of recurrence
Predictive: Determines patients who may benefit from specific types of systemic therapy (which tx will work best) |
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8 tumor characteristics used to define disease/predict risk of recurrence
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Tumor Size
Nodal Involvement Hormone Receptor HER2 Status Histologic Grade Proliferative Rate Vascular Invasion Response to Primary Therapy |
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When staging how does one define primary tumor size?
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T0 = no evidence of primary tumor
T1 = 2cm or less T2 = >2-5cm T3 = >5cm T4 = tumor of any size with extension into the chest wall and/or skin |
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When staging how does one define nodal involvement?
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N0 = No nodal involvement
N1 = 1-3 positive lymph nodes N2 = 4-9 positive lymph nodes N3 = 10+ positive lymph nodes |
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Is the presence of hormone receptors more predictive or prognostic?
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Preditive
Patients who are estrogen AND progesterone positive have a lower recurrence rate with tamoxifen than patients who are estrogen positive and progesterone negative |
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How does HER2 status affect chance of recurrence and treatment options?
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HER2 positive cancers are more agressive and have a higher response rate
Relatively resistant to endocrine therapy alone and respond better to an aromatase inhibitor Resistant to CMF (cyclophosphamide, methotrexate, fluorouracil) Respond best to anthracycline, taxane and trastuzumab (Herceptin) |
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What's the mechanism of action of Herceptin?
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Trastauzumab targets the extracellular domain of HER2
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What type of breast cancer is not assigned a histologic grade?
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Medullary carcinomas
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3 types of breast cancers have a more favorable prognosis compared with 4 other and unknown types.
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Tubular, mucinous and medullary subtypes have a more favorable prognosis compared with ductal, lobular, mixed, metaplastic and unknown types.
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How is a histologic grade assigned?
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Grade is determined by assessing the miotic index, differentiation and pleomorphism of cells. Well differentiated cells are assigned a more favorable grade of 1 than poorly differentiated cells (3)
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What are two proliferation markers? When is it useful to assess their presence?
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Cyclins (particularly women with high concentrations of cyclin E) have reduced 5 year disease-free survival and overall survival rates.
Ki-67 may also correlate with reduced survival rates. These are not assessed routinely but may be helpful in predicting recurrence in women with borderline tumor sizes and LN negative disease. |