Term
| What are risk factors for breast cancer? |
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Definition
- Gender - female
- Age - older
- Hormones - early period or late menopause. Use of HRT
- Genetics - p53, HER2, BRCA1/2
- ALCOHOL INCREASES RISK |
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Term
| What tools assess risk of breast cancer? |
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Definition
- Gail model
- Claus model
- BRCAPRO |
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Term
| How is screening for breast cancer completed? |
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Definition
- Exams - self exam once a month, clinical starting at age 20 every 1-3 years
- Mammogram - 40+ once yearly
- Breast MRI - high risk patients |
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Term
| How can breast cancer be prevented? |
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Definition
- Tamoxifen - ER+, increases endometrial cancers and VTE
- Raloxifene - only in post menopausal women. Less risk of VTE
- Mastectomy |
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Term
| What are types of non-invasive breast cancer? |
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Definition
- Ductal carcinoma in situ (DCIS) -15-50% progress to invasive, stays unilateral
- Lobular carcinoma in situ (LCIS) - rarely progresses, can affect both breasts
**basement membrane is still intact |
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Term
| What are types of invasive breast cancer? |
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Definition
- Invasive ductal carcinoma (IDC)- most common, worse prognosis. Metastasis to liver, lung, bone
- Invasive lobular carcinoma (ILC) - harder to detect, metastasis to retroperitoneal |
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Term
| How does breast cancer present? |
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Definition
- Most common: painless mass
- palpable lymph nodes
- High CEA indicates disease |
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Term
| What receptors are on breast cancer cells? |
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Definition
- Estrogen receptor
- Progesterone receptor
- HER2 receptor - must be + to benefit from HER2 therapy |
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Term
| What is staging for breast cancer? |
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Definition
| TNM:based on tumor size, nodal progression, and metastasis |
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Term
| What determines breast cancer prognosis? |
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Definition
- Tumor size
- Nodal involvement
- Young women, african americans have more aggressive disease |
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Term
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Definition
Unique to breast cancer:
- Low < 18: low risk of recurrance w/ solo endocrine therapy. Avoid adjuvant chemo
- Intermediate 18-30 - personal decision
- High > 31 - high risk of recurrence despite endocrine, adjuvant chemo needed |
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Term
| What is a sentinel lymph node biopsy? |
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Definition
| Dye injected near tumor, 1st lymph node to take up dye is removed |
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Term
| How is LCIS and DCIS treated? |
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Definition
- LCIS - observation alone.
- DCIS - Surgery with or without radiation. Tamoxifen only in lumpectomy patients for ER+ tumors |
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Term
| What is the treatment for Early stage (I,II) breast cancer? |
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Definition
- Surgery with or without radiation
- T = 0.6- 1 cm - Adjuvant endocrine + chemo, HER2+ add trastuzumab
- T = >1 - Endocrine + chemo + trastuzumab
**ER1 - do not use endocrine therapy |
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Term
| When is endocrine therapy warrented in breast cancer? |
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Definition
In hormone receptor (+) tumors:
- Tamoxifen - SERM, gold standard
- Aromatase inhibitor: post menopausal only. Anastrazole, letrozole, Exemestane. FOR 5 YEARS
**Do not give concurrently w/ chemo |
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Term
| What are the cornerstones of breast cancer chemotherapy? |
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Definition
Anthracyclines and taxanes within 12 weeks of surgery
- HER2(-) - dose dense doxorubicin + cyclophosphamide --> paclitaxel
- HER2(+) - Paclitaxel + cyclophosphamide + trastuzumab |
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Term
| What therapy should be given to HER2+ breast cancers? |
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Definition
| Trastuzumab/Herceptin - for all HER2+ over 1 cm |
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Term
| What is a therapy for metastatic breast cancer in post menopausal women? |
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Definition
| Exemestane + Everolimus - mTOR inhibitor |
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Term
| What is 1st line therapy for metastatic Her2+ breast cancer? |
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Definition
| Pertuzumab + Trastuzumab + Paclitaxel |
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Term
| What are the side effects of endocrine therapy in breast cancer? |
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Definition
Hot flashes and fatigue: tx = Effexor ER 75 qd
AI: myalgias and arthralgias. Give vit D and calcium supplements |
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Term
| What are side effects of anthracyclines used in breast cancer? |
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Definition
Cardiotoxicity - Dexrazoxane decr toxicity.
Alopecia
N/V |
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Term
| When can eribulin be used for breast cancer? |
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Definition
Failure of 2 chemo regimens for metastatic disease
**Ixabepilone: for tx failure |
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Term
| What biologics can be used for breast cancer? |
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Definition
- Trastuzumab - for HER2+. Infusion rxns and cardiotoxic
- Pertuzumab - prevents dimerization
- Ado-trastuzumab - HER2 + microtubule
- Lapatinib - kinase inhibitor of EGFR and HER2 |
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