BreastCancer
Terms
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- what are the RF of breast cancer
-
increasing age >60
genetic especially when <45 there is a 1.5-3 x increase
alterations BRCA
HER2neu
hormonal no preg, late menopause, early menarche, physical inactivity, obesity, alcohol - what makes a better chance of not contracting breast cancer
- late period, early menopause
- how is alcohol a RF for breast cancer
- it increases estrogen from increased folic acid
- how do you screen for breast cancer
-
self every month after year 20 right after period
clinically q 3 yrs 20-39 and q year anually 40+ yrs
mammogram anually 40+ - how can you prevent breast cancer
-
surgery in high risk if benefits>risks
- tamoxifin - what are types of invasive breast cancer
-
ductal
lobular
inflammatory breast - how can you tell if it is ductal invasive cancer
- prominent unilateral lump
- how can you tell it it is lobular invasive breast cancer
- thickening of breast
- how can you tell if it is inflamm breast cancer
- skin edema, redness, warmth
- what the types of non-invasive breast cancer
-
ductal carcinoma insitu
and lobular carcinoma in situ - how can you tell it is non-invasive ductal carcinoma in situ
- small non-palpable lesions
- how can you tell it is non-invasive lobular corcinoma in situ
- non-gross abnormality
- how do you determine tumor size
- 1 is <2cm, 2 is >2 cm <5cm, T3 is >5 cm
- how do you determine number of luymph nodes
- N1 - 1-3 axiallary, N2 - 4-9 axiallary or mammery, N3 - >10 axiallary, intraclavivular, supraclavicular
- what stage is metastasis
- stage 4
- what is the stage for carcinoma in situ
- stage 0
- what are the biomarkers and what do they say about the cancer
- ER/PR +, means less aggressive
- what does HER2/neu positive mean
- more aggressive
- what do you treat with HER2/neu positive
- trastuzumab
- what is the treatment of stage 0,1,2,
- goal is to cure with surgery, taxanes, anthracyclines, cyclo, methotrexate, or FU (best is doxo +cyclo)
- what is the superior treatment fo stage 0,1,2
- AC for 4 cycles followed by paclitaxel 4 cycles
- what is the treatment for ER/PR+ stage 0,1,2
- tamoxifen
- what are aromatase inh used for
- ER/PR+
- what is the treatment for stage 3
- neoadjuvant chemo
- what is the treatment for stage 4 ER/PR+
- aromatase inh
- what are the ADR of trastuzumab
- Black box- hypersens, cardiomyopathy
- what is the MOA of trastuzumab
- humanized monoclonal antibody to HER2neu receptor protein
- what is the dose of trastuzumab
-
4mg/kg IV over 90 min on Day 1
and 2mg/kg over 30 min q week - what is the treatement for pre-menopausal woman
- LHRH plus tamoxifen
- what is the MOA of tamoxifen
- competitively block estrogen receptor, estrogen agonist at bone, lipids, and endometrium; estrogen antagonists at breast and vaginal mucosa
- what is the dose of Tamoxifen
- 20 mg daily
- what are the ADR of tamoxifen
- hot flashes, fluid ret, thrombotic events, endometrial cancer
- what is the MOA of aromatase inhibitors
- inhibit or inactivate aromatase - suppress plasma estrogen levels
- dose for anastrazole, letrozole, exemestane
- 1mg, 2.5mg, 25mg po
- ADR of aromatase inh
- asthenia, athralgias, hot flashes, long-term osteoporosis