Question 1
Question
Breast Cancer Epidemiology:
- Most common form of cancer in women globally:
Leading cause of cancer [blank_start]death[blank_end] in women worldwide
Survival rates vary worldwide; >80% in North America, <[blank_start]40[blank_end]% in low income countries
- Third most common cancer in New Zealand:
600 deaths every year
[blank_start]3300[blank_end] women diagnosed each year, 25 men
[blank_start]80-92[blank_end]% 10 year survival rate
Question 2
Question
Select all the risk factors for BC.
Answer
-
Gene mutation BRCA1/2
-
Female
-
Male
-
Family history
-
Age
-
Estrogens
-
Alcohol intake
-
Post-menopausal obesity
-
Androgens
-
Smoking
Question 3
Question
Which of these is NOT a protective factor for BC?
Answer
-
Exercise
-
Early pregnancy
-
Breastfeeding
-
Mastectomy
-
Oophorectomy or ovary oblation
-
Selective estrogen receptor modulators (SERMs)
-
Aromatase inhibitors (AIs)
-
Appendectomy
Question 4
Question
Screening strategies depend on estimated risk of cancer.
Mammogram
[blank_start]Clinical[blank_end] breast exam
Breast [blank_start]self[blank_end]-exam
[blank_start]MRI[blank_end] (high risk)
Biopsy
CT-scan
Follow B.R.A.S: BREAST [blank_start]aware[blank_end], REDUCE [blank_start]risk[blank_end], ACT [blank_start]on changes[blank_end], SCREENING with mammograms [blank_start]over 40[blank_end]
Answer
-
Clinical
-
self
-
MRI
-
aware
-
risk
-
on changes
-
over 40
Question 5
Question
Clinical Presentation is variable.
Asymptomatic
Change in [blank_start]general[blank_end] appearance
New/persistent [blank_start]skin[blank_end] changes
New nipple [blank_start]inversion[blank_end]
Nipple [blank_start]discharge[blank_end]
Pain
Variable mass size, [blank_start]texture[blank_end] (nodular, thickened area)
Classically hard, immovable, single lesion irregular borders
Answer
-
general
-
skin
-
inversion
-
discharge
-
texture
Question 6
Question
Pathophysiology -
Most common histological types of [blank_start]epithelial[blank_end] breast carcinoma:
Infiltrating [blank_start]ductal[blank_end] carcinoma (70-80%)
Infiltrating [blank_start]lobular[blank_end] carcinoma (~8%)
[blank_start]Mixed[blank_end] ductal/lobular carcinoma (~7%)
Answer
-
epithelial
-
ductal
-
lobular
-
Mixed
Question 7
Question
Which of these is NOT a receptor we test for?
Answer
-
HER2
-
Progesterone (PR)
-
Estrogen (ER)
-
BRCA
-
EGFR
Question 8
Question
Choose the incorrect statement.
Answer
-
ER and PR are prognostic and predictive factors
-
25% of all cases are hormone receptor positive and so a candidate for hormone tx
-
HER2 overexpression present in 15-20% of patients and so it is a candidate for HER2 targeted therapy
Question 9
Question
Staging:
Stage 0 – Only in [blank_start]ducts and lobules[blank_end] (no spread)
Stage 1 - Only in [blank_start]breast[blank_end], no nodes
Stage 2 - Early, tumour spread to [blank_start]movable axillary[blank_end] nodes
Stage 3 - Locally advanced disease, spread to chest [blank_start]wall[blank_end], internal [blank_start]mammary[blank_end] lymph nodes
Stage 4 - Advanced or metastatic disease present at [blank_start]distant[blank_end] sites such as bone, liver, lungs, brain
Answer
-
ducts and lobules
-
breast
-
movable axillary
-
wall
-
mammary
-
distant
Question 10
Question
Treatment:
1. Surgery - Breast-conserving surgery ([blank_start]lumpectomy[blank_end]) or modified radial [blank_start]mastectomy[blank_end] (removal of entire breast with or without breast reconstruction)
2. Radiation - Mostly used in adjuvant setting, can be targeted or generalized, dose determined by [blank_start]extent[blank_end] of disease, may be used in Stage IV to palliate [blank_start]symptoms[blank_end] for metastases
3. Systemic Therapy - Adjucant: Chemotherapy, endocrine / hormonal therapy, targeted therapy. Reason for [blank_start]mortality[blank_end] reduction in developed countries.
Chemo:
- Chemo regimens [blank_start]similar[blank_end] regardless of hormonal status, but anti-HER2 therapy added on to those HER2 [blank_start]positive[blank_end]
- [blank_start]Anthracycline-based therapy with taxanes[blank_end] (if node positive) appear to have most evidence
Endocrine:
- Used to decrease risk of [blank_start]recurrence[blank_end], initiated [blank_start]after[blank_end] chemotherapy complete
Targeted Anti-HER2 Therapy:
- All are [blank_start]cardiotoxic[blank_end] – need baseline ECHO and follow up
Question 11
Question
Endocrine therapy regimens/options:
1. Pre-menopausal -
High risk? = [blank_start]LHRH agonist + exemestane 25mg[blank_end] PO daily, for 5 years
Low risk? = [blank_start]Tamoxifen 20mg[blank_end] PO daily, for 10 years
Alternative is surgical oophorectomy or medical menopause [blank_start](LHRH agonist) +/- aromatase inhibitor[blank_end]
2. Post-menopausal -
[blank_start]Aromatase Inhibitor[blank_end] (Letrozole, Anastrozole, Exemestane) OR tamoxifen ([blank_start]2nd line[blank_end])
Aromatase Inhibitors drugs of choice in metastatic disease
Question 12
Question
Which of the following is most appropriate hormonal therapy for a post-menopausal woman with ER positive breast cancer who has recently finished adjuvant chemotherapy post-total mastectomy?
Question 13
Question
Choose the incorrect statement about Trastuzumab.
Answer
-
Used in metastatic settings
-
Given as loading dose and maintenance dose (loading dose infused over 90 min to reduce infusion related reactions)
-
Given for 1 year or until disease progression or metastatic
-
Can be given with chemo / hormonal therapy but give before cycles with anthracycline are complete
Question 14
Question
Select ALL correct statements.
Answer
-
Chemo and targeted therapies are not used in Stage 0 cancer.
-
Radiation therapy is only used in Stages 0 and 1.
-
Chemotherapy is used in all stages.
-
Targeted therapy if patient is HER2+ is used in Stages 1, 2, and 3.
-
Endocrine therapy is used at all stages if patient is ER-.
Question 15
Question
Match the stage to the general Tx:
Stage 0 - [blank_start]Surgery, radiation, +/- endocrine[blank_end]
Early stage - [blank_start]Surgery, radiation, chemo,[blank_end] +/- endocrine +/- targeted
Locally advanced - [blank_start]Surgery, chemo,[blank_end] +/- endocrine +/- targeted
Metastatic - [blank_start]Chemo,[blank_end] +/- endocrine +/- targeted
Answer
-
Surgery, radiation, +/- endocrine
-
Surgery, radiation, chemo,
-
Surgery, chemo,
-
Chemo,
Question 16
Question
Rachel is a 42 year old pre-menopausal woman attending a breast cancer screening session. Her mother died of breast cancer at age 64. She eats a healthy diet, surfs at least twice weekly, does not smoke, and drinks approximately 3 glasses of wine per week. She works at Dunedin Hospital in the radiotherapy department but adheres to all safety precautions regarding radiation exposure. She has no history of any breast abnormalities.
Identify her risk factors:
- Female, estrogen, [blank_start]age, alcohol intake, family history[blank_end]
Identify two sctreening options for her:
- [blank_start]Mammogram, clinical breast exam[blank_end]
Answer
-
age, alcohol intake, family history
-
exercise, non-smoker
-
Mammogram, clinical breast exam
-
MRI, breast self-exam
-
Biopsy, mammogram
Question 17
Question
Linda is a 63 year old post-menopausal woman presenting with early stage (stage 2) breast cancer to the left breast. She is ER and HER2 receptor positive. Which of the following is LEAST likely to be recommended for Linda?
Answer
-
Surgery
-
Adjuvant chemotherapy
-
Radiation
-
Targeted therapy