HOW do i know i have it?
painless lump ; a lump with pain is correlated with nmmore advanced disease
Stages?
Stage 1, 2, 3, 4
Stages goals
stage 1 and 2 - cure
stage 3 and 4 - palliative
They Types of Surgery
BONUS POINTS **** do they have equal efficacy
Lympectomy and Radiation
Mastectomy
Targeted therapy? Length? how long is maintenance therapy
Trastuzumab Q week for a year
Adotratuzumab
Pertuzumab
1-2 years
FH:
SH:
FH: 1st degree and 2nd degree
SH: smoking, alcohol, high fat dietm and red meat diet
what are the receptors and targets that we look at?
Estrogen receptor and progestrone receptor Her2+
Surgery
to remove the tumor
Radiation
Aromatase Inhibitors + OAS
SE and how to manage?
Anastrazole ( 1mgQD)
Letrozole (2.5 mg QD)
Exemestane
SE: Hot flashes, Osteoporosis, Hyperlipidemia, and Weight gain - SSRI and Caltrate
OAS: Leuprolide and Goserlin
HPI
HPI: age, female, and caucasian, and Ashkenazi Jews
What can tell us on the Biposy that the cancer is rapid and aggressive?
Ki67 >20
Radiation
Shrink tumor before surgery or kill cancer cell systemically
Stage 1 or 2 ( size > or equal to 5 or they have oncotype Dx (> 30)
Stage 3 and 4 everyone gets chemo
Tamoxifen : Dose, Side effects, and protective factors
Dose: 20 mg QD
Side effects: Hot flashes, edometrial /uterine cancer, VTE events, and glaucoma
Protective: Hyperlipidemia and Bones
Labs
PET / CT
MRI
Biopsy ( core needle)
What can the tumor size tell us?
> / = 1 cm can get surgery
> / = 5 cm can get chemo
Hormonal
To Prevent reoccurance
Pathway of ER/ PR and HER2 as far as treatment
TALK IT OUT LOL
immunotherapy
Permbrolizumab
Atezolizumab
Nivolumab
PMH
Early menarche: (<12)
Late menopause (>55)
Nulliparity (no children)
Late Pregnancy: (>30)
Radiation to chest
HRT therapy
The most aggressive type out of ER and PR (negative or positve)
ER - and PR -
Immunotherapy
to kill cancer cells or maintenance therapy
Chemo agents with cycles and length. EXPLAIN WHO CANNT GET ACT AND WHO GETS IT AND WHICH IS PREFERRED
AC ( Doxorubicin and cyclophosphamide) 4 cycles and get them every 2/ 3 weeks followed by Taxol 12 cycles and get them every week
TC ( Docetaxel and cyclophosphamide) 4 cycles every 3 weeks
If they have a metastatic and can they be combined with AI? Which one is FIRST line? and what are the SEs
Palcociclib
Abemaciclib - First
Ribociclib
SE: Neutropenia, and anemia
and yes they can be combined with AI