Cancer Disease States (Breast first)

Breast cancer Risk Factors

Female, advancing age, FH of breast cancer, Hx of breast conditions, BRCA1/2 mutations, longer duration of menstrual cycle (starts before 11 to ends at 55 or later), nulliparity, older age at first live birth, increased BMI, alcohol consumption, carcinogens

Breast cancer Risk reduction strategies

Healthy lifestyle and diet, limit alcohol, physical activity, menopause before 45 yo, breastfeeding for at least 1 year, prophylactic bilateral mastectomy for high risk pts, Tamoxifen, Aromatase inhibitors, regular mammograms (40-45 yo plus)

Clinical presentation of Breast cancer

No Sx, lump found on mammogram/by patient on self exam, edema, nipple discharge, dimpling, redness/warmth, palpable axillary lymph nodes

Sx of breast cancer metastasis

bone pain, dyspnea, jaundice, abd pain, mental status changes

Treatment Overview for HR pos HER2 neg breast cancer

Endocrine therapy plus Chemotherapy

Treatment Overview for HR pos HER2 pos breast cancer

Chemo plus Anti-HER2 agent plus Endocrine therapy

Treatment Overview for HR neg HER2 neg breast cancer

Chemo only

Treatment Overview for HR neg HER2 pos breast cancer

Chemo plus Anti-HER2 agent

Boxed warnings/Counseling for Doxorubicin

cardiomyopathy, extravasation, myelosuppression, secondary malignancy, red/orange urine, highly emetogenic

Counseling/Warnings for cyclophosphamide

Patient needs to drink 2-3L of fluids per day for 72 hrs, monitor for bloody urine and hemorrhagic cystitis, moderate to high emetic potential, high EP when combined with anthracyclines

Counseling/Warning for Taxanes

HSR and fluid retention (give diphenhydramine and dexamethasone prohylaxis), peripheral neuropathy, low emetic potential, myelosuppression,

Counseling/Warnings for Anti-HER2 meds (trastuzumab and pertuzumab)

cardiotoxicity, infusion reactions and pulmonary toxicity, pregnancy warning

Aromatase inhbitiors counseling

ADRs of bone loss, menopausal symptoms, myalgia

Tamoxifen Warnings/Interactions

VTE and stroke risk, uterine malignancy, interacts with CYP2D6 (don’t give with fluoxetine or paroxetine)

CDK4/6 inhibitors use and warnings in breast cancer

used for HR pos HER2 neg advanced or metastatic breast cancer or early high risk BC; warning of QT prolongation, pneumonitis, severe skin reactions

PIK3CA inhibitor warnings

Severe hyperglycemia, dermatologic reactions, GI toxicities