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New notes

Note: my facilitator randomly started 30 mins early, so I missed a lot of this. Fill in whatever is missing.

  • Aims
    • To explore issues in the management of early breast cancer as an example of a curable malignancy.
  • Key concepts
    • Cancer presents in various ways.
    • Cancer needs to be diagnosed and the spread of cancer needs to be assessed.
    • Cancer treatments may include surgery, radiotherapy, chemotherapy or hormone treatment.
    • Many cancers can be cured.
  • Exercise 1: Breast cancer, lumpectomy, mastectomy and radiation
  • Group 1
    • Define early breast cancer. What are the definitions of locally advanced cancer and metastatic cancer?
  • Group 2
    • Discuss some of the evidence showing that lumpectomy and radiotherapy has the same outcome as mastectomy. (Resource - clinical trial paper with editorial.) What patients/tumours are not suitable for lumpectomy?
  • Exercise 2: Hormone receptors, chemotherapy, radiotherapy and outcomes

Group 1

  • Describe the role of oestrogen and progesterone receptors in breast cancer and how this influences treatment choices. Discuss the role of assessment of menopausal status in women with breast cancer.
    • In the breast, uterus, liver, bone
    • Estrogen binds to the receptor which causes estrogen response elements and coactivators to bind to the DNA and thus cause transcription, and then translation
      • This causes breast cells to proliferate
    • In cancer, increased cell division leads to increased gene mutation
      • Treatment – antiestrogens, SERMs (selective estrogen receptor modulators) and thus prevent proliferation of the cancer cells
    • Influences on treatment choices
      • Want to deprive cancer cells of hormones to reduce growth
      • Some cancers lack receptors
    • Hormone therapy
      • Eg: aromatase inhibitors
        • Leads to a reduced level of systemic estrogen in post-menopausal women
      • Eg: SERMS – block estrogen receptors
      • ERDs (estrogen receptor downregulation) – destroy receptors
    • Ovarian shut down preventing estrogen production

Group 2

  • What is chemotherapy? Why is it given - what is the aim? What are some of the common side effects?
    • Use of drugs to kill/slow cancer cell growth
    • IV, orally, tablets, skin cream, intramuscularly, straight into the tumour
    • Side effects:
      • Attack rapidly multiplying cells, hair, blood, digestive tract
      • Thus results in hairloss, mouth ulcers, reduced WBCs, RBCs, platelets
      • Bowel affected → diarrhoea, constipation
      • Fatigue, nausea, vomiting, itchyness, light sensitivity
    • Uses
      • Complete cure
      • Combination with surgery
      • Adjuvant – before/after treatments
        • To make tumours small and vulnerable and to prevent recurrence
      • Palliative – relieve symptoms and prolong life

Group 3

  • What is radiotherapy? Why is it given - what is the aim? What are some of the common side effects?
    • Treatment using radioisotopes to damage cancer cells
    • Used predominantly to reduce recurrence – often used after an lumpectomy/mastectomy
    • Side effects:
      • Damage to epithelial surfaces including the lining of the mouth/throat causing ulceration (skin changes)
      • Swelling – brain tumours, intracranial pressure
      • Infertility
      • Fibrosis (including lung), less elastic, scarring, hair loss, fatigue, other cancer
      • Vomiting, nausea, hairloss
      • Anaemia?
      • Lymphoedema

More side effects:

  • fatigue
    • caused by body using energy to repair damage done by radiotherapy, as well as substances produced directly by the tumour or as a host response
    • can also be caused by other treatments e.g. surgery/chemo, or other diseases also present (e.g. renal failure)
    • worse in treatment for brain tumours
    • can continue months after treatment has finished
  • nausea/vomiting
    • worse in those with treatment near the stomach
    • occurs after treatment (2-6 hours, lasts 2)
  • weight loss/anorexia
  • skin conditions
    • depends on skin e.g. pale skin becomes red and sore, dark skin feels itchy
  • hair loss
    • occurs only on treatment area - where radiation enters or leaves body
    • falls out after 2-3 weeks, grows back after treatment ends
  • anaemia/changes to blood
    • occurs when radiotherapy affects bone marrow
    • can contribute to fatigue
  • possible long term effects
    • long term counterparts to short term effects e.g. permanent hair loss/different colour or texture, changes to skin
    • infertility if ovaries/testes are in treatment area, narrowing of the vagina
    • lymphedema (swelling in a limb or on the body) if therapy damages lymph nodes → affected fluid drainage
    • dyspnoea – if therapy affects lungs
    • difficulty swallowing (narrowing of oesophagus, or reduced saliva) production/secretion
    • shrinking of bladder (more urine passed)
    • second cancer

Group 4

  • What is the likely long term outcome for Bronwyn? Will she be cured? What is the chance of relapse and what would this mean?
    • Chance of survival is high
      • 80-90% chance to become disease free
      • Chances of relapse
    • Effects:
      • Depression, anxiety + other psychosocial issues
      • Body image issues, fear
    • Relapse
      • Stage 0 – 98%; stage 1 – 80-98%; stage 2: 50-70%; stage 3: 30-60%
      • Chance of no recurrence over 5 years
      • Relapse into the lymph nodes, breast again, other breast is the most common
  • Wrap up of menopause / breast cancer scenario

Random other stuff

  • Adjuvant = complement the other therapy, and give with the other therapy
  • Neoadjuvant = complement the other therapy, and give before the other therapy
  • Brachytherapy - stick a probe into the site to emit radiation

Soon's notes

  • Breast cancer definitions
    • Early: stages 0-3
    • Locally advanced: stages 3-4
  • Stages:
    • Stage I (T1-3, N0, M0)
      • Cancers are localised to one part of the body
    • Stage II and III (T4, N0, M0 or any T, N1-3, M0)
      • Cancers are locally advanced
    • Stage IV (any T, any N, M1-3)
      • Metastasis
  • Lumpectomy + radiation vs lumpectomy vs mastectomy
    • Similar outcomes (survival and relapse), combined better
    • Most important factors in using lumpectomy + radiotherapy are:
      • Whether radiation is dangerous – physical problems/pregnant/site
      • Size of the tumour
  • Estrogen and progesterone receptors
    • In the breast, uterus, liver, bone
    • Estrogen binds to the receptor which causes estrogen response elements and coactivators to bind to the DNA and thus cause transcription, and then translation
      • This causes breast cells to proliferate
    • In cancer, increased cell division leads to increased gene mutation
      • Treatment – antiestrogens, SERMs (selective estrogen receptor modulators) and thus prevent proliferation of the cancer cells o Influences on treatment choices
      • Want to deprive cancer cells of hormones to reduce growth
      • Some cancers lakc receptors
    • Hormone therapy
      • Eg: aromatase inhibitors
        • Leads to a reduced level of systemic estrogen in post-menopausal women
      • Eg: SERMS – block estrogen receptors
      • ERDs (estrogen receptor domnregulation) – destroy receptors
      • Ovarian shut down preventing estrogen production
  • Chemotherapy
    • Use of drugs to kill/slow cancer cell growth
    • IV, orally, tablets, skin cream, intramuscularly, straight into the tumour o Side effects:
      • Attack rapidly multiplying cells, hair, blood, digestive tract
      • Thus results in hairloss, mouth ulcers, reduced WBCs, RBCs, platelets
      • Bowel affected 􏰁 diarrhoea, constipation
      • Fatigue, nausea, vomiting, itchyness, light sensitivity
    • Uses
      • complete cure
      • combination with surgery
      • adjuvant – before/after treatments
        • to make tumours small and vulnerable and to prevent recurrence
      • palliative – relieve symptoms and prolong life
  • Radiotherapy
    • Treatment using radioisotopes to damage cancer cells
    • Used predominantly to reduce recurrence – often used after an lumpectomy/mastectomy
    • Side effects:
      • Damage to epithelial surfaces including the lining of the mouth/throat causing ulceration
      • Swelling – brain tumours, intracranial pressure
      • Infertility
      • Fibrosis, less elastic, scarring, hair loss, fatigue, other cancer
  • Long term outcomes
    • Chance of survival is high
      • 80-90% chance to become disease free
      • chances of relapse
    • effects:
      • depression, anxiety + other psychosocial issues
      • body image issues, fear
    • relapse
      • stage 0 – 98%, stage 1 – 80-98% stage 2: 50-70% stage 3: 30-60%
      • chance of no recurrence over 5 years
      • relapse into the lymph nodes, breast again, other breast is the most common