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3rd Year - Reproductive Diseases > 15.4. Breasts - Treatment > Flashcards

15.4. Breasts - Treatment Flashcards

1
Q

Who is involved in the Treatment of Breast Cancer?

A

Multidisciplinary Team:

  1. Breast / Reconstructive Surgeon
  2. Radiologist / Cytologist / Pathologist
  3. Clinical / Medical Oncologists
  4. Psychologist
  5. Nurse Counselor / Palliative Care
  6. Patient and Partnet
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2
Q

What are the forms of Breast Cancer?

A
  1. “In Situ Carcinoma” - Ductal (DCIS) / Lobular (LCIS)
  2. Ductal
  3. Lobular
  4. Tubular
  5. Cribriform
  6. Medullary
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3
Q

What are the 5 principles of Management of a Patient with Breast Cancer?

A
  1. Establish the Diagnosis
  2. Assess the Severity - Staging
  3. Treat the Underlying Cause
  4. General Measures
  5. Specific Measures
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4
Q

How is the Diagnosis of Breast Cancer Established?

A
  1. History / Clinical Examination
  2. Mammography / Ultrasonography / Magnetic Resonance Mammography
  3. (FNA) Cytology / Core Biopsy +/- Image Guided
  4. Open (Surgical) Biopsy - Rare
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5
Q

What are the Risk Factors of Breast Cancer?

A
  1. Age
  2. Geographical Variation
  3. Age at Mecarche / Menopause / 1st Pregnancy
  4. Family History
  5. Past Benign Breast Disease / Cancer in other Breast
  6. Radiation / Lifestyle / OCP / HRT
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6
Q

What are the Signs / Symptoms of Breast Cancer?

A
  1. Lump / Thickening in Breast - Often Painless
  2. Discharge / Bleedomg
  3. Change in Size / Contours of Breast
  4. Change in Colour / Appearance of Areola
  5. Redness / Pitting of Skin over the Breast
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7
Q

What tests are available for Breast Cancer?

A
  1. Clinical Examination - 88% Sensitive
  2. Mammography - 93% Sensitive
  3. Ultrasound - 88% Sensitive
  4. FNA Cytology - 94% Sensitive
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8
Q

How is the Severity Assessed?

A
  1. Bloods - Hb / FBC / U&E’s / LFT’s
  2. Chest X-Ray
  3. Isotope Bone Scan
  4. Others as Clinically Indicated - No reliable Tumour Markers
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9
Q

How is Breast Cancer Staged?

A 
Tumour: 
T1 - 2cm
T2 - 2-5cm
T3 - >5cm
T4 - Fixed to Skin / Muscle
Nodes: N0 - None / N1 - Nodes in Axilla
Metastases: M0 - None / M1 Metastases
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10
Q

What Specific Measures can be done in Breast Cancer?

A
  1. Primary Breast Cancer - Local Control / Eradicate Disease
  2. Regional Tumour-Draining Nodes - Regional Control / Staging / Eradicate Disease
  3. Micro-Metastases - Eradicate Disease
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11
Q

What are the 2 main types of Surgical Procedure of the Breast?

A
  1. Breast Conservation - Wide Local Excision / Quadrantectomy or Segmentectomy
  2. Mastecomy
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12
Q

Who is Suitable for Breast Conservation Surgery?

A 
1. Tumour Size < 4cm
2/ Breast / Tumour Size Ratio
3. Suitable for Radiotherapy
4. Single (Not Multiple) Tumours
5. Minimal "In Situ" Cancer Component Presnt
6. Patient's Wish - Most Important
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13
Q

What is done when Breast Cancer has a N1 stage?

A
  1. “Regional” Control of the Disease
  2. Staging Prognostic Information
  3. Eradicate the Disease
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14
Q

What are the 3 Surgical Levels of the Axilla Anatomy?

A

Level 1 - Below and Lateral to the Pectoralis Minor
Level 2 - Behind the Pectorials Minor
Level 3 - Above and Medial to the Pectoralis Minor

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15
Q

Why is a Sentinel Lymph Node Biopsy done?

A

First Node to Receive Lymphatic Drainage - so First Node the Tumour Spreads to
Note - If Negative, rest of the Nodes in the Lymphatic Basin are Negative

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16
Q

How is the Axilla Treated, in Breast Cancer?

A
  1. If Sentinel Lymph Node is Clear of Tumour - None
  2. If Sentinel Lymph nodes contains Tumour:
  3. a) Remove them all Surgically - Axillary Clearance
  4. b) Give Radiotherapy to all of the Nodes in the Axilla
17
Q

What are complications of treatment of the Axilla in Breast Cancer?

A
  1. Lymphoedema
  2. Sensory Disturbance - Intercostobrachial Nerve
  3. Decreased Range of Movement of the Shoulder
  4. Nerve Damage - Long Thoracic / Thoracodorsal / Brachial Plexus
  5. Vascular Damage
  6. Radiation-Induced Sarcoma
18
Q

What is the Treatment for Micro-Metastases in Breast Cancer?

A
  1. Hormone Therapy
  2. Chemotherapy
  3. Targeted Therapies
19
Q

When can Hormone Therapy be given?

A

If the Hormone Receptors are Present

20
Q

What type of Hormone Therapy is given if:

  1. Premenopausal?
  2. Postmenopausal?
A
  1. Tamoxifen for 5 years
  2. a) If Good Prognosis - Tamoxifen for 5 years
  3. b) If Poor Prognosis - Arotamase Inhibitor for 5 Years
21
Q

When is Chemotherapy best given to a Patient?

A
  1. Better effects if age < 50
  2. Node Positive
  3. Grade 3 Cancers
22
Q

What is the Anti-HER-2 Therapy?

A

Tratuzumab - Monoclonal Antibody against HER-2 Receptors

23
Q

Who is Anti-HER-2 Therapy given to?

A

Patients with Over-Expression of HER-2 and Chemotherapy

24
Q

What must always be done in cases of Breast Cancer?

A

Follow up

3rd Year - Reproductive Diseases (41 decks)

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