Breast Cancer

Question 1

Radiotherapy is given to everyone who has had WLE/lumpectomy, when would you consider in mastectomy?

Answer 1

Mastectomy patients selectively:
large tumour
extensive nodal involvement (e.g. 4 or above)
involved margins (

Question 2

Side effects of radiotherapy?

early effects

Answer 2

Skin erythema to moist desquamation
Tiredness
Possible mild dysphagia if irradiating supraclavicular fossa

Question 3

Late effects of chemotherapy?

Answer 3

Local fibrosis and telangectasia
Lung fibrosis (rarely symptomatic)
Cardiac damage (ischaemic heart disease) – rarer now treatment better ‘planned’

Question 4

Side effects of hormone therapy

Answer 4

Infertility
Menopausal symptoms
Weight gain
Endometrial cancer
Deep venous thrombosis

Question 5

Side effects of chemotherapy

Answer 5

Nausea & vomiting
Infertility
Alopecia
Neutropenia (leading to sepsis)
Mouth ulcers
Lassitude

Question 6

Median survival with metastases?

Answer 6

Median survival with mets: 2 years (20% at 5 yrs)

Question 7

Palliative treatment for bony mets?

Answer 7

Radiotherapy

Bisphosphonates

Question 8

What treatment should you give if there are liver mets/ lymphangitis carcinomatosa?

Answer 8

Chemotherapy - a quicker response is needed

Question 9

What is the absolute benefit in survival of adjuvant chemotherapy in breast cancer?

Answer 9

Between 0% and 15%

Question 10

Difference between tamoxifen and aromatase inhibitors?

Answer 10

Tamoxifen binds to receptor

Aromatase inhibitors block synthesis of oestrogen

Question 11

What is the benefit of neo-adjuvant chemotherapy in breast cancer?

Answer 11

It decreases the number of people who need mastectomy