Breast Cancer Management Options Flashcards
1
Q
What happens at a triple assessment?
A
- Clinical examination
- Mammogram/Ultrasound
- Pathological/Biopsy
2
Q
What information do we gain from a triple assessment?
A
- The size
- The grade
- The patient’s family history etc.
- Nodal status
- HER2 Status
- Histology
- Performance status
- Age
3
Q
In terms of histology, what is easier to treat?
A
- Ductal, as it is generally better defined.
4
Q
What are the primary treatments available?
A
- Surgery = most common
- Neoadj = endocrine therapy, usually poor performance or if surgery is delayed
- Neoadj = chemo - usually nodal +ve
5
Q
What are the types of breast surgery and why are they used?
A
- Mastectomy - usually for large tumours or extensive disease where it is hard to remove the tumour. Also patient choice for some.
- Breast conserving tumour
6
Q
What types of axilla surgery are available?
A
- Sentinel lymph node biopsy - used if there are no positive lymph nodes identified at triple assessment. Normally used with radioactive dye.
- Axillary node clearance - used if positive axillary nodes are noted in triple assessment or if theres been neo-adjuvant surgery and nodal volume is assumed.
7
Q
What are possible adjuvant treatments?
A
- Post-mastectomy - if DCIS onlu, if disease is <5cm and node -ve
- Endocrine - 5 years or 10 years
- Chemo - if node +ve, large tumour, HER2 +ve and good performance status
- XRT - following BCS, could be after mastectomy
- Bisphosphates - bone infusion if people have osteoporosis etc.
8
Q
Breast Radiotherapy?
A
- Always after breast conserving surgery
- Often boost - less than 50 years or closer margins
- Chest wall RT if post mastectomy and T3, T4 or T1 and T2 if nodal involvement.
- Partial breast: Over 50, tumour smaller than 3cm, ER and HER2 +, LVI -ve, Non lobular, clear margins, must take 5 years hormone
- Omit RT - low risk disease, BCS, 70+, ER+ve, ER-ve, Grade 1/2, Hormones for 5 years, mammograms for 10 years - overally v low expectance of local recurrance
