Breast Cancer Management Options 2

Question 1

What is BCS?

Answer 1

• Breast conserving surgery

- Usually a lumpectomy or a wide local excision

Question 2

When will BCS be performed?

Answer 2

• Patient choice
• Dependent on tumour size, smaller and if cosmetic outlook will be acceptable
• Multi-focal but in one quadrant
• Sometimes after neoadjuvant chemo, which downsizes the surgery

Question 3

What us oncoplastic surgery?

Answer 3

• Remove the breast cancer while achieving good cosmetic results

Question 4

When will a mastectomy be performed?

Answer 4

• Local recurrance
• Operable tumours over 4cm in size
• Failed BCS
• If BCS would not provide good cosmetic outcome
• In central breast tumours

Question 5

What is therapeutic Mammoplasty?

Answer 5

• Removes the cancer and reshapes the breast at the same time
• Usually reduces the size of the breast
• More breast surgery may be offered to match sizes and shape

Question 6

When is sentinel lymph node biopsy used?

Answer 6

• Preferred over full lymph node clearance - less side effects
• If DCIS and low risk factors the patient will not have it

Question 7

When will axillary lymph node clearance used?

Answer 7

• Definitely positive lymph nodes
• Full axillary chain is removed, a bigger operation than SLN
• Histology will be performed on all nodes

Question 8

Why is hormone therapy used?

Answer 8

• ER+ve disease - related to the growth of cancer cells caused by oestrogen
• Drug depends on if they are pre/post menopausal
• If DCIS should be offered if RT not recommended /recieved after BCS
• May be neoadjuvant

Question 9

What is Tamoxifen?

Answer 9

• Drug for pre or peri menopausal women
• Given for 5 years but can be extended longer
• Male breast cancer for 5 years

Question 10

What hormonal treatment will be given to post-menopausal women?

Answer 10

• Medium/high risk = aromatose inhibitor
• Low risk = tamoxifen
• 5 years generally
• AI’s are better than tamoxifen in this case, 30% better at preventing recurrence

Question 11

Other reasons for the use of hormone therapy may be?

Answer 11

• To suppress ovarian function, temporary menopause, prescribed when there is higher risk of recurrence and chemo is used
• Males with ER+ve disease
• Metastatic breast cancer can develop resistance to endocrine treatment, second line is weaker. Using a second drug can reduce resistance

Question 12

What are some side effects of Tamoxifen?

Answer 12

• Tamoxifen - ( cant be give to anyone at risk of thromboembolisms)
• osteoporosis is a potential side effect.
• diarrhoea, skin reaction, alopecia, fatigue, hot flushes, nausea
• Increased chance of endometrial cancer, uterine sarcoma

Question 13

What are the side effects of anastrozole?

Answer 13

• Alopecia, decreased appetite, arthritis, drowsiness, bone pain etc

Question 14

What is trastuzumab?

Answer 14

• Monoclonal antibody, prevents the signalling of pathways so inhibits cancer cell
• Offered to anyone with T1c or abouve if they are HER2+ (Considered for lower staging)
• 3 weekly intervals
• Usually combined with chemo or RT
• 55% or less cardiac function, will NOT be prescribed

Question 15

Kadcyla, what is it?

Answer 15

• Not to be take during RT.
• Used for residual treatment in HER2+ patients (after surgery and chemo)
• Better than Herceptin along, but costs a lot more

Question 16

Why are bisphosphinates used?

Answer 16

• It is an anti-resorptive therapy reducing bone turnover
• Used for a long time in osteoporosis
• Reduces side effects which cause treatment-induced bone weakening, ovarian suppression, chemo, AIs
• Can increase possibility of bone necrosis - DEXA scan given ( and calcium supplements)
• Typically in post menopausal women with node positive disease, considered in node negative that may recurr.

Question 17

When is neo-adjuvant chemotherapy used?

Answer 17

• In the treatment of large tumours (greater than 3cm).
• In locally advanced breast cancer
• The aim being to reduce tumour size, to increase possibility of BCS, to reduce chance of metastasis.

Question 18

When is adjuvant chemo used?

Answer 18

• Risk dependent
• Given following surgery if sufficient risk (large tumour, node+ve and HER2+)
• Aim is to reduce metastases or local recurrence

Question 19

Anthracyclines?

Answer 19

• tumour antibiotics
• Change in DNA in cancer cells to stop grwoth and multiplication
• Best in G1-G2 of the cycle.
• Cardiotoxic
• Can react with RT

Question 20

Mitotic Inhibitors?

Answer 20

• anti-tumour activity, inhibit cell division
• Taxanes, freeze mitosis by stabilising microtubule formation
• Alkaloids bind to microtubules
• Cause peripheral neuropathy
• Myleosupression
• Alopecia

Question 21

Antimetabolites?

Answer 21

• Intefere with synthesis of DNA
• Effective in 5-phase
• Cause mucositis, diarrhoea, myleosurpression

Question 22

Alkylating agents?

Answer 22

• Damage DNA
• Most active in G0 but work in all sections
• Cause myleosuppression, nausea, vomiting, alopecia, gonadal dysfunction and rarely pulmonary fibrosis

Question 23

What are the pros and cons of Anthracyclines and Taxanes?

Answer 23

• Reduced cardiotoxicity, reduced nausea
• Additional side effects of neuropathy, neutropaenia and hypersensitivity
  (If not appropriate give anthracyclines with an alkylating agent)