Breast Cancer- Oncology Treatment Flashcards
How is DCIS managed?
Surgery (Breast conservation surgery or mastectomy) followed by Radiotherapy to the whole breast, 40Gy in 15# over 3 weeks, using 2 tangential fields
What % of breast lumps are operable?
84%
8% distant mets
8% locally advanced/inoperable
When does radiotherapy following BCS involve irradiation of breast alone?
Negative sentinel node biopsy (SNB)
Nodes containing micrometastases only (>0.2mm but <2mm) in SNB
< 4 nodes involved in an adequate axillary node clearance
When does radiotherapy following BCS involve a boost to the tumour bed?
Women under the age of 54 on the day of surgery
Posterior margin <1mm for invasive disease after full thickness excision
When is chest wall radiotherapy given following mastectomy?
Tumour size > 5 cm
4 or more involved nodes
Involved resection margins
T4 disease
When is radiotherapy to the ipsilateral axilla given?
> 1 positive macrometastases sentinel node
Extensive ECS post axillary clearance
When is radiotherapy to the supraclavicular fossa given?
> =4 nodes involved
Who should be considered as having involved nodes?
Patients with histologically proven lymph node involvement in whom there is a complete pathological response (scarring in node) within the nodes following neo-adjuvant systemic treatment
What nodes should not be considered involved?
Nodes containing isolated tumour cells (<0.2mm of disease)
How long are tamoxifen and letrozole given in adjuvant treatment?
10y and 5y respectively
When is trastuzumab given?
To patients whose cancer cells overexpress HER-2-neu as measured by IHC or FISH (25-30% of pts)
In locally advanced cancer when should radiotherapy be considered?
As initial therapy for a primary tumour that is considered inoperable
Also consider for patients still inoperable following primary systemic therapy
Consider post surgery for all patients
Patients with T>4b tumours at outset should be treated with 0.5cm bolus following mastectomy to increase the skin dose
Where does breast cancer commonly metastasise too?
Lung Liver Bone Brain Skin
