Breast Cancer treatment Flashcards
treatment options
Surgery
radiotherapy
systemic therapy
- hormonal, cytotoxic chemo, immuno
What is radiotherapy used for? (intent)
postop
primary radical for locally advanced (rare)
Palliative to painful bony mets, skin deposits, brain mets
Where is post-operative radiotherapy used on?
breast/chest wall
nodal areas: axilla, supraclavicular fossa
When is postop radio used?
all patients being treated conservatively (wide local excision/lumpectomy)
Mastectomy selected patients
Criteria for postop radiotherapy in mastectomy patients (3)
Large tumour
Extensive nodal involvement (4 or more)
involved margins (
Acute side effects of postop radiotherapy (3)
tiredness
skin erythema to moist desquamation
possible mild dysphagia if irradiating supraclav fossa
Post op radiotherapy - late adverse effects (3)
local fibrosis and telangectasia
lung fibrosis (rarely symptomatic)
cardiac damage (IHD) - rarer now due to better planned treatment
Post op radiotherapy - positive late effects
overall modest improvement in survival - probably need to prevent 4 recurrences to save 1 life
Previous excess cardiovascular mortality reduced with current techniques
systemic therapy - adjuvant, most operable why not curable
occult distant mets at presentation
adjuvant systemic therapy options
hormone therapy
cytotoxic chemo
immunotherapy
types of hormone therapy (3) and benefits
ovarian ablation
Herceptin - HER2 +ve
If OR/PgR +ve:
- tamoxifen
- aromatase inhibitors (anastrozole in post meno)
ALL decrease odds of death by 17%, absolute benefit of 6% at 10 years
adjuvant systemic therapy side effects : hormone therapy (5)
infertility
menopausal symptoms
endometrial cancer
weight gain
DVT
adjuvant systemic therapy side effects : chemotherapy (6)
infertility
mouth ulcers
neutropenia - sepsis
Alopecia
N/V
Lassitude
median survival with mets
18m - 2years (20% at 5yrs) but may be decades
varies from acute aggressive disease to chronic disease
where do breast mets go?
brain, bones (hip)
