Breast cancer : Treatment Options Flashcards
Local Treatment
surgery or
breast conservation surgery/ tx. BCT
SURGICAL TECHNIQUES:
BCT
wide local excision= excision of tumour plus 2cm of normal tissue
segmental mastectomy=a fan/wedge of tissue surrounding tumour
Indications for Mastectomy
large tumour size
clinical evidence of dermal invasion
locally advanced disease
previous radiation to chest wall
Multicentric breast cancer
more than one tumour, which have formed seperately from eachother
likely to be in different quadrants of breast or beyond 5cm of each other
Multifocal breast cancer
more than one tumour which have arisen from original tumour
likely to be in the same quadrant
BREAST RECONSTRUCTION:
expander /implant
use of expander to create breast mound
then permanent saline breast implant placed
BREAST RECONSTRUCTION
autogenous tissue
using patients own tissue to reconstruct breast mound
Ductal Carcinoma in Situ treated w
- BCT or mastectomy
-Whole Breast RT after BCS to decrease risk of recurrence
RADIOTHERAPY: Contraindications
previous radiation to breast/chest
possibility of pregnancy
connective tissue disease
inability to abduct arm
patient refusal
Radiation Therapy Options after BCT
whole breast radiation
boost
accelerated partial breast irradiation APRI
Post Mastectomy Radiation Therapy (PMRT)
reduces risk of recurrence in node positive patients by 10%
and 20 year mortality by 8%
Post Mastectomy Radiation Therapy (PMRT)
who is it recommended for
high risk patients including:
involved resection margin
involved axillary nodes
t3-t4 tumours
PMRT
starts
4 weeks after chemo
or 3-8 weeks after surgery if no chemo ( with arm movemnt and surgery healing)
Indications for RT to Axilla
no axilla surgery
involved lymph nodes
rarely will have both RT axilla and axillary lymph node dissection ALND
Systemic Therapies ( Pre-operative and Adjuvant)
chemo
endocrine therapy
HER2 targeted therapy
Chemotherapy
low risk patients
varierty of agents used
toxicities considered
Chemotherapy
high/intermediate risk patients
all should be offered adjuvant treatment dependent on PS and co-morb
Adjuvant Systemic Treatment (Chemotherapy)
start w/o delay after surgery
reduces risk of recurrence
senstivity to treatment
Recurrence of breast cancer after BCT
mastectomy w/ or w/o breast construction
Recurrence of breast cancer after mastectomy
additional surgery to remove tumour from mastectomy site , followed by RT
chemo and /or hormone therapy may be needed
Alternative treatment options for recurrent breast cancer include:
-hormone therapy
-surgery and/or radiation therapy if cancer is confined to one area
Treatment options- summarized pt 1
usually SURGERY FIRST
either BCT or mastectomy
if BCT =RT
if mast= +/- RT
Treatment options- summarized pt 2
chemo if greater than stage 1 unless contraindicted eg age
Considered if stage I and:
* young or
* Grade III or
* ER/PR-ve
Neoadjuvant Chemo/ RT
to down stage tumours
