Breast cancer : Treatment Options

Question 1

Local Treatment

Answer 1

surgery or
breast conservation surgery/ tx. BCT

Question 2

SURGICAL TECHNIQUES:
BCT

Answer 2

wide local excision= excision of tumour plus 2cm of normal tissue

segmental mastectomy=a fan/wedge of tissue surrounding tumour

Question 3

Indications for Mastectomy

Answer 3

large tumour size
clinical evidence of dermal invasion
locally advanced disease
previous radiation to chest wall

Question 4

Multicentric breast cancer

Answer 4

more than one tumour, which have formed seperately from eachother

likely to be in different quadrants of breast or beyond 5cm of each other

Question 5

Multifocal breast cancer

Answer 5

more than one tumour which have arisen from original tumour

likely to be in the same quadrant

Question 6

BREAST RECONSTRUCTION:
expander /implant

Answer 6

use of expander to create breast mound
then permanent saline breast implant placed

Question 7

BREAST RECONSTRUCTION
autogenous tissue

Answer 7

using patients own tissue to reconstruct breast mound

Question 8

Ductal Carcinoma in Situ treated w

Answer 8

• BCT or mastectomy
  -Whole Breast RT after BCS to decrease risk of recurrence

Question 9

RADIOTHERAPY: Contraindications

Answer 9

previous radiation to breast/chest
possibility of pregnancy
connective tissue disease
inability to abduct arm
patient refusal

Question 10

Radiation Therapy Options after BCT

Answer 10

whole breast radiation
boost
accelerated partial breast irradiation APRI

Question 11

Post Mastectomy Radiation Therapy (PMRT)

Answer 11

reduces risk of recurrence in node positive patients by 10%
and 20 year mortality by 8%

Question 12

Post Mastectomy Radiation Therapy (PMRT)
who is it recommended for

Answer 12

high risk patients including:
involved resection margin
involved axillary nodes
t3-t4 tumours

Question 13

PMRT
starts

Answer 13

4 weeks after chemo
or 3-8 weeks after surgery if no chemo ( with arm movemnt and surgery healing)

Question 14

Indications for RT to Axilla

Answer 14

no axilla surgery
involved lymph nodes

rarely will have both RT axilla and axillary lymph node dissection ALND

Question 15

Systemic Therapies ( Pre-operative and Adjuvant)

Answer 15

chemo
endocrine therapy
HER2 targeted therapy

Question 16

Chemotherapy
low risk patients

Answer 16

varierty of agents used
toxicities considered

Question 17

Chemotherapy
high/intermediate risk patients

Answer 17

all should be offered adjuvant treatment dependent on PS and co-morb

Question 18

Adjuvant Systemic Treatment (Chemotherapy)

Answer 18

start w/o delay after surgery
reduces risk of recurrence
senstivity to treatment

Question 19

Recurrence of breast cancer after BCT

Answer 19

mastectomy w/ or w/o breast construction

Question 20

Recurrence of breast cancer after mastectomy

Answer 20

additional surgery to remove tumour from mastectomy site , followed by RT

chemo and /or hormone therapy may be needed

Question 21

Alternative treatment options for recurrent breast cancer include:

Answer 21

-hormone therapy
-surgery and/or radiation therapy if cancer is confined to one area

Question 22

Treatment options- summarized pt 1

Answer 22

usually SURGERY FIRST
either BCT or mastectomy
if BCT =RT
if mast= +/- RT

Question 23

Treatment options- summarized pt 2

Answer 23

chemo if greater than stage 1 unless contraindicted eg age

Considered if stage I and:
* young or
* Grade III or
* ER/PR-ve

Question 24

Neoadjuvant Chemo/ RT

Answer 24

to down stage tumours