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Mammo > breast cancer treatment options > Flashcards

breast cancer treatment options Flashcards

1
Q

what is removed in a lumpectomy/ breast conserving surgery/ wide local excision (WLE)?

A

-surgical removal of tumor, ALND or sentinel node procedure, radiation, +/- chemo

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2
Q

what is removed in a total or simple mastectomy?

A

breast

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3
Q

what is removed in a radical mastectomy?

A

breast, ALND, pectoral major and minor

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4
Q

what is removed in a modified radical mastectomy?

A

breast, ALND, pectoral fascia

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5
Q

what is removed in a axillary lymph node dissection (ALND)

A

usually level 1 and 2 axillary nodes

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6
Q

lumpectomy (breast conserving surgery) indications

A

1) benign breast lumps
-fibroadenoma
-phyllodes tumor
2) high risk lesions
-LCIS (lobular carcinoma in situ)
-papilloma
-ADH (atypical ductal hyperplasia)
3) cancerous lesions
-DCIS (ductal carcinoma in situ)
-IDC (invasive ductal carcinoma)

if done for cancer treatment, usually followed by radiation therapy

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7
Q

lumpectomy risk factors

A

-bleeding/hematoma
-infection
-pain
-temporary swelling
-tenderness
-hardening of scar tissue
-change in shape of breast

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8
Q

mastectomy indications

A

treatment options for;
-DCIS
-stage 1 & 2 (early stage) breast cancer
-stage 3 (locally advanced) breast cancer (after chemo)
-breast cancer in more than one quadrant
-paget’s disease
-locally recurrent breast cancer
-prior breast cancer with radiation
-high risk lesions; ADH, LCIS
-carrier of gene mutation
-prophylactic surgery

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9
Q

mastectomy risk factors

A

-bleeding
-infection
-pain
-swelling (lymphedema)
-scar tissue hardening
-should pain and stiffness
-numbness (chest & armpit from node removal)
-hematoma/seroma

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10
Q

total mastectomy (simple)

A

-removal of breast tissue including skin, areola, nipple
-reconstruction can be performed immediately or at a later time

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11
Q

skin-sparing mastectomy

A

-removal of breast tissue, nipple and areola, but not skin
-skin left behind for reconstruction
-reconstruction can be done immediately

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12
Q

nipple-sparing mastectomy (areola sparing)

A

-removal of only breast tissue, spares skin, nipple, areola
-reconstruction performed immediately

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13
Q

prophylactic mastectomy

A

-surgical removal of one or both breasts in woman at high risk of breast cancer to reduce risk
-reduces risk of recurrence 90%
-irreversible decision
-usually followed by implant reconstruction

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14
Q

implant reconstruction

A

-expander inserted
-increased in size slowly
-takes months-year
-desired size reached
-expander removed
-implant inserted

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15
Q

reconstruction; own transplanted tissue

A

autologous

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16
Q

TRAM reconstruction (transverse rectus abdominus myocutaneous)

A

-surgical procedure that uses the tissue and muscle from abdominal area to create and form a new breast mound
-skin, muscle, fat, and blood vessels transferred

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17
Q

latissimus dorsi flap reconstruction

A

-surgical reconstruction procedure that skin, tissue, muscle used from upper back to create breast mound
-smaller amount of tissue; used on smaller to medium sized breasts

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18
Q

complication in flap reconstruction

A

-muscle weakness
-more extensive than a mastectomy or implant reconstruction
-larger incision
-change in breast sensation

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19
Q

advantages of flap reconstruction

A

-helps make pt feel whole again
-alternative to implant reconstruction
-breasts look natural under clothing

20
Q

External radiation therapy indications

A

-from a machine on the outside
-most common type
-has high energy rays

21
Q

internal radiation therapy indications

A

-from implanted device or liquids
-used on smaller cancers
-high dose with fewer side effects

22
Q

external beam radiation therapy (EBRT)
proton beam therapy

A

-energy directly to site, spares surrounding tissue
-may cause fewer side effects
-limited availability (Mayo clinic sites, MD anderson sites)

23
Q

radiation for lumpectomy

A

-higher chance of cancer recurring in the same breast if no radiation
-3-15% chance for recurrence in first 10 yrs

24
Q

mastectomy high risks

A

-positive lymph nodes
-tumor size > 5cm
-positive margins
-tumor that extends to skin, nipple, or chest wall

25
Q

brachytherapy- radiation seed (internal therapy)

A

-3-5 day therapy/twice a day
-catheter is connected to machine that inserts a radiation “seed”
-high dose radiation to site only

26
Q

intra-operative radiation therapy (IORT)

A

-RT given during lumpectomy surg right after cancer is removed
-single, high dose of rad is given directly to area where cancer was removed

27
Q

chemotherapy

A

-stop cancer cell growth, target rapidly dividing cells
-kills cancer cells
-used w/ other treatments (radiation, surg, HT

28
Q

chemotherapy indications
NEO adjuvant therapy (before surgery)

A

-shrink tumor size and conserve tissue
-decreased chance cancer will return

29
Q

chemotherapy indications
adjuvant therapy (after surgery)

A

-if cancer spread to lymph nodes
-premenopausal women (BC tends to be more aggressive)
-HER2 positive cancer- more aggressive
-metastatic cancers
-triple neg. BC
-inflammatory BC

30
Q

hormonal therapy (endocrine therapy) goal

A

block the effects of hormones on cancer cell, stop cell growth

31
Q

most common anti-estrogen drug

A

tamoxifen

32
Q

where are hormone receptors and proteins found

A

-on the surface and inside some cancer cells
-when hormones attach to the receptors, they cause cancer cell growth

33
Q

how do anti-estrogen drugs work?

A

-bind to cancer cell
-block ER/PR from binding to cancer cell
-stops growth
-can decrease tumor size

34
Q

aromatase inhibitors

A

-useful in postmenopausal women
-reduces the amount of estrogen in the body

35
Q

side effects of aromatase inhibitors

A

-joint stiffness/pain
-fewer than tamoxifen
-increased risk of osteoporosis, blood clots, and heart issues

36
Q

HER2+ (Human Epidermal growth factor Receptor)

A

-receptors on surface that stimulates cell growth
-overproduced in 20-25% breast cancer

37
Q

treatment drug for HER2+

A

-herceptin (trastuzumab); blocks HER2 receptor overstimulation
-combination of herceptin and chemotherapy
-can shrink tumor
-slow tumor growth

38
Q

ovarian ablation

A

-for premenopausal women
-shuts down ovaries to reduce female hormone production
-can be done with surgery, radiation
-not beneficial for postmenopausal b/c ovaries naturally stop producing hormones
-side effects; premature menopause, infertility

39
Q

triple negative breast cancer (TNBC)

A

-tumor that does not have any protein receptors
-chemotherapy works best; neoadjuvant + surgery + adjuvant + radiation
-more aggressive
-the STAGE of breast cancer and GRADE OF TUMOR will influence prognosis

40
Q

recurrence of breast cancer

A

-local: regrowth of cancer cells at original site
-regional: cancer cells travel from og site to settle in nearby nodes
-metastatic recurrence: cancer cells from og site have traveled to distant part of the body

41
Q

risk of recurrence
lumpectomy+radiation

A

-local recurrence; within 5 yrs
-depends on tumor characteristics
-5-15% recurrence rate

42
Q

risk of recurrence
mastectomy

A

-local recurrence within 5 yrs increases if node was involved originally
-rad can reduce risk
-considered local recurrence if new cancer develops on chest wall
-5-10% recurrence rate

43
Q

BRCA gene

A

breast cancer gene-tumor suppressing gene

44
Q

BRCA1 gene mutation

A

-located on chromosome 17
-30% of hereditary cases
-increase risk of ovarian cancer, of developing cancer in opposite breast
-men have 3x risk for prostate cancer

45
Q

BRCA2 gene mutation

A

-located on chromosome 13
-15% of heredity cases
-increase risk of; prostate, gallbladder, stomach, pancreas cancers
-males have increased risk of bc

Mammo (16 decks)

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