breast cancer treatment options Flashcards
what is removed in a lumpectomy/ breast conserving surgery/ wide local excision (WLE)?
-surgical removal of tumor, ALND or sentinel node procedure, radiation, +/- chemo
what is removed in a total or simple mastectomy?
breast
what is removed in a radical mastectomy?
breast, ALND, pectoral major and minor
what is removed in a modified radical mastectomy?
breast, ALND, pectoral fascia
what is removed in a axillary lymph node dissection (ALND)
usually level 1 and 2 axillary nodes
lumpectomy (breast conserving surgery) indications
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
lumpectomy risk factors
-bleeding/hematoma
-infection
-pain
-temporary swelling
-tenderness
-hardening of scar tissue
-change in shape of breast
mastectomy indications
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
mastectomy risk factors
-bleeding
-infection
-pain
-swelling (lymphedema)
-scar tissue hardening
-should pain and stiffness
-numbness (chest & armpit from node removal)
-hematoma/seroma
total mastectomy (simple)
-removal of breast tissue including skin, areola, nipple
-reconstruction can be performed immediately or at a later time
skin-sparing mastectomy
-removal of breast tissue, nipple and areola, but not skin
-skin left behind for reconstruction
-reconstruction can be done immediately
nipple-sparing mastectomy (areola sparing)
-removal of only breast tissue, spares skin, nipple, areola
-reconstruction performed immediately
prophylactic mastectomy
-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
implant reconstruction
-expander inserted
-increased in size slowly
-takes months-year
-desired size reached
-expander removed
-implant inserted
reconstruction; own transplanted tissue
autologous
TRAM reconstruction (transverse rectus abdominus myocutaneous)
-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
latissimus dorsi flap reconstruction
-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
complication in flap reconstruction
-muscle weakness
-more extensive than a mastectomy or implant reconstruction
-larger incision
-change in breast sensation
advantages of flap reconstruction
-helps make pt feel whole again
-alternative to implant reconstruction
-breasts look natural under clothing
External radiation therapy indications
-from a machine on the outside
-most common type
-has high energy rays
internal radiation therapy indications
-from implanted device or liquids
-used on smaller cancers
-high dose with fewer side effects
external beam radiation therapy (EBRT)
proton beam therapy
-energy directly to site, spares surrounding tissue
-may cause fewer side effects
-limited availability (Mayo clinic sites, MD anderson sites)
radiation for lumpectomy
-higher chance of cancer recurring in the same breast if no radiation
-3-15% chance for recurrence in first 10 yrs
mastectomy high risks
-positive lymph nodes
-tumor size > 5cm
-positive margins
-tumor that extends to skin, nipple, or chest wall
brachytherapy- radiation seed (internal therapy)
-3-5 day therapy/twice a day
-catheter is connected to machine that inserts a radiation “seed”
-high dose radiation to site only
intra-operative radiation therapy (IORT)
-RT given during lumpectomy surg right after cancer is removed
-single, high dose of rad is given directly to area where cancer was removed
chemotherapy
-stop cancer cell growth, target rapidly dividing cells
-kills cancer cells
-used w/ other treatments (radiation, surg, HT
chemotherapy indications
NEO adjuvant therapy (before surgery)
-shrink tumor size and conserve tissue
-decreased chance cancer will return
chemotherapy indications
adjuvant therapy (after surgery)
-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
hormonal therapy (endocrine therapy) goal
block the effects of hormones on cancer cell, stop cell growth
most common anti-estrogen drug
tamoxifen
where are hormone receptors and proteins found
-on the surface and inside some cancer cells
-when hormones attach to the receptors, they cause cancer cell growth
how do anti-estrogen drugs work?
-bind to cancer cell
-block ER/PR from binding to cancer cell
-stops growth
-can decrease tumor size
aromatase inhibitors
-useful in postmenopausal women
-reduces the amount of estrogen in the body
side effects of aromatase inhibitors
-joint stiffness/pain
-fewer than tamoxifen
-increased risk of osteoporosis, blood clots, and heart issues
HER2+ (Human Epidermal growth factor Receptor)
-receptors on surface that stimulates cell growth
-overproduced in 20-25% breast cancer
treatment drug for HER2+
-herceptin (trastuzumab); blocks HER2 receptor overstimulation
-combination of herceptin and chemotherapy
-can shrink tumor
-slow tumor growth
ovarian ablation
-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
triple negative breast cancer (TNBC)
-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
recurrence of breast cancer
-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
risk of recurrence
lumpectomy+radiation
-local recurrence; within 5 yrs
-depends on tumor characteristics
-5-15% recurrence rate
risk of recurrence
mastectomy
-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
BRCA gene
breast cancer gene-tumor suppressing gene
BRCA1 gene mutation
-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
BRCA2 gene mutation
-located on chromosome 13
-15% of heredity cases
-increase risk of; prostate, gallbladder, stomach, pancreas cancers
-males have increased risk of bc
