Breast Lecture 4 - Breast Disease

Question 1

Breast cancer presentation

Answer 1

Aymptomatic: breast screening (50-70yrs)
Symptomatic:
- lump
- mastalgia (persistent unilateral pain)
- nipple discharge (blood-stained)
- nipple changes (Paget’s disease, retraction)
- change in size or shape of the breast
- lymphoedema (swelling of the arm)
- dimpling of the breast skin

Question 2

describe T1 primary breast tumour

Answer 2

clinically palpable tumour size < 2cm

Question 3

describe T3 primary breast tumour

Answer 3

tumour size > 5cm

Question 4

which cancer patients are suitable for breast conservation surgery?

Answer 4

• Breast/tumour size ratio
• suitable for radiotherapy
• patient’s wish

Question 5

treatment of the axilla in breast cancer

Answer 5

• if sentinel lymph node (SLN) biopsy is negative (= clear of tumour), no further treatment required.
• if SLN contains tumour - either remove them all surgically (clearance = ANC) or give radiotherapy to all the axillary nodes

Question 6

what are the complications of axillary treatment?

Answer 6

• lymphoedema (10-17%)
• sensory disturbance (intercostobrachial n.)
• decrease ROM of shoulder joint
• nerve damage (long thoracic, thoracodorsal, brachial plexus)
• vascular damage
• radiation-induced sarcoma

Question 7

what are the complications of radiotherapy used for breast cancer?

Answer 7

• skin reaction - skin telangiectasis
• radiation pneumonitis
• cutaneous radionecrosis/osteonecrosis
• angiosarcoma

Question 8

what hormonal treatments can be used for breast cancer that is oestrogen receptor positive (ER+)?

Answer 8

Tamoxifen:
- 20 mg once daily over 5-10 years
- blocks directly on ER receptor
- effective in all age groups
- more effective given after chemotherapy
- !thromboembolic events

Aromatase inhibitors e.g. Arimidex (1mg) & Letrozole (2.5mg):
- once daily for 5 years
- inhibiting ER synthesis
- should only be used in postmenopausal women
- improve disease free survival
- !osteoporosis

Question 9

what are the traditional chemotherapy options for breast cancer?

Answer 9

• anthracycline combinations (Doxorubicin or Epirubicin - 2nd generation)
• taxane based combinations (e.g. Docetaxel - 3rd generation)

Question 10

what additional therapy can be offered with breast cancer that is HER2+?

Answer 10

Trastuzumab (Herceptin)/Pertuzamab:
- monoclonal antibody against HER-2 receptor
- given to patients with over-expression of HER2 and chemotherapy
- 50% decrease risk of recurrence
- 33% increase in survival at 3 years!