Breast lecture 4 - treatment

Question 1

epidemiology of breast cancer

Answer 1

1 in 8 women
46 000/year/UK
18% of cancer deaths
increased risk with increasing age

Question 2

MDT

Answer 2

radiologist 
medical oncologist 
clinical oncologist 
patient and partner 
breast surgeon 
reconstructive surgeon 
palliative care 
psychology 
nurse counsellor 
pathology 
cytologist 
radiologist

Question 3

2 types of in situ carcinoma

Answer 3

DCIS and LCIS

Question 4

invasive cancer types

Answer 4

ductal, lobular, cribriform, tubular, medullary

Question 5

2 ways to be diagnosed with breast cancer

Answer 5

present with symptoms

screening

Question 6

establishing diagnosis

Answer 6

history and exam
mammogram 
ultrasonography 
MR mammogram 
cytology - FNA 
core biopsy
open biopsy
image guided core biopsy or cytology

Question 7

risk factors

Answer 7

age 
age of menarche and menopause 
age of first pregnancy 
OCP 
HRT 
lifestyle 
past benign breast disease 
previous breast cancer 
radiation 
family history 
geography

Question 8

signs and symptoms

Answer 8

lump or thickening in breast - painless 
change in size or contours of breast 
discharge or bleeding 
peau d'orange 
change in colour or appearance of areola

Question 9

Sensitivity of tests

Answer 9

clinical exam and USS - 88%
mammogram - 93%
FNA - 94%

Question 10

Staging of breast cancer

Answer 10

Hb, FBC, U+E, LFT
CXR
isotope bone scan if spread to LN

Question 11

T staging

Answer 11

1: 0-2cm, 2: 2-5cm, 3:>5cm and 4 is fixed to skin or muscle

Question 12

2 options for surgery

Answer 12

mastectomy

breast conservation

Question 13

reasons for breast conservation surgery

Answer 13

patient wishes
less than 4cm
breast to tumour ratio

Question 14

sentinel LN negative?

Answer 14

all other are negative as no skip mets

Question 15

SLN contains tumour

Answer 15

surgical clearance or radiotherapy

Question 16

complications of treatment to axilla

Answer 16

lymphoedema 
sensory disturbance or nerve damage 
decreased ROM at shoulder 
vascular damage 
radiation induced sarcoma

Question 17

increased risk of recurrence

Answer 17

LN, grade, size, LVSI, No ER receptors, HER-2

Question 18

hormone therapy

Answer 18

ER positive - blocks oestrogen induced cell growth
tamoxifen if premenopausal or post but good prognosis
anastrozole (aromatase inhibitor) for 5-10 years if post-menopausal

Question 19

oncotype DX

Answer 19

21 gene assay to determine benefit of chemo

Question 20

Herceptin

Answer 20

monoclonal ab for Her 2 receptor

Question 21

follow up

Answer 21

clinical exam every 6 months for 3-5 years

mammogram every year for 10 years