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TM-Radiation Therapy 2 > Breast Oncology > Flashcards

Breast Oncology Flashcards

1
Q

Aetiology and risk factors for breast cancer?

A 
Increasing age
Family history
Endogenous hormones (early Period and late menopause)
High socio economic status
Alcohol
BRCA 1/2
Hormonal therapy
IR
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2
Q

What is the Breast anatomy?

A

Epithelial-ducts and lobules

Stromal- connective tissue

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3
Q

What is the Lymph drainage of breast

A

Laterally to axilla
Medially to IM
From axillary to supraclavicular nodes

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4
Q

What are the three groups of axilla LN?

A

1-Lateral to pec minor
2-under pec minor
3-medial to pec minor

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5
Q

What is ductal carcinoma in situ?

A

Proliferation of malignant cells that does not breach the basement membrane

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6
Q

What is lobular carcinoma in situ

A

Proliferation of malignant cells that does not breach the basement membrane

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7
Q

What is a ductal carcinoma?

A

Proliferation of malignant cells that does breach the basement membrane

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8
Q

What is lobular carcinoma

A

Proliferation of malignant cells that does breach the basement membrane
poorly defined

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9
Q

Natural spread of breast cancer?

A

Carcinoma in situ, invasion of basement membrane, LN then blood vessels

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10
Q

Signs and symptoms of breast cancer?

A

Lumps-benign changes
Asymmetry
changes in size shape
skin and nipple changes

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11
Q

Clinical presentation of cancer?

A

Pain
Nodal disease:oedema, palpable
After mammogram

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12
Q

Early detection

A

Breast checks independent
Mammogram
Checks from doctor

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13
Q

What is the screening group for mammograms?

A

50-69
younger age breast is too dense
older other co morbidities
can display false positives

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14
Q

What is the workup for breast cancer?

A

Mammgram
Ultrasound/mammogram
Surgery
then staging using CT

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15
Q

Staging of breast cancer?

A

Carcinoma in situ
Early stage breast cancer
Locally advanced
Metastatic

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16
Q

Early breast cancer treatment?

A

Surgery
XRT
Chemo
Hormone therapy

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17
Q

What is the benefits of surgery?

A

Primary treatment

Excise all tumour

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18
Q

What are the two types of surgery?

A

Lumpectomy-BCS

Mastectomy- removing whole breast tisuue, fascia and LN.

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19
Q

Is there much difference in survival between mastectomy and BCS?

A

No

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20
Q

Who is BCS not suitable for?

A

Cancer too big
Multifocal disease
Nipple or skin involvement
Locally advanced disease.

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21
Q

What was the standard axillary dissection?

A

level 1 and 2 nodes

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22
Q

What were some morbidity from Axilla surgery?

A

Lymphoedema, wound seroma, haemotoma, infection

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23
Q

What is the sentinel node?

A

First node cancer drains to

lower rates of lymphoedema and false posiives.

24
Q

What is adjuvant treatment?

A

treatment of potential microscopic disease

Local regional or distant

25
Q

What do oestrogen and progesterone do?

A

Oest-stimulate ductal growth
Prog-stimulate lobular development
are overexpressed in breast cancer

26
Q

What is HER 2

A

Growth factor gene

gene amplification in breast cancer

27
Q

What can radiotherapy used for in early breast cancer?

A 
Following BCS
Following mastectomy
reduce local recurrence by 70%
reduce overall recurrence by 50%
reduce death by 17%
28
Q

Do all women who have BCS require RT?

A

Yes reduction in local recurrence

Older late not much clinically better depends on stage of life.

29
Q

Should post masectomy patient undertake RT/

A

YES if large tumour, number of nodes and positive margins.

30
Q

What are the radiotherapy volumes?

A

Whole breast after BCT
Chest wall after masectomy
LN

31
Q

What are the margins for chest wall/breast

A

Med-midline
Sup-clavicle
Inf-1cm inferior to breast tissue
Lat-1cm lateral to breast tissue

32
Q

When should nodal RT be undertaken?

A

High suspicion of cancer

33
Q

Whn should SCF RT be undertaken?

A

If there is a high number of axillary LN present.

34
Q

What is the SCF technique?

A

Tangents to breast
Heavy weight anterior field
in accordance to SCF margins

35
Q

Is axillary RT indicated and what would change?

A

Not if there has been prior surgery may increase lymphoedema

Just extend lateral margin to neck of humerus

36
Q

What indicates Axillary RT?

A

Residual disease in axilla
sentinel node in axilla
less extensive surgery

37
Q

What is the role of IM RT and when is it indicated?

A

No clear evidence
Maybe for high rates of involvement
if sentinel node is IM

38
Q

What are the arguments of IM

A

Technically difficult
Increased toxicity
Isolated IM recurrence is rare
No proven benefit

39
Q

What are the techniques for IM RT?

A

Extend tangents
Match with electron field and move medial border
Highly conformal-IMRT/VMAT

40
Q

When is regional Nodal irradiation indicated?

A

SCF>4 LN
Axilla- high likelihood
IM-medial axillary node where feasible

41
Q

What is the standard fractionation regime?

A

50 in 25 to whole breast and chest wall

42
Q

What are some hypofraction prescriptions?

A

42.5 in 16
40 in 15
41.6 in 13

43
Q

What are the arguments for Hypofractionation?

A

reduction in treatment time

low alpha beta ratio

44
Q

What is the rationale for electron boost?

A

Local recurrence around tumour bed
10 in 5
16 in 8

45
Q

What are some acute toxicities of RT

A

Oedema
skin changes
Fatigue
Pharyngitis

46
Q

What are some late toxicities of RT

A 
fibrosis, 
change in pigmentation, 
telangiectasia-high dose to skin
 nipple retraction.
Rib osteitis
Interstitiual pneumonitis
 heart disease.
Brachial plexopathy
Secondary malignancies
47
Q

How can you reduce toxicities?

A

Ensure surgical wound healed and cellulitis treated
consider fraction size
CT plan
DIBH

48
Q

When can the prone technique be used?

A

Patients with large pendulous breasts/late seps
remove folds
reduce folds

49
Q

What are some prone technique limitations?

A

Not suitable for deep tumours-posterior legions
Heart falls towards the chest wall
Dont treat regional LN

50
Q

Advantages of IMRT breast?

A

Reduces heterogeneities
Conform complex target volumes
May allow treatment of LN with greater sparing
Can treat odd shapes

51
Q

Disadvantages of IMRT

A

Complexity
Respiratory cycle
greater dose to contralateral breast

52
Q

What is the rationale for PBI:

A

Treatment of whole breast
Occurs within 2cm of tumour bed
can hypofractionate it even more reduce dose to lungs and heart.

53
Q

What are some PBI techniques?

A

3DCRT
Brachytherapy
Intra-operative RT-TARGIT

54
Q

What are the PBI results to date?

A

Suggests higher local recurrence
concern fat necrosis, telangiectsia
Under investigation

only for low risk patients

55
Q

What are the main surgeries for early breast cancer?

A

Mastectomy
Wide local excision
Nodes

56
Q

When is adjuvant radiotherapy indicated?

A

For women after a wide local excision
High risk mastectomy women
tangents across nodes if high risk

TM-Radiation Therapy 2 (2 decks)

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