Breast surgery / treatment Flashcards
Describe the options for breast conservation surgery?
- wide local excision
- image guided local excision
- oncoplastic breast surgery
Describe what other treatments are given along side breast conservative surgery?
- chemotherapy
- endocrine therapy
- radiotherapy
What is the typical endocrine therapy given to breast cancer post-menopausal?
- aromatase imhibitors
- e.g. anastrozole
What type of endocrine therapy is given pre-menopausal?
- tamoxifen
Describe image guided local excision?
- non-palpable mass
- wires/clips radiologically inserted as guidance for surgical localisation
- magnetic seeds and radiofrequency can also be used
Describe oncoplastic breast surgery?
- safe oncological surgery while avoiding tissue deformity
- reshapes breast at time of surgery
- therapeutic mastopexy
- therapeutic reduction mammoplasty
- volume replacement
What type of conservative surgery could be done in a woman with smaller breasts?
- oncoplastic surgery = volume replacement
Aim of conservative breast surgery?
- clear margins >1mm + breast radiotherapy
Types of immediate mastectomy defect surgeries?
- aim to do at the time of the mastectomy
- implant reconstruction
- latissimus dorsi flap
- tummy flap
How are axillary nodes staged?
- sentinel node biopsy
Options to treat affected axillary nodes?
- axillary clearance
- axillary radiotherapy
Potential risk of an axillary clearance or axillary radiotherapy?
- lymphadema
Describe luminal A breast cancer?
- ER positive
- HER 2 negative
- best prognosis
Describe triple negative breast cancer (TNBC)
- ER, PR, HER2 negative
- worse prognosis
Indications for neoadjuvant chemotherapy
- downsizing a tumour
- locally advanced breast cancer
- large primary tumour
Adjuvant chemotherapy indications
- risk of relapse
- tumour extent
- high grade
- proliferation
- vascular invasion
What does the NHS PREDICT score include?
- age
- ER/PR / HER2 status
- Ki-67
- symptomatic or asymptomatic
When is genomic testing offered
- only for ER positive breast cancer
Acute side effects of chemotherapy?
- fatigue
- myelosuppression
- nausea/vomiting
- alopecia
Treatment of low risk ER positive breast cancer?
- tamoxifen or AI for 5 years
Treatment of high risk ER positive breast cancer?
- extended adjuvant AI
Late side effects of chemotherapy
- cardio-toxcity
- infertility
- neuropathy
HER 2 drug treatment?
- monoclonal antibodies (trastuzumab, pertuzumab)
- antibody drug conjugates
- kinase inhibitors
Side effects of HER 2 drugs?
- heart failure
- diarrhoea
- hand and foot syndrome
- interstitial lung disease
When is adjuvant bishosphonates recomended
- recommend for post-menopausal woman for bone protection
Indications for adjuvant radiotherapy
- reduce locoregional recurrence rates
- overall survival rates increase
