Breast surgery / treatment

Question 1

Describe the options for breast conservation surgery?

Answer 1

• wide local excision
• image guided local excision
• oncoplastic breast surgery

Question 2

Describe what other treatments are given along side breast conservative surgery?

Answer 2

• chemotherapy
• endocrine therapy
• radiotherapy

Question 3

What is the typical endocrine therapy given to breast cancer post-menopausal?

Answer 3

• aromatase imhibitors

- e.g. anastrozole

Question 4

What type of endocrine therapy is given pre-menopausal?

Answer 4

• tamoxifen

Question 5

Describe image guided local excision?

Answer 5

• non-palpable mass
• wires/clips radiologically inserted as guidance for surgical localisation
• magnetic seeds and radiofrequency can also be used

Question 6

Describe oncoplastic breast surgery?

Answer 6

• safe oncological surgery while avoiding tissue deformity
• reshapes breast at time of surgery
• therapeutic mastopexy
• therapeutic reduction mammoplasty
• volume replacement

Question 7

What type of conservative surgery could be done in a woman with smaller breasts?

Answer 7

• oncoplastic surgery = volume replacement

Question 8

Aim of conservative breast surgery?

Answer 8

• clear margins >1mm + breast radiotherapy

Question 9

Types of immediate mastectomy defect surgeries?

Answer 9

• aim to do at the time of the mastectomy
• implant reconstruction
• latissimus dorsi flap
• tummy flap

Question 10

How are axillary nodes staged?

Answer 10

• sentinel node biopsy

Question 11

Options to treat affected axillary nodes?

Answer 11

• axillary clearance

- axillary radiotherapy

Question 12

Potential risk of an axillary clearance or axillary radiotherapy?

Answer 12

• lymphadema

Question 13

Describe luminal A breast cancer?

Answer 13

• ER positive
• HER 2 negative
• best prognosis

Question 14

Describe triple negative breast cancer (TNBC)

Answer 14

• ER, PR, HER2 negative

- worse prognosis

Question 15

Indications for neoadjuvant chemotherapy

Answer 15

• downsizing a tumour
• locally advanced breast cancer
• large primary tumour

Question 16

Adjuvant chemotherapy indications

Answer 16

• risk of relapse
• tumour extent
• high grade
• proliferation
• vascular invasion

Question 17

What does the NHS PREDICT score include?

Answer 17

• age
• ER/PR / HER2 status
• Ki-67
• symptomatic or asymptomatic

Question 18

When is genomic testing offered

Answer 18

• only for ER positive breast cancer

Question 19

Acute side effects of chemotherapy?

Answer 19

• fatigue
• myelosuppression
• nausea/vomiting
• alopecia

Question 20

Treatment of low risk ER positive breast cancer?

Answer 20

• tamoxifen or AI for 5 years

Question 21

Treatment of high risk ER positive breast cancer?

Answer 21

• extended adjuvant AI

Question 22

Late side effects of chemotherapy

Answer 22

• cardio-toxcity
• infertility
• neuropathy

Question 23

HER 2 drug treatment?

Answer 23

• monoclonal antibodies (trastuzumab, pertuzumab)
• antibody drug conjugates
• kinase inhibitors

Question 24

Side effects of HER 2 drugs?

Answer 24

• heart failure
• diarrhoea
• hand and foot syndrome
• interstitial lung disease

Question 25

When is adjuvant bishosphonates recomended

Answer 25

• recommend for post-menopausal woman for bone protection

Question 26

Indications for adjuvant radiotherapy

Answer 26

• reduce locoregional recurrence rates

- overall survival rates increase