breast treatment Flashcards
How is the severity of breast cancer measured?
Staging the severity done by:
FBC, U&Es, LFTs, Ca2+/PO2
- Chest x-ray
- Others as clinically indicated
- No reliable tumour markers
What classification system is used for breast cancer?
TNM
Explain T staging for breast cancer?
Explain N staging for breast cancer?
- N0 – no regional lymph nodes palpable
- N1 - regional lymph nodes palpable and mobile
- N2 – regional lymph nodes palpable and fixed
Explain M staging for breast cancer?
Mx – distant metastases cannot be assessed
- M0 – no distant metastases
- M1 – distant metastasis
What is neo-adjuvant?
Neo-adjuvant = treatment before surgery
What is adjuvant?
Adjuvant = treatment after surgery
Describe the management for breast cancer?
Surgery
Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
- Masectomy – simple or skin sparing mastectomy
Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla - If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damagePrevention/adjuvant treatment
\+/- radiotherapy
- Over 3 weeks
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
\+/- chemotherapy
- Anthracycline combinations (dexorubican or epirubicin)
- Taxane based combinations (ocetaxel)
Indications – benefit best in younger woman (<50 years) and patients with increasing adverse prognostic factors (grade 3, LN pos, ER neg, Her2 pos)\+/- hormonal therapy
- Only given to oestrogen receptor positive cancers
- Blocks stimulation of cell growth by oestrogen
Tamoxifen - Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
Aromatase inhibitors (arimidex and letrozole)
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
\+/- biologics Trastuzumab - Monoclonal antibody against Her2 receptor
- Indication – only given to patients with over expression of Her2 and chemotherapy
What surgery can be done for breast cancer?
Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishesMasectomy – simple or skin sparing mastectomy
Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla - If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
What are indications for breast conservation surgery?
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
What are the 2 different kinds of masectomy?
- Masectomy – simple or skin sparing mastectomy
Why is surgery done to the axilla?
- Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla
What are possible complications of surgery to the axilla?
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
What is done after surgery to the axilla if:
- sentinal node is negative
- sential node is postiive?
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
What are possible complications of radiotherapy?
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
What chemotherapy is used for breast cancer?
- Anthracycline combinations (dexorubican or epirubicin)
* Taxane based combinations (ocetaxel)
What are indications for chemotherapy in breast cancer?
Indications – benefit best in younger woman (<50 years) and patients with increasing adverse prognostic factors (grade 3, LN pos, ER neg, Her2 pos)
Who is hormonal therapy given to?
- Only given to oestrogen receptor positive cancers
How does hormonal therapy work?
- Blocks stimulation of cell growth by oestrogen
What hormonal therapy drugs can be given for breast cancer?
Tamoxifen
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic eventsAromatase inhibitors (arimidex and letrozole)
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
For tamoxifen:
- action
- indication
- side effects
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
For aromatase inhibitors:
- action
- contraindications
- side effects
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
What biologic can be used for breast cancer?
Trastuzumab
- Monoclonal antibody against Her2 receptor
- Indication – only given to patients with over expression of Her2 and chemotherapy
What are indications for biologics (trastuzumab) for breast cancer)?
- Indication – only given to patients with over expression of Her2 and chemotherapy
What follow up is done after management of breast cancer?
- Mammogram of breasts every year for 3-10 years
* Clinical examination for 1-5 years
What is used to assess disease recurrence risk?
Nottingham prognostic index
Lymph node involvement Tumour grade Tumour size
What are factors increasing risk of breast cancer recurrence?
Nottingham prognostic index
Lymph node involvement Tumour grade Tumour size Steroid receptor status
- Negative ER/PR higher risk)Her2 status
- Positive higher risk
- Lymphovascular invasion
