Breast - Treatment options + Prognosis

Question 1

Wide local excision;

Breast-? surgery that can be used providing the breast is of adequate ? and the tumour location not ?/?.
? are checked to ensure they are clear of disease.

Answer 1

conserving
size
central/retroalveolar
margins

Question 2

Simple mastectomy;

Preferred when there are ? tumours (or ? breasts), ? location of the tumour or ? presentation with complications.

Answer 2

large
small
central
late

Question 3

Regional lymph nodes must also be managed, with ? node ? performed;

? is injected into/around the tumour bulk to identify the ? 1/2 nodes that ? the tumour, which are ? and analysed ?.

If negative, it can be assumed that there is ? ? involvement.
If positive, full ? ? is required (20% risk of ?).

Answer 3

sentinel 
biopsy
dye
first
drain
removed
histologically
no nodal
axillary clearance
lymphoedema

Question 4

Further treatment;

Most breast surgery is combined with adjuvant ? for invasive disease.
If there is ? disease, or ? ? tumours, chemotherapy is considered;
o Anthracyclines, ?, ?.

Answer 4

RTx
nodal
high grade
mtx
cyclophosphamide

Question 5

Further treatment;

If the tumour is ER/ HER positive, adjuvant ?/? treatment is given for ? years;
o ? if pre/peri-menopausal (breast-selective ? antagonist).
o ? inhibitors (e.g. letrazole, aromisin, exemestone) if postmenopausal, to stop ? ? production.
o ? (?) if HER2 positive (?%).
—>• This is always combined with ?.

Answer 5

hormonal
biologic
5
tamoxifen
ER
aromatase
peripheral oestrogen
herceptin
traztuzumab
25%
CTx

Question 6

Breast ? surgery can be performed at the same time or a later stage.
In ? disease, surgery is generally limited to procedures used for ?control. Medical treatment plus radiotherapy may be used for ? .

Answer 6

reconstruction
met
sx
palliation

Question 7

Tumour ?, ? status, ?, ER/?R status, and ? invasion all affect prognosis.

The ? ? ?(NPI) is widely used to assess survival and risk of ?, helping to select appropriate ? therapy;

Answer 7

size
nodal
grade
P
vascular
notts prognostic index
relapse
adjuvant

Question 8

NPI = (tumour ? x 0.2) + histological ? + ? status.

Tumour size is measured in ?.

Grade of ? is scored from 1-3 by the histologists.

Nodal status is also scored from 1-3;
o No nodes= 1, 1-? nodes= 2, >? nodes= 3.

Higher the NIP = ? the prog

Answer 8

size
grade
nodal
cm
differentiation
3
3

worse