Ix and management of Breast cancer

Question 1

which factors effect prognosis of breast cancer?

Answer 1

1. tumor grade and differentiation
2. histology
3. lymph node status
4. Oestrogen receptor expression
5. HER2 status

Question 2

What are the 3 surgical management options?

Answer 2

1. Breast conservation
   - Wide local excision of the lump
2. Masectomy - removal of the whole breast
3. Sentinal node biopsy/axillary clearance

Question 3

When is WLE indicated?

Answer 3

1. small tumors < 5 cm
2. Invasive or non invasive breast cancer
3. accompanied by post operative radiotheray

Question 4

When is a masectomy indicated?

Answer 4

1. wide spread disease and tumor > 5 cm

2. high risk family history

Question 5

simple vs skin sparing masectomy?

Answer 5

1. skin sparing - remove all redundant skin with breast tissue
2. remove just breast parenchyma and immediate reconstruction // nipple remains

Question 6

What is a sentinal node biopsy and when is it indicated?

Answer 6

1. determined if lymph node involvement
2. injection of blue dye allows the sentinel node to be identified and then biopsied, if clear than the rest of the lymphatic trunk it is associated with is also clear.

Question 7

How is lymph node status assessed?

Answer 7

1. Sentinel node biopsy

2. followed by axillary clearance surgery

Question 8

What follows surgery for breast cancer?

Answer 8

Post operative radiotherapy is key in apreventing recurrence

Question 9

How is endocrine therapy initiated?

Answer 9

oestrogen/HER2 receptor status of the malignant cells is determined histologically after a biopsy

2. receptor positive tumors have a better prognosis

Question 10

Name 2 anti oestrogen hormone therapies?

Answer 10

1. Tamoxifen
   anti oestrogen
2. Aromatase inhibitors (anastrozole)
   - blocks oestrogen synthesis

Question 11

What are the side effects of tamoxifen use?

Answer 11

1. increases risk of endometrial cancer
2. VTE
3. menopausal symptoms

Question 12

what is the anti HER2 receptor drug called?

Answer 12

Tratuzumab (Herceptin)

2. monoclonal antibody that blocks HER2 receptors on the surface of the tumor cells and slows growth

Question 13

Name 3 classes of adjuvant treatments?

Answer 13

1. Hormonal therapies
2. Radiotherapy - chestwall/breast after WLE/masectomy to reduce recurrence
3. Chemotherapy - for v poor prognosis of breast cancer