Management of breast cancer Flashcards
What are the different forms of management of breast cancer?
surgery
radiotherapy
hormone therapy
biological therapy
chemotherapy
Who may not be offered surgery?
Very frail, elderly lady with metastatic disease
What is done prior to surgery in women with breast cancer in women with no palpable axillary lymphadenopathy?
Pre-operative axillary ultrasound
If the pre-operative axillary ultrasound is positive, what is then done?
Sentinel node biopsy
What is a sentinel node biopsy done to assess?
The nodal burden
What is done prior to surgery in women with breast cancer in women with palpable axillary lymphadenopathy?
Axillary node clearance
What are the possible side effects of axillary node clearance?
Arm lymphedema
Functional arm impairment
What are the 2 forms of surgery that can be done for someone with breast cancer?
Wide local excision
Mastectomy
When might you carry out a wide local excision rather than a mastectomy?
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS <4cm
When might you carry out a mastectomy rather than a wide local excision?
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS>4cm
When is radiotherapy recommended for women after surgery?
Whole breast radiotherapy is recommended after a woman has had a wide-local excision
What is the purpose of radiotherapy after a wide local excision?
Reduce the risk of recurrence by around two-thirds
When might someone be offered radiotherapy if they have had a mastectomy?
T3-T4 tumours
or
Four or more positive axillary nodes
When might adjuvant hormonal therapy be offered in the management of breast cancer?
If tumours are positive for hormone receptors
What are the main three hormonal receptors in breast cancer?
Oestrogen (ER)
Progesterone (PR)
HER2 (human epidermal growth factor receptor type 2)
How are hormonal receptors detected in breast cancer?
Via breast pathology
What hormonal therapy would you give for ER positive (oestrogen) tumours in premenopausal women?
Tamoxifen
What type of drug is tamoxifen?
oestrogen receptor antagonist
What hormonal therapy would you give for ER positive (oestrogen) tumours in postmenopausal women?
Anastrozole
What is anastrozole?
Aromatase inhibitor
What hormonal therapy would you give for HER2 positive tumours?
Trastuzumab (Herceptin)
In which patients can Trastuzumab (Herceptin) not be used?
In patients with a history of heart disorders.
What are the possible side effects of tamoxifen?
Increased risk of endometrial cancer
Venous thromboembolism
Menopausal symptoms.
What menopausal symptoms can tamoxifen possibly cause?
Hot flushes
Nausea
Vaginal bleeding and discharge
Weight gain
What is the role of chemotherapy in breast cancer?
Can be used prior to surgery or after surgery
When might chemotherapy be used prior to breast can surgery?
To downstage a primary lesion
When might chemotherapy be used after breast can surgery?
Stage of the tumour, for example, if there is axillary node disease
What form of chemotherapy is used if there is axillary lymph node disease?
FEC-D is used in this situation.
