Management of breast cancer

Question 1

What are the different forms of management of breast cancer?

Answer 1

surgery
radiotherapy
hormone therapy
biological therapy
chemotherapy

Question 2

Who may not be offered surgery?

Answer 2

Very frail, elderly lady with metastatic disease

Question 3

What is done prior to surgery in women with breast cancer in women with no palpable axillary lymphadenopathy?

Answer 3

Pre-operative axillary ultrasound

Question 4

If the pre-operative axillary ultrasound is positive, what is then done?

Answer 4

Sentinel node biopsy

Question 5

What is a sentinel node biopsy done to assess?

Answer 5

The nodal burden

Question 6

What is done prior to surgery in women with breast cancer in women with palpable axillary lymphadenopathy?

Answer 6

Axillary node clearance

Question 7

What are the possible side effects of axillary node clearance?

Answer 7

Arm lymphedema
Functional arm impairment

Question 8

What are the 2 forms of surgery that can be done for someone with breast cancer?

Answer 8

Wide local excision
Mastectomy

Question 9

When might you carry out a wide local excision rather than a mastectomy?

Answer 9

Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS <4cm

Question 10

When might you carry out a mastectomy rather than a wide local excision?

Answer 10

Multifocal tumour
Central tumour
Large lesion in small breast
DCIS>4cm

Question 11

When is radiotherapy recommended for women after surgery?

Answer 11

Whole breast radiotherapy is recommended after a woman has had a wide-local excision

Question 12

What is the purpose of radiotherapy after a wide local excision?

Answer 12

Reduce the risk of recurrence by around two-thirds

Question 13

When might someone be offered radiotherapy if they have had a mastectomy?

Answer 13

T3-T4 tumours
or
Four or more positive axillary nodes

Question 14

When might adjuvant hormonal therapy be offered in the management of breast cancer?

Answer 14

If tumours are positive for hormone receptors

Question 15

What are the main three hormonal receptors in breast cancer?

Answer 15

Oestrogen (ER)
Progesterone (PR)
HER2 (human epidermal growth factor receptor type 2)

Question 16

How are hormonal receptors detected in breast cancer?

Answer 16

Via breast pathology

Question 17

What hormonal therapy would you give for ER positive (oestrogen) tumours in premenopausal women?

Answer 17

Tamoxifen

Question 18

What type of drug is tamoxifen?

Answer 18

oestrogen receptor antagonist

Question 19

What hormonal therapy would you give for ER positive (oestrogen) tumours in postmenopausal women?

Answer 19

Anastrozole

Question 20

What is anastrozole?

Answer 20

Aromatase inhibitor

Question 21

What hormonal therapy would you give for HER2 positive tumours?

Answer 21

Trastuzumab (Herceptin)

Question 22

In which patients can Trastuzumab (Herceptin) not be used?

Answer 22

In patients with a history of heart disorders.

Question 23

What are the possible side effects of tamoxifen?

Answer 23

Increased risk of endometrial cancer
Venous thromboembolism
Menopausal symptoms.

Question 24

What menopausal symptoms can tamoxifen possibly cause?

Answer 24

Hot flushes
Nausea
Vaginal bleeding and discharge
Weight gain

Question 25

What is the role of chemotherapy in breast cancer?

Answer 25

Can be used prior to surgery or after surgery

Question 26

When might chemotherapy be used prior to breast can surgery?

Answer 26

To downstage a primary lesion

Question 27

When might chemotherapy be used after breast can surgery?

Answer 27

Stage of the tumour, for example, if there is axillary node disease

Question 28

What form of chemotherapy is used if there is axillary lymph node disease?

Answer 28

FEC-D is used in this situation.