Non-surgical management of breast cancer

Question 1

Benefit of postoperative radiotherapy

Answer 1

Reduces risk of local recurrence by about a half

Question 2

When is radiotherapy used as adjuvant to mastectomy?

Answer 2

High risk patients i.e. Large tumour; extensive nodal involvement; involved margins

Question 3

Acute side-effects of radiotherapy

Answer 3

Skin erythema and moist desquamation
Tiredness
Dysphagia

Question 4

When might dysphagia be seen as a side effect of radiotherapy/

Answer 4

If supraclavicular fossa is irradiated

Question 5

What does moist desquamation look like?

Answer 5

Thin, red, weeping skin

Question 6

Late side effects of radiotherapy

Answer 6

Skin fibrosis and telangiectasia
Lung fibrosis
Ischaemic heart disease (rarer now)

Question 7

Endocrine adjuvant therapy

Answer 7

Tamoxifen (block ER)
Aromatase inhibitors (prevent oestrogen synthesis)
Ovarian ablation

Question 8

Systemic adjuvant therapy in a HER2+ tumour

Answer 8

Trastuzumab

Question 9

Tamoxifen is mainly used for…

Answer 9

Pre-menopausal women, or post menopausal women with a low recurrence risk

Question 10

Aromatase inhibitors are mainly used for…

Answer 10

Post-menopausal women

Question 11

Side effects from hormone therapy

Answer 11

Infertility
Menopausal symptoms
Weight gain

Question 12

Chemotherapy side effects

Answer 12

Nausea and vomiting
Infertility
Alopecia
Neutropenia
Mouth ulcers
Lethargy

Question 13

Median survival with mets from breast cancer

Answer 13

2 years