plenary Flashcards
limitations of mammogram
- subjective
- lack of consistency in positioning
- missing cancers in periphery if exposure not adequate
- dense breast
- can be uncomfortable
multi disciplinary team
Improves communication, coordination and decision making
Improved care
Up to date with evidence based practice
Breast Surgeons/Oncologists/Pathologist/Radiologists/Cancer Nurse Specialists/Mammographers/Plastic Surgeons/MDT coordinator/Research Nurses
breaking bad news
Setting
Quiet room/Adequate privacy
Involve your Cancer Nurse Specialist
Avoid distractions: pagers/ Phones
Assess patients perception
Before you tell, ask
Warning shots may lessen the shock
Address patients emotions with empathy
Silence to disbelief, crying, denial or anger
- offer contact number
- offer follow up consultation
surgery
Breast Conservation Surgery
Wide Local Excison
Oncoplastic Procedures
Mastectomy
Reconstruction
Immediate or delayed
magseed marked wide local excision
Stainless stell Pellet 5x1mm Seed is not magnetic Temporarily magnetised by Sentimag Probe 18 Gauge Deployment USS visible Can be placed under US/Mammo/Tomo guidance
staging TNM
Early Stage ( Cancer not beyond breast and regional LNs)
Stage 0
DCIS
Stage 1
Stage 2
Locally Advanced Breast Cancer
Stage 3
Inflammatory Breast Cancer
Advanced Breast Cancer
Stage 4
5 year survival
Stage 1
98%
Stage 2
90%
Stage 3
70%
Stage 4
25%
endocrine treatment
Oestrogen receptor SERM ( Selective Estrogen Receptor Modulator) Tamoxifen,Raloxifene Aromatase inhibitors Letrozole,Anastrozole,Exemestane
Second line endocrine Treatment Everolimus PI3K/AKTmTOR pathway down regulator Palbociclib,ribociclib CDK4/6 inhibitors
anti her 2 treatment
Her 2 marker
20-25% breast cancer shows Her 2 protein overexpression
Trastuzumab
Pertuzumab
neoadjuvant therapy
NACT ( Neoadj Chemotherapy)
NAET ( Neoadj Endocrine Therapy)
Rarely RT
metastatic cancer
Symptom directed investigation and treatment
Mostly palliative treatment
Longer survival in oligometastatic disease
