Treating Breast Cancer Flashcards
When did the clinical trials comparing the use of radical mastectomy and wide excision with XRT occur?
Between the 1970s and 1980s
How do the survival rates between wide local excision+XRT and mastectomy compare?
They are equivalent
How does breast cancer kill you?
The metastatic spread of breast cancer is what causes death, not the lump alone. This is why the use of XRT is so important.
When was Tamoxifen first discovered and what was it originally developed as?
As an oral contraceptive in the 1960s
When was the first oncological clinical trial for the use of tamoxifen in breast cancer?
1971 at The Christie
Which women always get offered the use of chemotherapy in their breast cancer treatment?
Women who are at risk of micrometasteses
What is the sentinel lymph node?
The very first lymph node on the pathway of lymphatic drainage from the site of the tumour/malignancy.
When do we offer women with breast cancer sentinel lymph node biopsy?
When they are asymptomatic of nodal or metastatic spread of the cancer. The biopsy is then sent for histology and analysed. If cancer is detected then there is need for axillary node clearance
What is the purpose of sentinel node biopsy?
To reduce the occurrence of lymphoedema following axillary node clearance which is a long term consequence of full nodal clearance.
How do we identify the sentinel lymph node?
We inject the site of the tumour with blue dye and this will travel to the sentinel lymph node
What are 3 indications for the need of a mastectomy for breast cancer treatment?
- Multifocality; if there is more than 1 tumour in the breast, it may not be appropriate to perform a wide local incision as the surgery will be too complex and the breast may be left looking very unlike the contralateral side.
- Recurrence locally - if original treatment has been unsuccessful, a mastectomy may be necessary
- DCIS or invasion of >4cm - the tumour may be very large or infiltrative. This is also dependent on breast size. If the breast is small and the tumour is big in comparison, then lumpectomy would be difficult
- Inflammatory breast cancer - very aggressive and involves the skin so mastectomy is needed.
- BrCa mutations
What 3 characteristics of cancer are used to determine its stage?
- Tumour size (T)
- Nodal involvement (N)
- Metastatic spread (M)
When a breast cancer is classed as ‘Triple negative’ what is the cancer negative for?
The cancer is negative for the presence of;
- Oestrogen receptors
- Progesterone receptors
- HER2 receptors
What is the consequence for treatment when a breast cancer is triple negative?
This means the cancer will be unresponsive to any of the hormonal or endocrine treatments. The patient will only be able to have surgery, radiotherapy and some chemotherapies.
