treatment of breast cancer

Question 1

treatment of DCIS?

Answer 1

either breast conservation surgery or mastectomy + radiotherapy to the whole breast over 3 weeks

Question 2

treatment for early invasive cancer?

Answer 2

RADIOTHERAPY FOLLOWING BREAST CONSERVING SURGERY
Irradiation of Breast alone:
-Negative sentinel node biopsy (SNB)
-Nodes containing micrometastases only (>0.2mm but <2mm) in SNB
-< 4 nodes involved in an adequate axillary node clearance

Boost to tumour bed

• Women under the age of 54 on the day of surgery
• Posterior margin <1mm for invasive disease after full thickness excision

RADIOTHERAPY FOLLOWING MASTECTOMY
Chest wall radiotherapy
-Tumour size > 5 cm
-4 or more involved nodes
-Involved resection margins
-T4 disease

RADIOTHERAPY TO THE IPSILATERAL AXILLA

• > 1 positive macrometastases sentinel node
• Extensive ECS post axillary clearance

RADIOTHERAPY TO THE SUPRACLAVICULAR FOSSA
-4 or more involved nodes

Question 3

give two hormone based therapies

Answer 3

If tumour is ER positive
Tamoxifen-premenopausal women
Letrozole- only in postmenopausal women, blocks oestrogen production from adipose tissue

Question 4

name the drug given in the over expression of HER-2

Answer 4

trastuzumab

Question 5

locally advanced cancer treatment

Answer 5

consider radiotherapy for primary tumour that is considered inoperable and the consider surgery after

Question 6

treatment for metastatic disease

• visceral disease?
• bone disease?

Answer 6

• give chemo

- hormonal treatment