Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cancer Care > Treatment Of Breast Cancer > Flashcards

Treatment Of Breast Cancer Flashcards

1
Q

All breast lumps should undergo …

A

Triple assessment procedure - hospital based assessment clinic that allows the early and rapid detection of breast cancer
Women and men can be referred by GP to this one stop clinic if they have signs or symptoms that meet the breast cancer 2 week wait or if suspicious findings on screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What steps are involved in the triple assessment ?

A

Clinical assessment - history and examination
Imaging - mammography or USS
Histology - code biopsy or FNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does mammography involve?

A

Compression views of the breast across two views - oblique and craniocaudal
Allowing for detection of mass lesions or microcalcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Who is USS more useful for ?

A

Women <35 and in men
Due to the density of the breast tissue in identifying anomalies
Also used during core biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is MRI used in triple assessment?

A

Not routinely
Can be useful in assessment of lobular breast cancers and in assessing response to neoadjuvant therapy
High sensitivity but low specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the difference between core biopsy and FNA?

A

Core biopsy gives full histology - allowing differentiation between invasive and in situ carcinoma
FNA only provides cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens at each stage of the triple assessment?

A

The suspicion of malignancy is graded to create overall risk index - establish whether likely benign lesion or if patient should go onto have more definitive biopsy and further intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the scoring that occurs at the triple assessment

A 
Examination:
P1 - normal 
P2 - benign 
P3 - uncertain/ likely benign 
P4 - suspicious of malignancy 
P5 - malignant

Imaging score
M1/U1 - normal
M2/U2 - benign
Etc

Histology score
B1- normal
B2 - benign
Etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where will the treatment plan be developed?

A

MDT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does adjuvant mean?

A

After surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does neo-adjuvant mean?

A

Before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does palliative mean?

A

Symptom control

Not curative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Surgical breast conserving treatment is only suitable for…

A

Localised, operable disease

No evidence of metastatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common surgical breast conserving treatment?

A

Wide local excision (WLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe wide local excision

A

Excision of tumour typically ensuring a 1cm margin of macroscopically normal tissue is taken along with the malignancy

Chosen if:

  • solitary lesion
  • peripheral tumour
  • small lesion in large breast
  • DCIS <4cm
  • patient choice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a mastectomy?

A

Removes all the tissue of the affected breast along with significant portion of overlying skin (muscles of chest wall left intact)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When are mastectomies indicated?

A 
Multi focal disease 
High tumour:breast tissue ratio 
Disease recurrence 
Patient choice 
Risk reducing cases - strong FH of breast cancer/ ovarian cancer, positive gene mutations, previous history of breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is axillary surgery performed?

A

Often alongside WLE and mastectomy to assess nodal status and remove any nodal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a sentinel node biopsy?

A

Removal first few lymph nodes into which tumour drains
The nodes are identified by injecting blue dye with associated radioisotope into peri-areolar skin
Radio activity detection/ visual assessment (as nodes become blue) can identify sentinel nodes - removed and sent for histological analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is axillary node clearance?

A

Removing all nodes in axilla
Ensuring not to damage important structures in axilla
Send for histological analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What common complications can occur from axillary node clearance?

A

Paraesthesia
Seroma formation
Lymphoedema in upper limb and functional arm impairment

22
Q

Outline the treatment for early stage disease

A

Early stage = localised tumours without metastatic spread

WLE or mastectomy
Axillary node sampling at least (e.g sentinel node biopsy) but usually axillary node clearance
Adjuvant radiotherapy to chest wall (recommended for all with invasive cancer after WLE)
RT to axilla if positive nodes on sampling and node clearance not performed
Adjuvant chemotherapy improves survival particularly in young with node positive disease (consider in all expect excellent prognosis patients)
Tamoxifen and herceptin also have a role

23
Q

What are side effects of RT to chest wall or axilla?

A 
Pneumonitis
Rib fracture
Pericarditis
Lymphoedema 
Brachial plexus injury
24
Q

Medical treatment is commenced usually after primary surgery, yet it can be the treatment of choice in…

A

Elderly patients

Those unfit for surgery

25
Q

What medication treatment options are there (not surgery)?

A

Chemotherapy
Radiotherapy
Immunotherapy
Hormone therapy - biggest contributor to improved survival

26
Q

What hormone treatments are there?

A

Tamoxifen

Aromatase inhibitors

27
Q

Who is tamoxifen typically given to?

A

Pre-menopausal patients

28
Q

How does tamoxifen work?

A

Blockade of oestrogen receptors - so lack of DNA synthesis inside cancer cells
Affected cell remains in G0/G1 phases of cell cycle
It is a selective oestrogen selective modulator (SERM)

29
Q

What does tamoxifen increase the risk of?

A

Thromboembolism during and after surgery or periods of immobility
In bone and endometrial tissue = oestrogen agonist - improves bone density (positive) but increases risk of endometrial cancer

30
Q

How do aromatase inhibitors work?

A

Bind to oestrogen receptors - prevent further malignant growth and prevent further oestrogen production
Block the conversion of androgens to oestrogen in peripheral tissue

31
Q

Who are aromatase inhibitors typically given to?

A

Post menopause patients as adjuvant therapy

Pre menopausal women majority of oestrogen production occurs in ovary, but in post-menopausal women majority occurs in adrenals - from conversion of androgens
- aromatase inhibitors inhibit the conversion of androgens to oestrogen in adrenals, so only suitable in post-menopausal women

32
Q

Immunotherapy is used in those whose…

A

Cancers express specific growth factor receptors

33
Q

What is herceptin?

A

Also know as Trastuzumab

Monoclonal antibody that targets human epidermal growth factor receptor (HER2 positive malignancies)

34
Q

How is herceptin used?

A

As adjuvant or monoclonal therapy in those who have had at least 2 chemotherapy regimes for metastatic breast cancer

35
Q

What is a common side effect of herceptin?

A

Cardiotoxicity - need to monitor cardiac function before and during treatment
ECHO

36
Q

What are some examples of aromatase inhibitors?

A

Anastrozole
Letrozole
Exemestane

37
Q

What are the side effects of tamoxifen?

A 
Fatigue
Hot flushes
Mood changes
Cardiovascular- VTE risk increased 
Fatty liver
Reduced libido
38
Q

How is herceptin usually given?

A

IV every 3 weeks

39
Q

What does a triple negative tumour mean?

A

Not oestrogen receptor, progesterone receptor or HER2 receptor positive

These tumours have worst prognosis - target therapies not effective

40
Q

Outline the treatment plan for advanced disease

A

Advanced= locally advanced cancers that cannot be cured with surgery alone and metastatic breast cancer

Surgery
Chemotherapy plus specific treatment dependant on molecular type e.g hormone therapy or immunotherapy
Localised treatment options e.g RT for individual bony met pain

41
Q

What percentage of breast cancers will express oestrogen receptors?

A

75%

42
Q

The fact that a tumour is receptor positive, indicates a higher or lower level of cell differentiation?

A

Higher - hasn’t differentiated to an extent as to become unrecognisable

43
Q

Where does breast cancer typically spread to?

A 
Lungs 
Bones
Liver
Brain 
Adrenals
44
Q

Radiotherapy after WLE reduces risk of disease reoccurrence from 30% to…

A

10%

45
Q

Tamoxifen can cause uterine cancer in rare cases, so what symptom should you warn the patient of?

A

Vaginal bleeding - should report

46
Q

Is radiotherapy offered to women who have had a mastectomy?

A

If T3 or T4 tumours and for those with 4 or more positive axillary nodes

47
Q

Why might chemotherapy be used before surgery (neoadjuvant)?

A

To downstage a primary lesion before surgery - may allow breast conserving surgery rather than mastectomy

48
Q

Axillary node clearance is associated with what percentage risk of lymphoedema and functional arm impairment?

A

14%

49
Q

What is the most important side effect of aromatase inhibitors?

A

Osteoporosis

50
Q

How are BRCA gene mutations inherited?

A

Autosomal dominant
Having one part with mutation results in 50% chance of that gene being passed onto child
There is 50% chance of sibling having the gene

51
Q

What is a seroma?

A

A mass or lump caused by the build up of lymph fluid at the site of the surgery

Cancer Care (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions