Treatment of Breast Disease Flashcards
How is the severity of breast cancer measured?
Staging the severity done by:
- FBC, U&Es, LFTs, Ca2+/PO2
- Chest x-ray
- Others as clinically indicated
- No reliable tumour markers
What classification system is used for breast cancer?
TNM
Explain T staging for breast cancer?
Explain N staging for breast cancer?
- N0 – no regional lymph nodes palpable
- N1 - regional lymph nodes palpable and mobile
- N2 – regional lymph nodes palpable and fixed
Explain M staging for breast cancer?
- Mx – distant metastases cannot be assessed
- M0 – no distant metastases
- M1 – distant metastasis
What is neo-adjuvant?
Neo-adjuvant = treatment before surgery
What is adjuvant?
Adjuvant = treatment after surgery
Describe the management for breast cancer?
- Surgery
- Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
- Masectomy – simple or skin sparing mastectomy
- Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
- Breast conservation surgery
- Prevention/adjuvant treatment
- +/- radiotherapy
- Over 3 weeks
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
- +/- chemotherapy
- Anthracycline combinations (dexorubican or epirubicin)
- Taxane based combinations (ocetaxel)
- Indications – benefit best in younger woman (<50 years) and patients with increasing adverse prognostic factors (grade 3, LN pos, ER neg, Her2 pos)
- +/- hormonal therapy
- Only given to oestrogen receptor positive cancers
- Blocks stimulation of cell growth by oestrogen
- Tamoxifen
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
- Aromatase inhibitors (arimidex and letrozole)
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
- +/- biologics
- Trastuzumab
- Monoclonal antibody against Her2 receptor
- Indication – only given to patients with over expression of Her2 and chemotherapy
- Trastuzumab
- +/- radiotherapy
What surgery can be done for breast cancer?
-
Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
- Masectomy – simple or skin sparing mastectomy
-
Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
What are indications for breast conservation surgery?
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
What are the 2 different kinds of masectomy?
- Masectomy – simple or skin sparing mastectomy
Why is surgery done to the axilla?
- Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla
What are possible complications of surgery to the axilla?
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
What is done after surgery to the axilla if:
- sentinal node is negative
- sential node is postiive?
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
What are possible complications of radiotherapy?
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
What chemotherapy is used for breast cancer?
- Anthracycline combinations (dexorubican or epirubicin)
- Taxane based combinations (ocetaxel)
What are indications for chemotherapy in breast cancer?
- Indications – benefit best in younger woman (<50 years) and patients with increasing adverse prognostic factors (grade 3, LN pos, ER neg, Her2 pos)
Who is hormonal therapy given to?
- Only given to oestrogen receptor positive cancers
How does hormonal therapy work?
- Blocks stimulation of cell growth by oestrogen
What hormonal therapy drugs can be given for breast cancer?
-
Tamoxifen
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
-
Aromatase inhibitors (arimidex and letrozole)
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
For tamoxifen:
- action
- indication
- side effects
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
For aromatase inhibitors:
- action
- contraindications
- side effects
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
What biologic can be used for breast cancer?
- Trastuzumab
- Monoclonal antibody against Her2 receptor
- Indication – only given to patients with over expression of Her2 and chemotherapy
What are indications for biologics (trastuzumab) for breast cancer)?
- Indication – only given to patients with over expression of Her2 and chemotherapy
What follow up is done after management of breast cancer?
- Mammogram of breasts every year for 3-10 years
- Clinical examination for 1-5 years
What is used to assess disease recurrence risk?
-
Nottingham prognostic index
- Lymph node involvement
- Tumour grade
- Tumour size
What are factors increasing risk of breast cancer recurrence?
-
Nottingham prognostic index
- Lymph node involvement
- Tumour grade
- Tumour size
- Steroid receptor status
- Negative ER/PR higher risk)
- Her2 status
- Positive higher risk
- Lymphovascular invasion
