Treatment of Breast Disease Flashcards
What are the 2 types of breast cancer?
In situ carcinoma
Invasive carcinoma
What are the subtypes of in situ carcinoma?
Ductal carcinoma in situ
Lobular carcinoma in situ
What are the subtypes of invasive carcinoma?
Ductal Lobular Tubular Cribriform Medullary
What is used to establish a diagnosis in breast cancer?
History and clinical examination Mammography Utrasonography Magnetic resonance mammography Cytology (FNAC) Core biopsy Image guided cytology/ core biopsy Open (surgical biopsy)
What are the risk factors for breast cancer?
Age Age at menarche and menopause Age at first pregnancy Family history Previous benign breast disease Cancer in other breast Radiation Oral contraceptive or HRT Lifestyle (high fat, alcohol)
What are the signs and symptoms of breast cancer?
Lump or thickening or breast, often painless
Discharge or bleeding
Change in size or contours of breast
Change in colour or appearance of areola
Redness or pitting of skin (orange)
How do you assess of beast cancer once the diagnosis is made?
Hb FBC, U&Es, LFTs
CXR
Isotope bone scan
What technique is used to stage breast cancer?
Tumour Node Metastases
What are the 2 main surgical procedures for breast cancer?
Breast conservation (Wide local incision, quadranectomy, segmentectomy) Mastectomy
What patients are suitable for breast conservation as a surgical treatment?
Tumour size <4cm Breast/tumour size ratio Suitable for radiotherapy Single tumour Minimal in situ cancer component present
How many axilla levels are there?
3
What is the first axilla level?
Below and lateral to pec minor
What is the second axilla level?
Behind pec major
What is the third axilla level?
Above and medial to pec minor
Why is a sentinel lymph node biopsy important in the treatment of breast cancer?
First node to receive lymphatic drainage and to which tumour spreads
If negative, rest of nodes in lymphatic basin are negative
What is involved in the treatment of the axilla?
If SLN negative no further treatment
If SLN positive remove nodes surgically or give radiotherapy to all axillary nodes
What are the complications of axilla treatment?
Lymphoedema Sensory disturbance Decrease ROM of shoulder joint Nerve damage Vascular damage Radiation induced sarcoma
What are the treatments for micrometastases?
Hormone therapy
Chemotherapy
Targeted therapies
What types of hormone therapies are given?
Premenopausal - tamoxifen for 5 yrs
Postmenopausal - tamoxifen for 5 yrs if goof prognosis, aromatase inhibitor for 5 yrs if poorer
What type of chemotherapy is used to treat micrometastases?
Antracyclines
Taxanes
How are patients managed who have over expression of HER2
Anti HER2 therapy (Trastuzumab)
What follow up is given fro breast cancer?
Examination 6 monthly for 5 years
Yearly after that
