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Reproduction > Treatment of Breast Disease > Flashcards

Treatment of Breast Disease Flashcards

1
Q

2 main pathological types of breast cancer

A
  • In situ carcinoma (definition)

- Invasive carcinoma (definition)

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2
Q

2 subsets of in situ carcinoma

A
  • Ductal carcinoma in situ

- Lobular carcinoma in sit

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3
Q

5 subsets of invasive carcinoma

A
  • Ductal
  • Lobar
  • Tubular
  • Cribriform
  • Medullary
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4
Q

5 principals for the management of a patient with breast cancer

A
  • Establish the diagnosis
  • Assess the severity (“staging”)
  • Treat the underlying cause
  • General measures
  • Specific measures
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5
Q

Signs and symptoms of breast cancer

A
  • Lump or thickening of breast (most common + usually painless)
  • Discharge/bleeding
  • Change in siz3 or contours of breast
  • Change in colour or appearance of areola
  • Redness or pitting of skin (“like the skin of an orange”)
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6
Q

Tests for breast cancer and their sensitivity

A
  • Clinical exam, 88%
  • Ultrasound, 88%
  • Mammography, 93%
  • FNA cytology, 94%
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7
Q

Tests to assess severity (“staging”)

A
  • FBC, U&E’s, LFT’s
  • CXR
  • Isotope bone scan
  • Others as clinically indicated
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8
Q

How to stage patients with breast cancer

A

Tumour, Nodes, Metastases (TNM)

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9
Q

Grades of tumour in TMN

A
  • T1 (2cm)
  • T2 (2-5cm)
  • T3 (>5cm)
  • T4 (fixed to skin or muscle)
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10
Q

Grades of nodes in TMN

A
  • N0 (none)

- N1 (nodes in axilla)

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11
Q

Grades of metastases in TMN

A
  • M0 (none)

- M1 (metastases)

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12
Q

2 main types of surgical treatment for breast cancer

A
  • Breast conservation (wide local excision, quadrantectomy or segmentectomy)
  • Mastectomy
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13
Q

When is breast conservation = mastectomy for overall survival

A

When tumours are <4cm in size

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14
Q

Patients suitable for breast conservation

A
  • Tumour <4cm
  • Breast/tumour size ratio
  • Suitable for radiotherapy
  • Single, not multiple, tumours
  • Minimal in situ cancer component present
  • Patient’s wish, most important
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15
Q

What kind of tumour carries the highest risk of the breast containing more disease (in situ or invasive cancer)

A

2cm invasive cancer

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16
Q

How do axillary nodes relate to the management of breast cancer

A
  • Regional control of disease

- Staging prognostic information

17
Q

Describe the 3 levels of the surgical anatomy of the axilla

A
  • Level 1, Below + lateral to pec minor
  • Level 2, Behind pec minor
  • Level 3, Above + medial to pec minor
18
Q

What is a sentinel lymph node (SLN) and how is it related to the management of breast cancer

A
  • First node to receive lymphatic drainage
  • First node to which tumour spreads
  • If -ve, res of nodes in lymphatic basin are negative
19
Q

Treatment of axilla in breast cancer

A
  • SLN = -ve no further treatment required

- SLN = +ve either remove them all surgically (axillary clearance) or give radiotherapy to all nodes in axilla

20
Q

6 complications of treatment to axilla

A
  • Lymphoedema
  • Sensory disturbance (intercostobrachial n.)
  • Decreased ROM of shoulder joint
  • Nerve damage (Long thoracic, thoracodorsal, brachial plexus)
  • Vascular damage
  • Radiation induced sarcoma
21
Q

What nerves are commonly damaged during axillary clearance

A
  • Intercostobrachial Nerve
  • Long thoracic nerve
  • Thoracodorsal nerve
  • Brachial plexus
22
Q

3 methods of treatment for micrometastases

A
  • Hormone therapy
  • Chemotherapy
  • Targeted therapies
23
Q

Type of hormone therapy given if premenopausal

A

Tamoxifen for 5 years

24
Q

Type of hormone therapy given if postmenopausal

A
  • Tamoxifen for 5 years (if excellent prognosis)
  • Aromatase inhibitor for 5 years (if poorer prognosis)

(intermediate prognosis tamoxifen for 2yrs + AI for 3yrs)

25
Q

2 types of chemotherapy drug used to treat micrometastases

A
  • Anthracyclines

- Taxanes

26
Q

Drug used in anti-her2 therapy

A

Trastuzumab (monoclonal antibody against Her2 receptor

27
Q

-Follow up of breast cancer

A
  • Clinical exam 6 monthly for 5 years
  • Yearly exams after 5 years, discharge after 5 or 10 years
  • Mammogram of breast(s) yearly for 10 years

Reproduction (22 decks)

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