Treatment of Breast Disease Flashcards
2 main pathological types of breast cancer
- In situ carcinoma (definition)
- Invasive carcinoma (definition)
2 subsets of in situ carcinoma
- Ductal carcinoma in situ
- Lobular carcinoma in sit
5 subsets of invasive carcinoma
- Ductal
- Lobar
- Tubular
- Cribriform
- Medullary
5 principals for the management of a patient with breast cancer
- Establish the diagnosis
- Assess the severity (“staging”)
- Treat the underlying cause
- General measures
- Specific measures
Signs and symptoms of breast cancer
- 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”)
Tests for breast cancer and their sensitivity
- Clinical exam, 88%
- Ultrasound, 88%
- Mammography, 93%
- FNA cytology, 94%
Tests to assess severity (“staging”)
- FBC, U&E’s, LFT’s
- CXR
- Isotope bone scan
- Others as clinically indicated
How to stage patients with breast cancer
Tumour, Nodes, Metastases (TNM)
Grades of tumour in TMN
- T1 (2cm)
- T2 (2-5cm)
- T3 (>5cm)
- T4 (fixed to skin or muscle)
Grades of nodes in TMN
- N0 (none)
- N1 (nodes in axilla)
Grades of metastases in TMN
- M0 (none)
- M1 (metastases)
2 main types of surgical treatment for breast cancer
- Breast conservation (wide local excision, quadrantectomy or segmentectomy)
- Mastectomy
When is breast conservation = mastectomy for overall survival
When tumours are <4cm in size
Patients suitable for breast conservation
- Tumour <4cm
- Breast/tumour size ratio
- Suitable for radiotherapy
- Single, not multiple, tumours
- Minimal in situ cancer component present
- Patient’s wish, most important
What kind of tumour carries the highest risk of the breast containing more disease (in situ or invasive cancer)
2cm invasive cancer
How do axillary nodes relate to the management of breast cancer
- Regional control of disease
- Staging prognostic information
Describe the 3 levels of the surgical anatomy of the axilla
- Level 1, Below + lateral to pec minor
- Level 2, Behind pec minor
- Level 3, Above + medial to pec minor
What is a sentinel lymph node (SLN) and how is it related to the management of breast cancer
- First node to receive lymphatic drainage
- First node to which tumour spreads
- If -ve, res of nodes in lymphatic basin are negative
Treatment of axilla in breast cancer
- SLN = -ve no further treatment required
- SLN = +ve either remove them all surgically (axillary clearance) or give radiotherapy to all nodes in axilla
6 complications of treatment to axilla
- Lymphoedema
- Sensory disturbance (intercostobrachial n.)
- Decreased ROM of shoulder joint
- Nerve damage (Long thoracic, thoracodorsal, brachial plexus)
- Vascular damage
- Radiation induced sarcoma
What nerves are commonly damaged during axillary clearance
- Intercostobrachial Nerve
- Long thoracic nerve
- Thoracodorsal nerve
- Brachial plexus
3 methods of treatment for micrometastases
- Hormone therapy
- Chemotherapy
- Targeted therapies
Type of hormone therapy given if premenopausal
Tamoxifen for 5 years
Type of hormone therapy given if postmenopausal
- Tamoxifen for 5 years (if excellent prognosis)
- Aromatase inhibitor for 5 years (if poorer prognosis)
(intermediate prognosis tamoxifen for 2yrs + AI for 3yrs)
2 types of chemotherapy drug used to treat micrometastases
- Anthracyclines
- Taxanes
Drug used in anti-her2 therapy
Trastuzumab (monoclonal antibody against Her2 receptor
-Follow up of breast cancer
- 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
