Treatment of Breast Disease Flashcards
Pathological types of breast cancer
In situ carcinoma
Invasive carcinoma
Types of in situ carcinoma
Ductal carcinoma in situ
Lobular carcinoma in situ
Types of invasive carcinoma
Ductal Lobular Tubular Cribriform medullary
Two ways to be diagnosed with breast cancer
- Present with a symptom
2. NHS breast screening programme
5 principles of management for a patient with breast cancer
Establish the diagnosis
Assess the severity ("staging")
Treat the underlying cause
General measures
Specific measuresRisks for breast cancer
Age Geographical variation Age at menarche and menopause Age at first pregnancy FH Previous benign breast disease Cancer in the other breast Radiation Lifestyle (obesity, alcohol) Oral contraception HRT
Symptoms of breast cancer
Lump/thickening in breast - often painless
Discharge or bleeding
Change in size or contours of the breast
Change in colour or appearance of the areola
Redness or pitting of skin over the breast, like orange skin
Investigations of breast cancer
clinical exam
mammography
USS
FNA cytology
Definition of sensitivity
The ability of a test to detect if it is there
Investigations of staging of breast cancer
Hb FBC, U and Es, LFTs CXR Isotope bone scan (if spread to lymph nodes) Others as clinically indicated No reliable tumour markers
Staging of breast cancer (TNM)
T (tumour) - T1 = 0-2cm - T2 = 2-5cm - T3 = >5cm - T4 = fixed to skin or muscle N (nodes) - NO = none - N1 = nodes in axilla - N2 = large of fixed nodes in axilla M (metastases) - M0 = none - M1 = metastases
Two main types of surgical procedure of the breast
Breast conservation surgery
Masectomy
Types of breast conservation surgery
Wide local excision
Quadrantectomy
Segmentectomy
Tumour size clinically indicated for breast conservation surgery
< 4cm
What does it mean if the sentinel lymph node biopsy is negative?
Rest of the nodes in the lymphatic basin are negative, as there are no “skip” metastases
What is the first node to which a breast cancer tumour would spread to?
Sentinel lymph node
Treatment to the axilla if the sentinel lymph node contains tumour
Remove all of them surgically (clearance) OR
Radiotherapy to all nodes in the axilla
Complications of treatment to the axilla
Lymphedema
Sensory disturbance (intercostobrachial nerve)
Decreased ROM of shoulder joint
Nerve damage (long thoracic, thoracodorsal, brachial plexus)
Vascular damage
Radiation induced sarcoma
After the breast is treated, what must be carried out?
Eradication of micrometastatic disease
What factors are associated with increased risk of disease recurrence in breast cancer?
Lymph node involvement Tumour grade Tumour size Absence of oestrogen receptors Presence of Her2 receptors Lymphovascular invasion of tumour (even if nodes not involved)
Treatment of micrometastases in breast cancer
Hormone therapy
- oestrogen receptors (only given if hormone receptors present)
- zoladex, tamoxifen, aromatase inhibitors
Chemotherapy
Targeted therapies
- anti-her2 therapy - transtuzumab
In the treatment for micrometastases for breast cancer, when does chemotherapy have the best effects?
< 50 year olds
When is anti-Her2 therapy given in the treatment for micrometastases?
Patients with overexpression of Her2 and chemotherapy
What do oestrogen receptors do in the treatment of micrometastases?
Blocks stimulation of cell growth by oestrogen
What types of hormone therapies are given in the treatment of micrometastases of breast cancer?
Premenopausal = tamoxifen for 5 years Postmenopausal = tamoxifen for 5 years if excellent prognosis Others = get aromatase inhibitor e.g. anastrole for 5 - 10 years
Follow up after having treatment for breast cancer
Clinical exam 6 monthly for 3-5 years
Discharge after 3-5 years, or even sooner
mammogram at yearly intervals for 10 years
Look in the breast clinic for …..
Breast pain (cyclical or non-cyclical) Benign lumps - fibroadenoma - cysts - fibrocystic change - fat necrosis Nipple symptoms - discharge - bleeding - eczema ( pagents) Gynaecomastia
What drug is used in breast cancer in ER +ve women who are pre or peri menopausal?
Tamoxifen
What drug is used in breast cancer in ER +ve women who are post menopausal?
Aromatase inhibitors
