Treatment of Breast Disease Flashcards
How common is breast cancer?
1 in 8 women
What are the risk factors for breast cancer?
Age PMH BRCA 1 + 2 Early menarche and late menopause Late or no pregnancy HRT Alcohol (>14units/week) Weight Post-radiotherapy (Hodgkins's disease)
How does breast cancer present?
Asymptomatic Lump Breast pain Nipple discharge (bloody) Nipple changes Change in size/shape Lymphoedema Dimpling of breast skin
What nipple changes are seen in breast cancer?
Dryness - Paget’s disease
Retraction
What lymphoedema is suggestive of breast cancer?
Swelling of the arm
What radiological exams are used for breast cancer?
Bilateral mammograms/USS
What cytological exams are used for breast cancer?
FNAC
Core biopsy
Which is the most sensitive form of breast imaging?
Mammography
Breast imaging sensitivity is reduced in which women?
Young women (increased glandular tissue)
What is the most sensitive test for breast lumps?
FNAC
What are the different types of breast cancer?
Invasive
Non-invasive
What are the different types of invasive breast cancer?
80% Ductal carcinoma
10% lobular carcinoma
10% others
What are the other types of invasive breast cancer?
Mucinous Tubular Papillary Medullary Sarcoma Lymphoma
What are the types of non-invasive breast cancer?
Ductal Carcinoma In situ
Lobular carcinoma in situ
How is breast cancer staged?
FBC, U+E, LFT, CA2+/PO2-
Chest x-ray
What do abnormal LFTs suggest in breast cancer?
Advanced disease
How would a palpable tumour <2cm be staged?
T1
How would a palpable tumour 2-5cm be staged?
T2
How would a palpable tumour >5cm be staged?
T3
How would a tumour invading skin be staged?
T4a
How would a tumour invading chest wall be staged?
T4b
How would a tumour invading skin and chest wall be staged?
T4c
How is inflammatory breast cancer staged?
T4d
How are breast tumours N-staged?
N0 - No regional nodes palpable
N1 - Regional nodes palpable (mobile)
N2 - Regional nodes palpable (fixed)
How is breast cancer managed?
SURGERY
Radiotherapy
Chemotherapy
Hormonal Therapy
What surgeries are given for breast tumours?
Breast conservation surgery
Mastectomy
What is the treatment for tumours <4cm?
Breast conservation + radiotherapy
What factors are taken into consideration for patients with breast tumours?
Breast/tumour size ratio
Patient’s wishes
What is the use of axilla surgery in breast cancer?
Prognostic information/staging
Regional control of disease
When are sentinel lymph node biopsies performed?
When preoperative axillary USS are normal/benign
What treatment is required if the SLN biopsy is negative?
None
What treatment is required if the SLN biopsy is positive?
Surgical clearance
Radiotherapy to the axillary nodes
What complications are associated with axillary treatment?
Lymphoedema Sensory disturbance Decreased shoulder ROM Nerve damage Vascular damage Radiation-induced sarcoma
Sensory disturbance due to axillary treatment is associated with injury to which nerve?
Intercostobrachial nn.
Nerve damage due to axillary treatment is associated with injury to which nerve?
Long thoracic
Thoracodorsal
Brachial plexus
What factors are associated with increased risk of breast cancer recurrence?
Lymph node involvement Tumour grade Tumour size Steroid receptor status HER2 status (+ve) Lymphovascular invasion
What is the local adjuvant therapy for breast cancer?
Radiotherapy
What is the systemic adjuvant therapy for breast cancer?
Hormone therapy
Chemotherapy
Targeted therapy
Which breast cancer patients receive radiotherapy?
All patients after wide local excision (adjuvant)
After mastectomy if local involvement
What complications are associated with adjuvant breast radiotherapy?
Skin reactions - telangiectasis Radiation pneumonitis Cutaneous radionecrosis Osteonecrosis Angiosarcoma
What drugs are used in hormone therapy for breast cancer?
Tamoxifen
Aromatase Inhibitors
(Arimidex, Letrozole)
Which types of breast cancer hormone therapy be used for?
Estrogen receptor positive (ER+) breast cancer
Which dose of Tamoxifen is used for breast cancer hormone therapy?
20mg daily
5-10 years
How does Tamoxifen work?
Directly blocks ER receptor
Tamoxifen is most effective in which groups?
All age groups
Post chemotherapy
Tamoxifen increases the risk of what?
Thromboembolic events
What Aromatase Inhibitors are used for breast cancer? (and what dose)
Arimidex (1mg)
Letrozole (2.5mg)
Both once daily 5 years
Aromatase Inhibitors are indicated in which breast cancer patients?
Estrogen Receptor Positive
POSTmenopausal women
Aromatase inhibitors increase the risk of what?
Osteoporosis
What is the role of Zoladex?
Hormone therapy for breast cancer
Inhibits FSH + LH
Which women benefit most from chemotherapy?
<50y/o
Patients with more adverse prognostic factors
What scoring is used to determine whether chemotherapy would be of benefit in breast cancer?
Oncotype DX
Which Chemotherapy drugs are used in breast cancer?
CMF
Antracycline
Taxane
Which drugs can be used in women with HER2+ breast cancer?
Anti-Her2 therapy
Trastuzumab (Herceptin)
What is the follow-up regiment post breast cancer treatment?
Patient observation
Clinical examination 1-5 years
Yearly mammograms
