Treatment of Breast Disease Flashcards
1
Q
How is the severity of breast cancer measured?
A
Staging the severity done by:
- FBC, U&Es, LFTs, Ca2+/PO2
- Chest x-ray
- Others as clinically indicated
- No reliable tumour markers
2
Q
What classification system is used for breast cancer?
A
TNM
3
Q
Explain T staging for breast cancer?
A
4
Q
Explain N staging for breast cancer?
A
- N0 – no regional lymph nodes palpable
- N1 - regional lymph nodes palpable and mobile
- N2 – regional lymph nodes palpable and fixed
5
Q
Explain M staging for breast cancer?
A
- Mx – distant metastases cannot be assessed
- M0 – no distant metastases
- M1 – distant metastasis
6
Q
What is neo-adjuvant?
A
Neo-adjuvant = treatment before surgery
7
Q
What is adjuvant?
A
Adjuvant = treatment after surgery
8
Q
Describe the management for breast cancer?
A
- Surgery
- Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
- Mastectomy – simple or skin sparing mastectomy
- Surgery to axilla – gives prognostic information, regional control of disease/eradication in axilla
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
- Breast conservation surgery
- Prevention/adjuvant treatment
- +/- radiotherapy
- Over 3 weeks
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
- +/- chemotherapy
- Anthracycline combinations (dexorubican or epirubicin)
- Taxane based combinations (ocetaxel)
- Indications – benefit best in younger woman (<50 years) and patients with increasing adverse prognostic factors (grade 3, LN pos, ER neg, Her2 pos)
- +/- hormonal therapy
- Only given to oestrogen receptor positive cancers
- Blocks stimulation of cell growth by oestrogen
- Tamoxifen
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
- Aromatase inhibitors (arimidex and letrozole)
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
- +/- biologics
- Trastuzumab
- Monoclonal antibody against Her2 receptor
- Indication – only given to patients with over expression of Her2 and chemotherapy
- Trastuzumab
- +/- radiotherapy
9
Q
What surgery can be done for breast cancer?
A
-
Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
- Mastectomy – simple or skin sparing mastectomy
-
Surgery to axilla – gives prognostic information, regional control of disease/eradication in axilla
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
10
Q
What are indications for breast conservation surgery?
A
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
11
Q
What are the 2 different kinds of masectomy?
A
- Masectomy – simple or skin sparing mastectomy
12
Q
Why is surgery done to the axilla?
A
- Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla
13
Q
What are possible complications of surgery to the axilla?
A
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
14
Q
What is done after surgery to the axilla if:
- sentinal node is negative
- sential node is postiive?
A
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
15
Q
What are possible complications of radiotherapy?
A
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
