treatment options Flashcards
4 treatment options
surgical
reconstruction
nonsurgical
therapy
purpose is to eradicate the disease in the breast and lymph
surgery and radiation
5 surgical options
lumpectomy/breast conserving surgery/wide local excision WLE
total/simple mastectomy
radical mastectomy
modified radical mastectomy
axillary lymph node dissection ALND
indications for a certain procedure:
benign breast lumps
high risk lesions
cancerous lesions
if done for cancer treatment usually followed by radiation therapy
lumpectomy
2 benign breast lumps
fibroadenoma
phyllodes tumor
3 high risk lesions
lobular carcinoma in situ LCIS
papilloma
atypical ductal hyperplasia ADH
2 cancerous leions
ductal carcinoma in situ DCIS
invasive ductal carcinoma IDC
lumpectomy risk factors
bleeding/hematoma
infection
pain
temporary swelling
tenderness
hardening of scar tissue
change in shape of breast
3 types of mastectomys
total
skin sparing
nipple sparing
indications for a certain procedure:
DCIS
stages 1,2,3
B CA in more than one quadrant
inflamm B CA- after chemo
paget’s disease
locally recurrent B CA
prior B CA with radiation
high risk lesions
carrier of gene mutation
prophylactic surgery
mastectomy
mastectomy risk factors
bleeding
infection
pain
swelling (lymphedema)
scar tissue hardening
shoulder pain and stiffness
numbness
hematoma
removal of breast tissue including skin, areola, nipple; reconstruction can be performed immediately or at a later time
total mastectomy- simple
removal of breast tissue, nipple and areola but not the skin; skin left behind for reconstruction which can be performed immediately
skin sparing mastectomy
removal of only breast tissue, spares skin, nipple and areola; reconstruction performed immediately
nipple sparing mastectomy
surgical removal of one or both breasts in a woman at high risk of breast cancer to reduce her risk; reduces risk of recurrence 90%; irreversible decision; usually followed by implant reconstruction
prophylactic mastectomy
3 reconstruction options
breast reconstruction with implants- immediate or delayed
breast reconstruction with your own transplanted tissue- autologous
no reconstruction- use prosthesis
own transplanted tissue
autologous
2 types of autologous reconstruction- flap reconstruction
TRAM- transverse rectus abdominus myocutaneous- most common
latissimus dorsi
surgical procedure that uses the tissue and muscle from abdominal area to breast and form a new breast mound; skin, muscle, fat and blood vessels transferred
transverse rectus abdominus myocutaneous TRAM
surgical reconstruction procedure that skin, tissue, muscle used from upper back to create breast mound; smaller amount of tissue; used on smaller to medium sized breasts
latissimus dorsi flap reconstruction
complications of flap reconstruction
muscle weakness
more extensive
larger incisions
longer healing time
longer hospital stays
may need more than one surgery
change in breast sensations
advantages of flap reconstruction
help make patient feel whole again
alternative to implants
improve self esteem and body image
helps breasts look natural under clothing
avoid the need for an external prothesis
3 non surgical options
radiation
chemo
hormone
a radiation therapy which may be used to treat B CA at almost any stage;
commonly used on lumpectomy;
also used to control B CA that has spread;
can still be recommended for mastectomy patients; begins a few weeks after surgery or 3-4 weeks after chemo if needed;
burn to chest wall;
usually given daily 5-6 weeks;
fatigue;
kills abnormal and normal cells;
treatment itself is painless
external beam radiation therapy EBRT
deposits energy directly to site
spares surrounding tissue
may cause fewer side effects
limited availability
external beam radiation therapy- proton beam therapy
external beam radiation therapy for a certain procedure:
surgeon goes in and “scoops out” the affected tissue;
relatively higher chance of CA recurring in the same breast if no radiation;
3-15% chance for recurrence in the first 10 years
lumpectomy
external beam radiation therapy for a certain procedure:
whole breast is removed;
radiation indicated: high risk recurrence rate on chest wall;
have a 5-10% chance of recurrence
mastectomy
1 type of external beam radiation therapy
proton beam therapy
2 types of internal radiation therapy
brachytherapy
intra-operative radiation therapy
3-5 day therapy/twice a day, a catheter is connected to a machine that inserts a radiation seed; high dose radiation to site only; once therapy is complete, seed is removed, patients return to normal daily activities; catheter/balloon are removed on final day
internal radiation therapy- brachytherapy radiation seed
radiation therapy given during lumpectomy surgery right after the CA has been removed; while the underlying breast tissue is still exposed, a single, high dose of radiation is given directly to the area where the cancer was removed
intra-operative radiation therapy IORT
4 systemic therapy types
chemotherapy
hormone therapy
anti-HER2 therapy
ovarian ablation
goal: to stop cancer cell growth, targets rapidly dividing cells
used to kill breast cancer cells; frequently used in conjunction with other treatments; it can increase the chance of cure; decrease chance of recurrence; alleviate symptoms; help live a longer and better quality of life
chemotherapy
indications for a certain procedure:
NEO Adjuvant Therapy (before surgery)- shrink tumor size and conserve tissue; decrease the extent of disease; decrease chance cancer will return
Adjuvant Therapy (after surgery)- usually recommended if cancer has spread to lymph nodes; premenopausal women; HER2 positive cancer; with some advanced stage cancers or metastatic cancers; triple negative B CA; inflammatory B CA
chemotherapy
another name for “before surgery”
NEO adjuvant
another name for “after surgery”
adjuvant
2 types of chemotherapy
IV
oral
another name for hormonal therapy
endocrine therapy
goal is to block the effects of hormones on cancer cell, stop cancer cell growth; estrogen/progesterone receptors; serm- anti estrogen drugs;
positives: for pts at high risk; shown to reduce risk of recurrence; reduce risk of metastatic cancer growth and progression; shown to strengthen bones
hormonal therapy
proteins found on the surface and inside some cancer cells; when hormones attach here, they cause cancer cell growth
hormone receptors
type of hormonal therapy useful in postmenopausal women; reduces the amount of estrogen in the body
aromatse inhibitors
2 hormone therapy types
estrogen/progesterone
anti-HER2/ neu therapy
protein receptors on surface that stimulates cell growth
HER2
oldest form of systemic therapy for premenopausal women; shuts down ovaries to reduce female hormone production
ovarian ablation
tumor does not have any protein receptors; poorer prognosis if left untreated; chemo works best; can be more aggressive and difficult to treat
triple negative breast cancer TNBC
treatment for early breast cancer:
lumpectomy + radiation VS mastectomy
overall survival rate is the same
regrowth of CA cells at original site
local recurrence
3 types of recurrence
local
regional
metastatic
cancer cells travel from original site to settle in nearby nodes
regional recurrence
CA cells from the original site have traveled to distant parts of the body
metastatic recurrence
lymph nodes in armpit area; level 1,2,3
axillary nodes
lymph nodes above the clavicle
supraclavicular nodes
lymph nodes located along the breastbone
internal mammary node
located on chromosome 17
30% of hereditary cases
increase risk of ovarian CA
increase in developing a CA in opposite breast
men have 3x the risk for prostate CA
BRCA 1 gene mutation
located on chromosome 13
15% of hereditary cases
increase risk of other cancers
males have increased risk for B CA
BRCA 2 gene mutation
