treatments for breast cancer Flashcards
what breast conserving surgical treatment can be done?
NB: breast conserving surgery is only suitable for individuals with localised operable disease and no evidence of metastases
A wide local excision can be done. Involves excision of the tumour and 1cm margin of normal tissue with it.
what is a mastectomy and when is it indicated?
removes all the tissue of the affected breast, and part of the overlying skin
indicated in multifocal disease, high tumour:breast tissue ratio, disease recurrence, or prophylactically (e.g BRCA2 positive)
what is axillary surgery?
done with wide local excisions and mastectomies to asses nodal status and remove any nodal disease.
what is the process of a sentinel node biopsie?
a senile node biopsy involves a dual technique
- injecting radioisotope
- inject blue dye
into breast to detect which lymph nodes the breast drains into (the sentinel nodes), which can be removed and sent to histology.
what is the process of axillary node clearance?
involves clearing all the nodes in the axilla, sent for histology.
common complicatiomns include paraesthesia, seroma formation, lymphedema.
what genes predispose people to cancer?
BRCA1, BRCA2, PTEN, TP53
what hormone treatments can be done in malignant non metastatic disease?
therapy is adjuvent to reduce the risk of relapse.
adjuvent radiotherapy ois offered to all patients after wide local excisions and post mastectomy cases with positive resection margins, tumours above 5cm or 4+ pathological nodes in the axilla
how can tamoxifen be used in breast cancer?
used in pre menopausal patients.
blockade of oestrogen receptors so is prophylactic against cancer
however as its a partial antagonist it increases risk of thromboembolism and uterine carcinoma (due to pro oestrogen affects on the uterus)
when are aromatase inhibitors used?
act through binding to oestrogen receptors to inhibit further malignant growth and oestrogen production
block conversion of androgens to oestrogen in peripheral tissue
advised for post menopausal patients as adjuvant therapy but expensive, however no ADR of uterine cancer or thromboembolism
when is immunotherapy used?
I patients whose cancers express specific growth factor receptors
e.g HER2 positive malignancies, for which Herceptin, a monoclonal antibody, is used to target.
NB: a common side affect is cardiotoxicity so monitor cardiac output before and during treatment.
what is a therapeutic mammoplasty?
a type of oncoplastic management
involves a WLE combined with a breast reduction technique, giving a smaller, uplifted breast with a preserved nipple and blood supply
what is a latissimus doors flap?
part of L. Dorsi muscle and its overlying skin is used to reconstruct removed breast, either as a free or pedicle flat. useful for smaller breast.
what is a transverse rectus abdominal muscle flap (TRAM)?
abdominal muscle, skin and fat used to reconstruct removed breast, either as free or pedicle flap.
what is a deep inferior epigastric flap (DIEP)?
uses tissue from the abdomen and its overlying skin to reconstruct the breast, but is only preformed as a free flap
good as unlike TRAM flap, no muscle is used therefore abdominal muscle strength is usually maintained.
On a biopsy of breast cancer, what receptors are tested for?
oestrogen and HER2 to target treatment.
aka can use herceptin if HER2 positive or tamoxifen if oestrogen receptor positive.
