Treatment options

Question 1

Masectomy

Answer 1

Total: breast
Radical: breast, lymph nodes, pectoralis maj/min (outdated)
Modified radical: breast, lymph nodes, pectoral fascia
ALND: Level 1/2
Indications: DCIS, stage 1/2/3 BC, BC in more than 1 quadrant, Pagets, Inflamm BC, recurrent BC, carrier of gene mutation.

Question 1

Lumpectomy

Answer 1

Surgical removal of tumor, lymph nodes, radiation/chemo.
Indications: benign breast lumps, high risk lesion, cancerous lesion

Question 2

Masectomy types

Answer 2

Total: remove breast tissue including skin, aerola, nipple.
Skin sparing: remove breast tissue, nipple, aerola but NOT skin.
Nipple sparing: removal of ONLY breast tissue, spares nipple/aerola

Question 3

Prophylactic masectomy

Answer 3

Surgical removal of one or both breasts. Done in women with high risk of BC. Reduces risk by 90%. Still a 5-10% of recurrence rate on same breast, less than 2% recurrence on opposite breast.

Question 4

EBRT

Answer 4

Burns chest wall killing abnormal & normal cells. commonly used in DCIS, lumpectomy & controls spreading CA. Given daily for 5-6 wks. Will begin after surgery 5 wks/after chemo 3-4 wks.

Question 5

Brachytherapy (internal)

Answer 5

A catheter is connected to a machine that inserts a high dose rad seed sent to the site. Done 3-5 days twice a day.

Question 6

IORT

Answer 6

Rad therapy given right after lumpectomy. The mass has been removed by surgeon then on the exposed breast tissue a single high dose of rad will be given where mass was.

Question 7

Chemo

Answer 7

Stops cancer cell growth & rapidly dividing cells. Used w/ other treatments, surgery, drugs, rad therapy.

Question 8

Chemo neo adjuvant (before surgery)

Answer 8

Shrinks tumor/conserves tissue.

Question 9

Chemo adjuvant (after surgery)

Answer 9

Recommended if has spread to lymph nodes, premenopausual women (BC aggressive), advanced/metastatic CA, Her 2 (aggressive)

Question 10

Endocrine therapy

Answer 10

Breast CA hormone +. Estrogen/progesterone receptors feed CA cells. Tamoxifen common. Works by binding to CA cell, blocking ER/PR from binding.

Question 11

Aromatose inhibitor

Answer 11

Useful with postmenopausal women, decreases amount of estrogen in body.
Side effects: increase risk of osteoporosis, blood clots & heart issues

Question 12

Anti Her2

Answer 12

Her 2 are protein receptors that stimulate cell growth. 20-25% in CA.
Treatment:
Herceptin. Will block her 2 overstimulation.
Combo of herceptin/chemo. Will shrink tumor.

Question 13

Ovarian ablation:

Answer 13

Shuts down ovaries to reduce hormone production. Done on premenopausual women. Can be done through surgery, rad, drugs.
Side effects: early menopause, infertility, hot flashes

Question 14

TNBC

Answer 14

Tumor that does NOT have any receptors. Chemo will work best, neoadjuvant -> surgery -> adjuvant -> rad. Aggressive/difficult to treat. 10-20% of BC.

Question 15

Early BC treatment

Answer 15

Lumpectomy + radiation= Masectomy
Overall rate is the same

Question 16

BRCA 1

Answer 16

Located on chromosome 17. High risk of ovarian CA & BC in opposite breast. Men 3x risk of prostate CA. 30% of hereditary cases

Question 17

BRCA 2

Answer 17

Located on chromosome 13. High risk of other CA’s stomach etc. Men increase risk of BC.15% of hereditary cases

Question 18

Implant reconstruction

Answer 18

An expander will be inserted, over months/yrs will slowly expand size. Once at adequate size implant will be inserted

Question 19

TRAM transverse rectus abdominal myocutaneous

Answer 19

Surgical procedure uses tissue/muscle from abdominal area to create & form a new breast mound

Question 20

Latissimus Dorsi

Answer 20

Uses tissue, skin, muscle from upper back to create mound.
Downsides: muscle weakness, longer healing, more extensive, need for more surgeries