Treatment of Breast Disease Flashcards
Where are patients with breast cancer referred?
Referred to the new patient clinic, where they receive clinical (history + examination), radiological (bilateral mammogram + ultrasound) and cyto-pathological (FNA + core biopsy) assessment of their disease
What examination should be done in suspected breast cancer?
Examination of a patient with suspected breast cancer should involve both breasts, the axillae and lymph nodes
Why is a core needle biopsy preferable to FNA?
A core biopsy can give more information on a cancer than fine needle aspiration as it can tell you if the cancer is invasive and if it is hormone receptor positive
What are the pathological types of breast cancer?
Pathological types of breast cancer can be thought of as invasive (80% ductal carcinoma, 10% lobular carcinoma, 10% others) or non-invasive (ductal carcinoma in situ, lobular carcinoma in situ).
What investigations can be used in staging breast cancer?
- Chest x-ray
- FBC, Us&Es, LFTs, calcium, oxygen
- Others as indicated
How is breast cancer staged?
Tx Primary tumour cannot be assessed T0 Primary tumour not palpable T1 Clinically palpable tumour -size < 2 cm T2 Tumour size 2-5 cm T3 Tumour size > 5 cm T4a Tumour invading skin T4b Tumour invading chest wall T4c Tumour invading both T4d Inflammatory breast cancer N0 No Regional lymph nodes palpable N1 Regional lymph node palpable- mobile N2 Regional lymph node palpable- fixed Mx Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis
What is the basis of management of breast cancer?
Basis of management of breast cancer is surgery +/- radiotherapy (reduce breast recurrence) +/- chemotherapy (reduce systemic recurrence) +/- hormone therapy
What are the main operations offered for breast cancer?
The two main surgical procedures in management of breast cancer are breast-conserving surgery (tumour taken out with 1mm margin of healthy tissue) or mastectomy
Which patients should be considered for breast conserving surgery?
- Tumour size clinically<4cm – IN THE OLD DAYS
- Breast/Tumour size ratio
- Suitable for radiotherapy
- Single tumours – IN THE OLD DAYS
- Patient’s wish – most important!!
For what reasons can surgery to the axilla be done?
Surgery to the axilla can be done either for purposes of prognosis or for regional control of the disease.
When is a sentinel node biopsy done?
A sentinel lymph node biopsy is done when a preoperative axillary ultrasound is normal
What are the implications of the results of a sentinel node biopsy?
If sentinel node is clear, all nodes will be clear and so ni further treatment of the axilla is required
If it is positive, either remove all axillary lymph nodes surgically or give radiotherapy to the axilla
What are the possible complications of axillary treatment?
- Lymphoedema (10-17%)
- Sensory disturbance (intercostobrachial n.)
- Decrease ROM of the shoulder joint
- Nerve damage (long thoracic, thoracodorsal, brachial plexus)
- Vascular damage
- `Radiation-induced sarcoma
What factors are associated with an increased risk of disease recurrence?
- Lymph node involvement
- Tumour grade
- Tumour size
- Steroid receptor status (negativity- ER/PR neg)
- HER2 status (positivity- HER2 pos)
- Lymphovascular invasion
How can adjuvant treatment be given?
Local radiotherapy
Systemic chemotherapy
Hormone therapy
Targeted therapies
