Breast - Breast Cancer Management Flashcards Preview

Year 3- Surgery > Breast - Breast Cancer Management > Flashcards

Flashcards in Breast - Breast Cancer Management Deck (14)
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1
Q

Explain the Aetiology of breast cancer

A
  • Most breast cancers arise from duct tissue (ductal) or lobular tissue (lobular) and are carcinomas
  • Carcinoma in situ: cancer has not spread beyond local tissue- can be lobular or ductal
  • Invasive: cancer spread to surrounding tissue -can be lobular or ductal
  • Invasive ductal carcinoma is the most common type (has recently been renamed to No Special type)
2
Q

When should you consider referring someone to the 2 week pathway?

A
  • Age 30 and over and have unexplained breast lump with or without pain
  • Age 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other concerning change
3
Q

Outline the 5 options available for breast cancer treatment

A
  • Surgery
  • Radiotherapy
  • Hormone therapy
  • Biological therapy
  • Chemotherapy
4
Q

Surgery: who is offered surgery?

A
  • Vast majority of women with breast Ca are offered surgery
  • Exception: elderly very frail lady who may be better managed with hormonal therapy
  • 2/3 of tumours can be removed with WLE
5
Q

What features are used to determine whether a mastectomy or WLE is performed?

A

Mastectomy

  • Multifocal tumour
  • Central tumour
  • Large lesion in small breast
  • DCIS >4cm

WLE

  • Solitary lesion
  • Peripheral tumour
  • Small lesion in large breast
  • DCIS <4cm

*All women should be offered breast reconstruction to achieve cosmetically suitable result, regardless of type of operation they have

6
Q

What is a sentinel node biopsy?

A
  • Surgical procedure to determine whether cancer has spread from primary tumour into the lymphatic system. Gold standard
  • Sentinel node: first node that a section of a breast drains into
  • If the node is negative, there is no need for further dissection
  • If the node is positive, axillary clearance and radiotherapy will be offered to the patient.
7
Q

Outline the axillary clearance levels

A
  1. Up to axillary vein level
  2. Up to medial border of pectoralis minor
  3. Up to border of first rib
8
Q

Outline surgical complications

A
  • Haematoma or seroma
  • Frozen shoulder
  • Long thoracic nerve palsy (winged scapula)
  • Lymphoedema
9
Q

When do we offer radiotherapy?

A

Whole breast radiotherapy is recommended for:

  • Women who has had WLE: reduces risk of recurrence by 2/3
  • Mastectomy patients for T3/T4 tumours
  • Patients with 4 or more positive axillary nodes
10
Q

What hormonal therapy is offered to patients?

A
  • Tamoxifen: ER+ve cancer - offered to both pre and peri menopausal women and for 5 years after diagnosis. Works as oestrogen receptor block
  • Anastrozole: ER+ve cancers in post-menopausal women - work as aromatisation inhibitors (aromatisation accounts for the majority of estranged production in post-menopausal women)
12
Q

What are important side effects of tamoxifen?

A
  • Increased risk of endometrial cancer
  • Venous thromboembolism
  • Menopausal symptoms
12
Q

What biological therapies are offered to breast cancer patients? What important C/I is there?

A

Trastuzumab: HER2 +ve patients (only useful 20-25% these tumours). Works by binding to the HER2 receptor and slowing down cell duplication

S/E: fever, infection, insomnia, rash, heart failure, allergic reactions and lung disease

CI: cannot be used in patients with history of heart disorders or heart failure

13
Q

What is the Nottingham Prognostic index?

A

Index used to give an indication of survival

14
Q

What are borders of the axilla?

A
  • Anterior border: pectoralis major and minor
  • Lateral border: intertubercular sulcus of humerus
  • Medial border: serrated anterior and thoracic wall
  • Posterior border: scapularis, teres major and latissimus doris

https://teachmeanatomy.info/wp-content/uploads/Transverse-View-of-the-Borders-of-the-Axilla.jpg

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