breast cancer Flashcards
(25 cards)
commonest type of breast cancer
invasive ductal carcinoma
indications for mastectomy
- multifocal tumour
- central tumour
- large lesion in small breast
- DCIS >4cm
(patient choice)
indications for wide local excision
- solitary lesion
- peripheral tumour
- small lesion in big breast
- DCIS <4cm
(patient choice)
prognostic scoring system used for breast cancer
Nottingham Prognostic Index
- gives indication of 5 year suvival
- includes tumour size x 0.2 + lymph node score + grade score
breast cancer risk factors
nulliparity, 1st child >30
early menarche, late menopause
COCP
not breastfeeding
p53 gene mutations
obesity
age and frequency of breast screening
50-70yrs
- offered every 3 years
after age of 70, encouraged to make their own appointments
inflammatory breast cancer pathophys
cancerous cells block lymph drainage in an inflamed appearance of the breast
2 week wait referal criteria
age >=30
- unexplained breast lump with or without pain
age >=50 with any of these sx in ONE nipple only;
- discharge
- retraction
- other changes of concern
when to consider 2 week wait referral
- skin changes that suggest breast cancer
- age >=30 with unexplained lump in axilla
management of <30s with unexplained breast lump with or without pain
non-urgent referral
who gets surgery for breast cancer
everyone except frail old ladies with metastatic disease
prior to surgery, what determines management of breast cancer
the presence / absence of axillary lymphadenopathy
management of women with NO palpable axillary lymph pre-surgery
pre-operative axillary ultrasound before surgery
- if negative –> sentinal node biopsy to assess nodal burden
management of women WITH palpable axillary lymph pre-surgery
axillary node clearance in primary surgery
complications fo axillay node clearance
lymphoedema
functional arm impairment
in those who have had a wide local excision, how can they reduce the risk of recurrence
breast radiotherapy after !
- reduces recurrence by 2/3rds
hormonal management of (ER+) breast cancer in pre- and peri-menopausal women
tamoxifen !
hormonal management of ER+ breast cancer in postmenopausal women
aromatase inhibitors
-> anastrozole
(ER+)
side effects of tamoxifen
increased risk of ;
- endometrial cancer
- VTE
- menopausal sx - hot flushes
menstrual disturbance - vag bleeding, amenorrhoea
biologic therapy used for HER2 + breast cancer
trastuzumab (Herceptin)
!! cant be used if history of heart disorders
role of chemotherapy in breast cancer management
prior to surg - downstage tumour
after surg - if axillary node disease
–> FEC-D used in this situ
tamoxifen !
selective oestrogen receptor modulator (SERM)
used in mx of oestrogen receptor positive BC (ER+)
aromatase inhibitor side effects
osteoporosis
hot flushes
arthralgia, myalgia
insomnia
what test must be done before initiaing anastrozole
DEXA scan !!
can cause osteoporosis
