breast cancer JH Flashcards
(43 cards)
genetics and breast cancer
FHx strongest RF
first degree relative 2-3x higher risk
BRCA1 and BRCA2 major risk genes associated with BC
personal Hx RF of BC
age
previous BC
high breast density
previous exposure to radiation (chest)
inc exposure to oestrogen
- early menarche, late menopause
- combined oral contraceptives/HRT
- nulliparous
- never breast fed
higher social/economic status
white ethnicity
lifestyle RF with BC
lower incidence in those who exercise regularly
higher incidence in obese patients
inc risk when acohol consumed regularly (even small quantities)
screening for BC
mammogram
x-ray of the breast tissue to detect presence of cancer that is too small to see/feel
How is diagnosis of BC made?
self examination or screening
usually facilitated using TRIPLE ASSESSMENT:
- clinical exam (characteristics of the lump, size/texture/moves)
- breast imaging (mammogram, ultrasound, to diff between solid/fluid filled lump)
- pathological evaluation (biopsy, assessment of tissue from lump)
What is first line Tx?
surgery
aim of surgery as first line Tx
remove the primary breast tumour, sent to lab for assessment
4 types of surgery for BC
- wide local excision
- radical mastectomy surgery
- conventional mastectomy surgery
- axillary surgery
What is wide local excision?
breast conserving surgery/lumpectomy
tumuor removed with small margin (1cm) of uninvolved surrounding tissue
better cosmetic outcome
patients not suitable for wide local excision
proir radiotherapy
widespread disease
tumour >5cm
persistent pathological margin
What is radical mastectomy surgery?
removal of breast, pectoralis major and minor muscles and axillary contents
What is conventional mastectomy surgery?
removal of breast including skin and nipple
pectoral muscle maintained unless evidence of tumour invasion
What is axillary surgery?
used to get lymph nodes for pathological examination required for all bc cases
- sentinel lymph node biopsy
- axillary lymph node dissection
- axillary lymph node clearance
axilla frequent site of lymph node metastases
What is lymphoedema?
build up of lymphatic fluid in lymph nodes
caused by surgery/radiotherapy
they cut off some of the lymph nodes
lymph fluid normally flows along lymph vessels and drains through lymph nodes
arm can become stiff, uncomfortable, tight
Tx for lymphoedema
compression tockings
massage
exercises
consideration for patient with lymphoedema
take blood/BP/injections in other arm
When can radiotherapy be used?
after surgery for early bc
combined with systemic therapy and surgery for locally advanced cancer
combined with systemic therapy for Tx of metastatic disease
What patients should receive radiotherapy?
all patients who have undergone bresat conserving surgery
- LT survival equivalent to mastectomy
Should radiotherapy be given after axillary surgery?
not recommended
30-40% risk of significant lymphoedema
adverse effects of radiotherapy
EARLY
- skin Tx areas become more sensitive, red, swollen
- fatigue
- hair loss
LATE
- breast changes (smaller, harder, skin changes)
- bone damage (ribs, collar bone)
- cardiac, respiatoty toxicity (less comon now, more targeted)
adjuvant chemotherapy
started within 31 days of surgery or earliest clinically appropriate date
considerations for adjuvant chemotherapy
nodal involvement
oestrogen R status
HER2 status
When is neo-adjuvant chemotherapy considered?
for locally advanced disease and tumours where down staging may facilitate breast conserving surgery
What to determine before neo-adjuvant chemotherapy?
ER, PR, HER2 status
