Flashcards in Breast Cancer Treatment Deck (41):
In a wide local excision what margins are you aiming for?
1cm at all margins.
When would MRI screening be indicated for a women with suspected breast cancer?
1. Discrepancy between the clinical and imagining assessment of disease extent.
2. If breast density means mammography is not accurate
3. To assess tumour size if breast conserving surgery is being considered for invasive lobular cancer.
What is the aim of giving neoadjuvant chemotherapy?
To reduce tumour size meaning that breast conservation surgery can be performed rather than a mastectomy
How do you assess the effect of neiadjuvant chemotherapy?
Radiography: Mammography, US, MRI
What is meant by oncoplastic surgery?
Integration of breast cancer surgery and plastic surgery - avoids tissue deformity and improves aesthetical outcomes
What is meant by a pedicle flap?
Flap of tissue is taken from the back or tummy without cutting the original blood supply
What is meant by a free flap?
Tissue is taken and tissue and blood vessels are cut. When the flap is in place the blood vessels are sewn back together.
What is a transverse rectus abdominis flap?
A flap is taken including all or part of the transversus rectus abdominus, skin and fat. This can e done as a free or pedicled flat.
What is a latissimus dorsi flap?
Pedicle flap surgery using skin an fat from the upper back and the underlying lattisimus dorsi
What is a deep inferior epigastric artery perforator flap?
Free flap. Fat and skin is taken from the tummy area but the muscle is left intact.
What two muscles in the lowee body can be used to make a free flap in oncoplastic surgery?
Gluteus maximus muscle
What are the main problems seen with breast implants after mastectomy?
Infection causing loss of implants
Capsular contracture - formation of scar tissue around the breast that causes the breast to harden causing discomfort
Implant rippling - The appearance of visible ridges or wrinkles that show through the skin.
What % of breast implants need revisional surgery?
Describe the current method of implant surgery in mastectomy patients?
1. Mastectomy and creation of sbmuscular pocket with expander insertion
Clinic visits every two weeks for expansion
2. Exchange of expander for permanent implant.
What treatment is used in patients who have bony metatastases as a result of breast cancer?
What are the two most common classes of chemotheraputic drugs used in breast cancer?
Briefly describe the mechanism of action of anthracycline chemotheraputic durgs.
1. Inhibition of DNA and RNA synthesis by intercalating into the DNA strand.
2. Inhibition of topoisomerase II enzyme, preventing the relaxing of supercoiled DNA and thus blocking DNA transcription and replication.
3. Iron-mediated generation of free oxygen radicals that damage the DNA, proteins and cell membranes.
4. Induction of histone eviction from chromatin that deregulates DNA damage response.
What is the main adverse effect of anthracycline chemotheraphy drugs?
Briefly describe the mechanism of action of taxane chemotherapy agents such as paclitaxel.
Disrupution of microtubule formation. This therefore inhibits cell division
What is capecitabine?
A chemotherapy agent that is a prodrug that is enzymatically converted to 5-fluorouracil (5-FU) in the body which works to inhibit DNA synthesis
Through what system is tamoxifen metabolised into its active metabolites by?
What are the two types of aromatase inhibitors used in breast cancer treatment and how do they work?
1. Irreversible steroidal inhibitors, such as exemestane (Aromasin), forms a permanent and deactivating bond with the aromatase enzyme.
2. Non-steroidal inhibitors, such as anastrozol and letrozole , inhibit the synthesis of estrogen via reversible competition for the aromatase enzyme.
What is the mechanism of action of aromatase inhibitors?
Inhibit aromatase which is the enzyme causing the conversion of androgens into oestrogens
In what type of breast cancer is chemotherapy most effective?
Er -ve and/or Her2 +ve
What stain is used to look for cancer cells in DCIS?
What tests would you want to avoid in a women who has a newly found breast cancer in pregnancy?
Pelvic X Ray/CT
What breast cancer treatment drugs would you want to avoid in pregnancy?
Can you give chemotherapy in pregnancy? If so when and what type?
- Not in first trimester
- In second and third trimester anthracycline agents are safe.
- There is less data on taxanes so these should be reserved for women with node positive cancer.
Is breast cancer surgery dafe in pregnancy?
Yes and can be undertaken in all trimesters
Is radiotherapy for breast cancer safe in pregnancy?
No. Only done if required to save life or vital organs eg in spinal cord compression.
How long is it recommended women wait after treatment for breast cancer until the conceive?
2 - 3 years
Describe the breast cancer screening programme?
Every three years between the ages of 50 and 70
(After 70 not invited but still allowed to come for screening)
What is the lifetime risk of developing breast cancer?
1 in 8
What % of familial breast cancers are caused by BRACA genes?
In what % of breast cancer is the cause a faulty gene?
10 - 15%
What is meant by a high penetrance gene?
If you have the gene the risk of you getting the condition is high (eg in BRACA)
What do the BRACA 1 and 2 genes do when they are working correctly?
Involved in fixing damaged DNA and therefore helping maintaining the stability of the cells genetic information
If you have a BRACA1 mutation what is your lifetime risk of breast cancer?
If you have a BRACA2 mutation what is your lifetime risk of breast cancer?
What type of breast tumour is associated with BRACA mutations?