Breast Cancer treatment Flashcards
(26 cards)
treatment options
Surgery
radiotherapy
systemic therapy
- hormonal, cytotoxic chemo, immuno
What is radiotherapy used for? (intent)
postop
primary radical for locally advanced (rare)
Palliative to painful bony mets, skin deposits, brain mets
Where is post-operative radiotherapy used on?
breast/chest wall
nodal areas: axilla, supraclavicular fossa
When is postop radio used?
all patients being treated conservatively (wide local excision/lumpectomy)
Mastectomy selected patients
Criteria for postop radiotherapy in mastectomy patients (3)
Large tumour
Extensive nodal involvement (4 or more)
involved margins (
Acute side effects of postop radiotherapy (3)
tiredness
skin erythema to moist desquamation
possible mild dysphagia if irradiating supraclav fossa
Post op radiotherapy - late adverse effects (3)
local fibrosis and telangectasia
lung fibrosis (rarely symptomatic)
cardiac damage (IHD) - rarer now due to better planned treatment
Post op radiotherapy - positive late effects
overall modest improvement in survival - probably need to prevent 4 recurrences to save 1 life
Previous excess cardiovascular mortality reduced with current techniques
systemic therapy - adjuvant, most operable why not curable
occult distant mets at presentation
adjuvant systemic therapy options
hormone therapy
cytotoxic chemo
immunotherapy
types of hormone therapy (3) and benefits
ovarian ablation
Herceptin - HER2 +ve
If OR/PgR +ve:
- tamoxifen
- aromatase inhibitors (anastrozole in post meno)
ALL decrease odds of death by 17%, absolute benefit of 6% at 10 years
adjuvant systemic therapy side effects : hormone therapy (5)
infertility
menopausal symptoms
endometrial cancer
weight gain
DVT
adjuvant systemic therapy side effects : chemotherapy (6)
infertility
mouth ulcers
neutropenia - sepsis
Alopecia
N/V
Lassitude
median survival with mets
18m - 2years (20% at 5yrs) but may be decades
varies from acute aggressive disease to chronic disease
where do breast mets go?
brain, bones (hip)
metastatic disease local problems - palliative options
palliative radiotherapy: bony mets, brain mets
drainage of pleural or peritoneal effusions
pining of path #
metastatic disease: systemic therapy options
hormone therapy if ER/PG +ve
Chemo
Bisphosphonates for bony mets
If HER+ve Trastuzumab
Hormonal agents
aromatase inhibitors
Tamoxifen,
Progestagens;
with above therapies used in sequence
When chemo used instead of hormonal ?
LIVER mets or lymphangitis carcinomatosa
Chemo options in metastatic disease
anthracyclines, taxanes, capecitabine
Use in sequence so long as respond and patient fit
Who gets radiotherapy after breast surgery?
Anyone who has had lumpectomy; those with higher risk tumours after mastectomy
What is the absolute benefit in survival of adjuvant chemotherapy in breast cancer?
Between 0% and 15%
What is the major difference between aromatase inhibitors and tamoxifen?
AIs lower circulating oestrogen in post-menopausal women; tamoxifen is partial agonist at receptor
What is the benefit of neo-adjuvant chemotherapy in breast cancer?
It decreases the number of people who need mastectomy
