breast treatment Flashcards
(27 cards)
How is the severity of breast cancer measured?
Staging the severity done by:
FBC, U&Es, LFTs, Ca2+/PO2
- Chest x-ray
- Others as clinically indicated
- No reliable tumour markers
What classification system is used for breast cancer?
TNM
Explain T staging for breast cancer?
Explain N staging for breast cancer?
- N0 – no regional lymph nodes palpable
- N1 - regional lymph nodes palpable and mobile
- N2 – regional lymph nodes palpable and fixed
Explain M staging for breast cancer?
Mx – distant metastases cannot be assessed
- M0 – no distant metastases
- M1 – distant metastasis
What is neo-adjuvant?
Neo-adjuvant = treatment before surgery
What is adjuvant?
Adjuvant = treatment after surgery
Describe the management for breast cancer?
Surgery
Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
- Masectomy – simple or skin sparing mastectomy
Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla - If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damagePrevention/adjuvant treatment
\+/- radiotherapy
- Over 3 weeks
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
\+/- chemotherapy
- Anthracycline combinations (dexorubican or epirubicin)
- Taxane based combinations (ocetaxel)
Indications – benefit best in younger woman (<50 years) and patients with increasing adverse prognostic factors (grade 3, LN pos, ER neg, Her2 pos)\+/- hormonal therapy
- Only given to oestrogen receptor positive cancers
- Blocks stimulation of cell growth by oestrogen
Tamoxifen - Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
Aromatase inhibitors (arimidex and letrozole)
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
\+/- biologics Trastuzumab - Monoclonal antibody against Her2 receptor
- Indication – only given to patients with over expression of Her2 and chemotherapy
What surgery can be done for breast cancer?
Breast conservation surgery
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishesMasectomy – simple or skin sparing mastectomy
Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla - If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
What are indications for breast conservation surgery?
- Indications – breast:tumour size ratio, suitability for radiotherapy, patients wishes
What are the 2 different kinds of masectomy?
- Masectomy – simple or skin sparing mastectomy
Why is surgery done to the axilla?
- Surgery to axillar – gives prognostic information, regional control of disease/eradication in axilla
What are possible complications of surgery to the axilla?
- Complications – lymphoedema, sensory disturbance, decreased ROM of shoulder joint, nerve damage, vascular damage
What is done after surgery to the axilla if:
- sentinal node is negative
- sential node is postiive?
- If sentinel node is negative is fine, if positive need to remove them all surgically or give radiotherapy to all axillary nodes
What are possible complications of radiotherapy?
- Complications – skin reaction, radiation pneumonitis, cutaneous radionecrosis, angiosarcoma (immediate to long term)
What chemotherapy is used for breast cancer?
- Anthracycline combinations (dexorubican or epirubicin)
* Taxane based combinations (ocetaxel)
What are indications for chemotherapy in breast cancer?
Indications – benefit best in younger woman (<50 years) and patients with increasing adverse prognostic factors (grade 3, LN pos, ER neg, Her2 pos)
Who is hormonal therapy given to?
- Only given to oestrogen receptor positive cancers
How does hormonal therapy work?
- Blocks stimulation of cell growth by oestrogen
What hormonal therapy drugs can be given for breast cancer?
Tamoxifen
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic eventsAromatase inhibitors (arimidex and letrozole)
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
For tamoxifen:
- action
- indication
- side effects
- Action – blocks directly on ER receptor
- Indication – effective in all age groups
- Side effects – thromboembolic events
For aromatase inhibitors:
- action
- contraindications
- side effects
- Action – inhibiting ER synthesis
- Contraindication – NOT given to postmenopausal woman
- Side effects – osteoporosis
What biologic can be used for breast cancer?
Trastuzumab
- Monoclonal antibody against Her2 receptor
- Indication – only given to patients with over expression of Her2 and chemotherapy
What are indications for biologics (trastuzumab) for breast cancer)?
- Indication – only given to patients with over expression of Her2 and chemotherapy
