Treatment for Breast Cancer Flashcards
(26 cards)
Who should be involved?
MDT of
Breast surgeons, radiologist, oncologists, pathologist
Breast cancer specialist nurses
Patient
Types of surgery
Breast conserving
Mastectomy
Axillary
What is breast conserving surgery?
Wide local excision with excision of the tumour + 1cm margin of normal tissue.
Indications of WLE
Localised operable disease and no evidence of metastatic disease
Only suitable for focal smaller cancers
What is mastectomy?
Removes all breast tissue
THe skin is then reconstructed.
Indications of mastectomy
Multifocal disease
High tumour:breast tissue ratio
Disease recurrence
Patient choice
When is axillary surgery done?
Alongside WLE and mastectomies in order to assess nodal status + remove any nodal disease
Sentinel node biopsy is done.
What is sentinel node biopsy?
Sentinel node biopsy involves removing first lymph nodes into which the tumour drains
Nodes are identified by injecting a blue dye with associated radioisotope into the peri-areolar skin, the nodes should then become blue.
The sentinel node is removed and sent for histology.
What is axillary node clearance?
Removes all nodes in the axilla and sent for histology
Complications of axillary node clearance.
Paraesthesia
Seroma formation
Lymphoedema in upper limb
What is risk-reducing mastectomy?
Removes healthy breast tissue in order to reduce the risk of developing breast cancer.
It is only suitable for high risk patients that wants to have it done.
Risk factors that warrants risk-reducing mastectomy
Strong FH of breast or ovarian cancer
BRCA1/2, PTEN or TP53 mutations
Previous history of breast cancer
Give examples of hormonal treatments
Tamoxifen
Aromatase inhibitor
Immunotherapy
When is medical treatment used?
Usually after primary surgery or in elderly patients unfit for surgery.
Radiotherapy is offered to all patients after WLE in post-mastectomy cases with positive resection margins, tumour size >5 cm or 4 or more pathological nodes in axilla.
When is tamoxifen used?
In pre-menopausal patients
Acts through blockade of oestrogen receptors meaning the patient must be ER+
Risks of tamoxifen
Used as prophylaxis against breast cancer
But it increases risk of thromboembolism during and after surgery or period of immobility
Increases risk of uterine carcinoma as well due to its pro-oestrogenic effect on uterus.
Give examples of aromatase inhibitors
Anastrozole
Letrozole
Exemestane
How do aromatase inhibitors work?
Bind to oestrogen receptors to inhibit further malignant growth and prevent further oestrogen production.
Blocks conversion of androgens to oestrogen in peripheral tissues as well.
When are aromatase inhibitors used?
Post-menopausal patients as adjuvant therapy
Shown to be superior in this patient subgroup to tamoxifen.
Give examples of immunotherapies
Herceptin (Trastuzumab) monoclonal antibody
When is immunotherapy used?
In patients whose cancers express specific growth factor receptors.
Herceptin is used in HER-2+ve malignancies
Used as adjuvant therapy or in monotherapy in patients who have received at least two chemotherapy regimen for metastatic breast cancer.
Cardiotoxicity can happen so cardiac function needs monitoring
What is therapeutic mammoplasty?
WLE + breast reduction technique.
The end-result is a smaller and uplifted breast with the nipple and areola preserved.
Give examples of flap formations
Latissimus Dorsi flap
Transverse Rectus Abdominal Muscle flap TRAM
Deep inferior epigastric perforator flap DIEP
Explain lats dorsi flap
Part of lats dorsi muscle and its overlying skin used to reconstruct the removed breast.
This is only used to reconstruct smaller breasts because only a small bit can be used of the muscle.
