Breast pathology treatment Flashcards

1
Q

TNM staging T

A
Tx: primary tumour cannot be assessed
T0: not palpable
T1:Clinically palpable tumour -size < 2 cm 
T2: Tumour size 2-5 cm
T3: tumour size>5cm
T4: Tumour invading skin
o	T4b: Tumour invading chest wall
o	T4c: Tumour invading both
o	T4d :Inflammatory breast cancer
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2
Q

TNM staging N

A

N0: no regional lymph nodes palpable
N1: regional lymph nodes palpable- mobile
N2: regional lymph nodes palpable- fixed

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3
Q

TNM staging M

A

Mx: Distant metastases cannot be assessed
M1: No distant metastasis
M1: Distant metastasis

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4
Q

Surgery

A
  • Mastectomy
  • Breast conserving surgery
  • Surgery to axilla
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5
Q

Who is eligible for breast conserving surgery

A
  • Tumour size<4cm
  • Breast/tumour ratio
  • Suitable for radiotherapy
  • Single tumours- OLD DAYS
  • Patients wish
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6
Q

What does axillary surgery involve?

A
  • Sentinel node lymph node biopsy: first node to receive lymphatic drainage
  • First node to receive tumour spread if it spreads
  • If negative rest of nodes are negative
  • If positive: remove all surgically and give radiotherapy to rest of axillary nodes
  • Only performed when pre-op axilla USS is normal/benign
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7
Q

complications of surgery to axilla

A
  • Lymphodema
  • Sensory disturbance
  • Decrease ROM of the shoulder joint
  • Nerve damage
  • Vascular damage
  • Radiation induced sarcoma
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8
Q

Radiation

A

o All patients after Wide Local Excision as adjuvant treatment
o 40gy-50Gy over 3 weeks
o Boosts reduce local reccurence
o After Mastectomy if thes is LN involvement

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9
Q

complications of radiation

A
  • Skin reactions
  • Radiation pneumonitis
  • Cuteneos radionecrosis/ osteonecrosis
  • Angiosarcoma
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10
Q

Hormone therapies available?

A
Tamoxifen 
•	20mg once daily over 5-10yrs
•	Blocks directly on ER receptor
•	Effective in all age groups
•	More effective given after chemotherapy
•	!Thromboembolic events

Aromatase inhibitors
• Once daily for 5 years
• Inhibiting ER synthesis
• Should only be used in postmenopausal women
• Improve disease free survivial (switch thx)
• !Osteoporosis

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11
Q

Different types of chemotherapy?

A
  • CMF Combinations (1st generation)
  • Anthracycline Combinations
  • Taxane based Combinations

More modern :
“Oncotype DX” – 21 gene assay to determine whether chemotherapy likely to be of benefit

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12
Q

Targeted therapies available?

A

Trastuzumab (Herceptin®)
•Monoclonal antibody against Her-2 receptor
•Given to patients with over-expression of Her2 and chemotherapy
•50% decrease risk of recurrence
•33% increase in survival at 3 years!

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13
Q

Factors associated with increased risk of reoccurence

A
  • Lymph node involvement
  • Tumour grade
  • Tumour size
  • Steroid receptor status
  • HER2 status
  • LVI
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14
Q

Follow up

A

oClinical examination for 1-5 years
oMammogram of breasts at regular intervals for 3-10 years
oPatient to keep eye on it
oOpen Access to service

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