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BREAST CANCER (TREATMENT (SURGERY (mastectomy:
simple: all breast, no…
BREAST CANCER
TREATMENT
HORMONAL
side effects:
- bone loss (monitor bine density, bisphos trtmt)
- menopausal (hot flushes/sweats, vag bleeding/dryness, red.libido, moody)
- tamoifen (VTE, visual)
SURGERY
mastectomy:
- simple: all breast, no muscle
- modified: all breast, ax. node dissection
- radical: breast, all muscle, ax. contents
breast conserving:
- tumour excised with 1cm surrounding
- not suitable for many:
- prior radiotherapy
- widespread disease
- tumour over 5cm
- 35 or younger
inflam tumours
CHEMOTHERAPY
NODE NEG:
- anthracycline containing
- EC (epirubi/cyclophos) x6
- FEC (5fu/epirubi/cyclophos) x6
- alternative
- CMF (cyclophos/methotrex/5fu)
NODE POS:
- taxane containing
- FEC-T (5fu/epirubi/cyclophos-docetaxil)
- alternative
RADIOTHERAPY
- always for breast conserving
- only given after mastectomy in patients at high risk of recurrence
-
DIAGNOSIS
clinical examination
- mammography (x-ray)
- ultrasonography (differentiates between solid+fluid)
pathological evaluation
- pathological evaluation
- biopsy
- fine needle aspirate
breast imaging
- characteristics of lump, size, texture and whether it moves
STAGING
N
N0 - no palpable axillary
N1a - palpable nodes w/o tumours
N1b - palpable nodes w/ tumours
N2 - nodes over 2cm, fixed to oneanother and deep structures
N3 - supraclavicular or infraclavilar nodes
-
T
T0 - nowt
T1 - less than 2cm, not fixed to muscle
T2 - 2-5cm, not fixed to muscle
T3 - above 5cm
T4 - any size, fixation to chest wall or skin ulceration
RISK FACTORS
- female, over 65, genetic mutations, 2 1st degree rels, personal history, high breast tissue density, atypical hyperplasia
- 1 1st degree rel, high dose rads to chest, high bone density
- baby after 30, early period, late menopause, no babies, never breastfeed, recent contraceptive use, hormone replacement, postmenopausal obesity, tall, booze, personal history of other cancers, rich, jew
PRESENTATION
- lumps, skin dimpling, nipple discharge, lumps, pain, axillary, change in size and shape