Please enable JavaScript.
Coggle requires JavaScript to display documents.
REGUB Surgery: Breast Cancer & Screening (ii) (Screening (disease must…
REGUB Surgery: Breast Cancer & Screening (ii)
Triple Assessment
aim = establish firm dx before definitive tx is undertaken
1) Hx + exam
essential 1st step
accurate hx of presenting complaint + risk factor profile
physical exam to assess tumour characteristics + spread (axillary nodes, distant mets)
findings
S (surgeon) 2: benign
S3: most likely benign
S4: concerning
S5: most likely malignant
2) Radiological assessment
mammogram
detects 80-90% of breast cancers
detects tumours that are not clinically palpable
R staging (same as B/C)
US
if women <35
young breast tissue is active + white, + since tumours are also white they can't be seen on mammogram (in older women breast tissue is deprived of hormones + hence black)
provides additional info on tumour characteristics
3) Cytology/Pathology
FNAC
performed in OPD
aspirate from lump assessed by cytologist
allows demonstration of presence/absence of malignant cells (no tissue architecture - hence can't distinguish invasive from non-invasive)
cytological dx
stereotactic core bx
maintains tissue architecture - can differentiate invasive vs non-invasive
method of choice
local anaesthetic
small tissue sample from lump
histological dx
can be performed under x-ray guidance
C/B 1: no dx possible
C/B2: benign
C/B3: atypia, probably benign
C/B4: suspicious for malignancy
C/B5: malignant
wire-guided bx
occasionally required to allow sampling of a non-palpable radiological abnormality to provide a definitive tissue dx
needle placed under x-ray guidance into abnormal area
needle acts as guide to surgeon
performed under general anaesthetic
Adjuvant therapies
hormonal therapy
tamoxifen
premenopausal
ER +ve
anti-oestrogen
reduces relapse
aromatase i (anastrozole)
postmenopausal
herceptin (trastuzumab)
monoclonal ab directed @ Her2neu R (in 20% of breast cancer patients - used to have poor prognosis but now tx v effective)
exact MOA unknown
radio
must give after breast conserving surgery (risk of local recurrence)
in selected patients after mastectomy who are deemed high risk for chest wall recurrence
chemo
decision made @ MDM
only give if it will enhance survival
consider in all node +ve patients
considered in some node -ve patients with a high recurrence risk
typical regime = CMF (cyclophosphamide, MTX, 5FU)
also: adriamycin, taxol (plant-alkaloid from Yew tree bark in Cali)
Screening
detect cancer with no signs/symptoms
should detect prior to systemic spread (e.g. calcifications = early sign), alter natural hx, defer death
disease must be a/w
high morbidity+mortality+costs+incidence+prevalence
known natural hx + biology (prostate cancer not understood well)
pre-clinical phase with high prevalence + is detectable
effective tx when caught early
test must be
effective (sensitive + specific)
safe (low radiation), simple, inexpensive
acceptable (cost - mammogram = €120, comfort - some discomfort a/w mammogram)
should reduce mortality of screened pop compared to non-screened pop
criticisms
lead time bias: apparent increase in survival time without reduction of mortality
length bias: clinical out observations are not adjusted for progression rate of disease (i.e. screening programmes tend to detect less aggressive forms, while patients with aggerssiveforms present directly)
RCTs obviate (remove) these biases
reduces mortality by up to 30% when women >50 screened for breast cancer
Ire: 50-64 y/o every 2 yrs (getting extended yo 69, ideally should be 47-69)