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Breast cancer (Risk factors (Hormonal Early menarche Late menopause …

- - - - a. Hormones
        Indication: ER/PR+
        
        i. ER-R antagonist
        Indication: pre-menopause
        E.g. tamoxifen
        SE: teratogen, VTE, uterine ca,osteoporosis, reduced fertility
        
        ii. Aromatase inhibitors
        Indication: postmenopausal (reduces oestrogen levels)
        MOA:antagonise ERs, inhibits androgen - oestrogens
        SE: uterine cancer, vaginal bleeding
        
        iii. GnRH analogues
        Inidcation: pre-menopause
        E.g. goserelin
        MOA: activate GnRH
      - b. HER2
        Indication: adjuvent/
        monotherapy for HER2+
        E.g. herceptin (trastuzumab)
        MOA: MAb to HER2, inhibits cell growth
        SE: cardiomyopathy
  - - - a. Seintinel node bopsy
        MOA: identify draining LNs with blue dye,
        remove likely affected LNs for histology
      - b. Axillary clearance
        MOA: removal of all axillary nodes
        SE: lymphoedema, seroma, parasthesia
    - - a. Mammopasty
        MOA: WLE plus breast reduction,
        with smaller and uplifted breasts,
        preserved nipple and blood supply
      - b. Flap formation
        
        ii. Transverse Rectus Abdominal Muscle (TRAM)
        MOA: abdominal muscle, skin, and fat used to
        reconstruct either as a free or pedicle flap;
        advantage = removing abdominal fat
        disadvantage = reduced abdo muscle strength
        
        ii. Deep Inferior Epigastric Perforator (DIEP)
        MOA: tissue from the abdomen and its overlying
        skin to reconstruct the breast as a free flap
        advantage = no muscle used so abdo strength maintained.
        
        i. Latissimus dorsi
        Indication: smaller breasts
        Part of LD muscle and its overlying skin used to reconstruct the removed breast, either as a free or pedicle flap; limited vol muscle available so only used for small breasts