- Types
- Ductal Carcinoma In Situ (DCIS)
- Lobular Carcinoma In Situ (LCIS)
- Invasive Ductal Carcinoma (IDC)
- Invasive Lobular Carcinoma (ILC)
- Other types
- Paget's disease of the nipple
- Phyllodes tumours of the breast
- Metastasis
- Bone
- Liver
- Lung
- Classify
- Oestrogen receptor positive
- Mainly older women
- HORMONE
- Oestrogen receptor negative
- Mainly younger women
- CHEMOTHERAPY
- www.predict.nhs.uk
MANAGEMENT
SURGERY
- WIDE LOCAL EXCISION (WLE)
- Done mainly for focal disease
- Followed by sentinel node biopsy (methylene blue)
- If sentinel node is positive, then axillary lymph node excision can be done
- Lymphoedema (20% risk)
- Brachial plexus injury
- Long thoracic nerve injury
- MASTECTOMY
- Done mainly for multifocal disease
MEDICAL (USUALLY ALWAYS USED AS AN ADJUNCT TO SURGERY) (HELPS PREVENT RECURRENCE)
- Oestrogen receptor positive
- Tamoxifen
- Oestrogen receptor antagonist
- Increases risk of endometrial cancer
- Letrozole (node positive?), Anastrozole (node negative?), Exemestane (metastases?)
- Aromatase inhibitor (stops production of oestrogen)
- Follow up with bone scan, and give Ca2+/Vit D to counter the effects of osteoporosis (Decreasing what little oestrogen is left)
- Zoladex (Goserelin Acetate)
- Gonadotropin releasing hormone superagonist (GnRH agonist)
- Increases oestrogen and testosterone production in a non-pulsatile fashion such that production decrease
- Eventual decrease in oestrogen and testosterone
- Useful for prostate cancer, breast cancer, and precocious puberty
- Chemotherapy
- Oestrogen receptor negative
- Chemotherapy (Bolded is a sample combination - FEC)
- 5-fluorouracil
- Epirubicin
- Cyclophosphamide
- Doxorubicin
- Methotrexate
- Docetaxel
- Zoladex?
- HER2/neu receptor positive
- Trastuzumab
- Monoclonal antibody
- Arrest in cell stage G1 after treatment
RADIOTHERAPY (SOMETIMES USED AS AN ADJUNCT TO BOTH CHEMOTHERAPY and SURGERY) (HELPS PREVENT RECURRENCE)
- Targeted versus not targeted - 'radiotherapy equivalent of mastectomy'
- Has to be first simulated and planned
- Treatment is then given after planning
- HAS BEEN SHOWN TO IMPROVE ALL SUCCESS RATES
- Not used so much after mastectomy, since even though there is still an improvement, because with mastectomy the % recurrence is so small anyway (given the chemotherapy that would inevitably be given)
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