Review Note
Last Update: 02/18/2024 05:30 AM
Current Deck: Part 2::6. High Yield Questions::Breast
PublishedCurrently Published Content
Front
A 33 year old woman presents with an inflammatory carcinoma of the left breast with palpable axillary lymphadenopathy. The skin changes cross midline and extend below the ipsilateral inframammary fold. Staging shows no distant disease.
a) Outline your complete management plan for this patient. (3)
Back
History including:
- time course and character of breast symptoms
- PMH including contraindications to radiotherapy
Family planning discussions including:
- fertility wishes
- fertility preservation may require changes to chemotherapy to avoid cyclophosphamide
- egg freezing or embryo freezing
Examination including breast, regional lymph nodes
Biopsy of skin + left palpable axillary LN(with clip)
If not completed – MMG + US of breast and axillae
Presumably staging CT has already been completed as per stem
1. Neoadjuvant chemotherapy (usually Adriamycin, cyclophosphamide followed by sequential paclitaxel)
- cycles every 3 weeks
- fortnightly reviews / every cycle to rule out disease progression
2. If she has an adequate clinical response to proceed to surgery, then proceed to non-skin sparing left mastectomy and left axillary clearance
3. Adjuvant radiotherapy to chest wall. Inclusion of axillary nodes or comprehensive nodes will depend on histopathology from axillary dissection.
- radiotherapy 50 Gray in 25 fractions
4. Followed by adjuvant chemotherapy (Xeloda) ((unless PCR))
[Alternatively: if not suitable for surgery after 1.]
- then can proceed to second line chemotherapy or palliative radiotherapy
- time course and character of breast symptoms
- PMH including contraindications to radiotherapy
Family planning discussions including:
- fertility wishes
- fertility preservation may require changes to chemotherapy to avoid cyclophosphamide
- egg freezing or embryo freezing
Examination including breast, regional lymph nodes
Biopsy of skin + left palpable axillary LN(with clip)
If not completed – MMG + US of breast and axillae
Presumably staging CT has already been completed as per stem
1. Neoadjuvant chemotherapy (usually Adriamycin, cyclophosphamide followed by sequential paclitaxel)
- cycles every 3 weeks
- fortnightly reviews / every cycle to rule out disease progression
2. If she has an adequate clinical response to proceed to surgery, then proceed to non-skin sparing left mastectomy and left axillary clearance
3. Adjuvant radiotherapy to chest wall. Inclusion of axillary nodes or comprehensive nodes will depend on histopathology from axillary dissection.
- radiotherapy 50 Gray in 25 fractions
4. Followed by adjuvant chemotherapy (Xeloda) ((unless PCR))
[Alternatively: if not suitable for surgery after 1.]
- then can proceed to second line chemotherapy or palliative radiotherapy
Further information, not for memorising (no card)
Exam
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