1. Staging/investigation
a. bloods + LFT, ALP
b. diagnostic bilateral mammogram, ultrasound
c. determination of ER/PR/Her2 status
d. KIV breast MRI
e. bone scan (localized symptoms, elevated ALP, T3N1M0)
f. abdominal +/- pelvic CT/US/MRI (elevated ALP, abnormal LFT, abdominal symptoms, abnormal physical examination of abdomen or pelvis, T3N1M0)
g. chest imaging (if pulmonary symptoms present)
h. genetic counseling if high risk
i. tamoxifen: annual gynae assessment if uterus present
j. aromatase inhibitor/ovarian failure: BMD (also remember to give calcium and vit D tabs)
2. JH guidelines for metastatic breast CA
a. AC – Taxol – Gem/Cis – Femara – Xeloda
b. ECF, Epirubicin, 5FU, cyclophosphamide
c. Aromatase inhibitors (arimidex)
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