Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute complication during curative treatment
Neutropenic sepsis, pulmonary embolism, anaphylaxis, acute cardiopulmonary toxicity, rapidly expanding postoperative haematoma or flap compromise can become life threatening during otherwise curative breast treatment.
Action: Use the relevant ABCDE and acute oncology or surgical emergency pathway, stop the suspected infusion where appropriate, obtain cultures or imaging without delaying antibiotics, anticoagulation, haemorrhage control or resuscitation and contact the breast oncology or surgical team immediately.
Synopsis
Stage operable invasive breast cancer accurately, integrate histology and ER, HER2 and genomic risk, choose breast and axillary treatment and deliver risk-adapted systemic, radiation and survivorship care.
Early breast cancer is operable invasive disease without distant metastasis; curative planning integrates tumour size, nodes, grade, subtype, comorbidity and patient priorities.
Core pathology should report invasive type and grade and test oestrogen receptor and HER2; progesterone receptor and proliferation or genomic tests add selected prognostic or predictive information.
Do not perform routine CT, bone scan or PET-CT for every asymptomatic small node-negative cancer; stage systemically when symptoms, examination, laboratory results or higher anatomical burden makes metastasis plausible.
Key red flags
A rapidly expanding postoperative breast or axillary swelling, hypotension, severe pain or drain output suggests haemorrhage requiring urgent surgical review.
Possible occult metastasis
Persistent bone pain, neurological change, respiratory symptoms, hepatomegaly or abnormal liver and calcium results requires systemic staging before a purely local plan.
Investigation priorities
01
Core histology with ER and HER2First step
Confirm invasion, histological type and grade and identify the principal predictive treatment targets.
02
First-line breast and axillary imagingFirst line
Define multifocality, extent and contralateral disease and identify nodes requiring preoperative sampling.
Management branches
Operable diseaseChoose breast and axillary surgery
Biopsy confirms invasive cancer that is suitable for primary surgery.
Map tumour extent, breast-to-tumour ratio, genetics, radiotherapy feasibility, reconstruction and preference and compare breast conservation with mastectomy using equivalent-survival information where appropriate.
Stage a clinically and ultrasound node-negative axilla with sentinel-node biopsy and plan targeted or more extensive axillary treatment only when nodal findings justify the additional morbidity.
Key medicines
Tamoxifen for ER-positive diseaseGive tamoxifen 20 mg orally once daily for the planned endocrine duration, commonly at least 5 years, with extension or switch determined by menopausal status, recurrence risk, tolerance and current guidance.
Anastrozole after menopauseGive anastrozole 1 mg orally once daily within a postmenopausal adjuvant sequence, with total endocrine duration and any tamoxifen switch chosen from recurrence and toxicity review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.