Breast Flashcards
Early breast cancer
Stage 1, 2a, 2 bNizam sir upto IIA
Locally advanced breast cancer
The term LABC encompasses patients with -
operable disease at presentation (clinical stage T3N1)-
inoperable disease at presentation (clinical stage T4 and/or N2 to N3)
IBC(clinical stage T4dN0 to N3, also inoperable)
Ipsilateral supraclav lymphadenopathy now classified as N3 disease, was previously classified as M1.
Metastatic breast cancer
Stage 4
Management of early invasive cancer
Mastectomy with axillary node clearance or breast conservation followed by postoperative rt and or adjuvant systemic therapy
Absolute contraindication of breast conservation surgery
Nccn:
Absolute
• RT during pregnancy•
Diffuse suspicious or malignant-appearing microcalcifications•
Widespread disease that cannot be incorporated by local excision of a single region or segment of breast tissue that achieves negative margins with a satisfactory cosmetic result•
Diffusely positive pathologic margins•
Homozygous (biallelic inactivation) for ATM
Relative contraindication to breast conservation surgery
Prior RT to the chest wall
Active connective tissue disease involving the skin (especially scleroderma and lupus)•
Persistently positive pathologic margin
Patients with a known or suspected genetic predisposition.
Histopathological type of breast cancer
Primary:
Carinoma, sarcoma, melanoma, lymphoma
From carcinoma
Invasive carciinoma (MPS AICU)
Invasive, NOS
Ductal
Tubular
Lobular
Medullary
Mucinous
Papillary
Pagets
Squamous cell
Secretory
Other: phyllodes
Non invasive: DCIS, LCIS
secondary
Opposite breast
Lung
Colon
APBI indication
invasive ductal carcinoma
Age >/50yrs
Tumor size </2cm
With negative margin width >/2 mm with no LVI, ER positive
Or
DCIS
Low /intermediate nuclear grade
Screening detected DCIS measuring size </2.5 cm with negative margin width of >/3mm
APBI type
EBRT (30gy/5#)
Balloon/ interstitial (34 Gy/10# BID)
38.5 Gy in 10# BID in EBRT
Disease with retro orbital extension
Breast
Lung
Lymphoma
Leukemia
Mets and recurrent chemo for HR - ve, her 2- ve breast tumor
1st line
PDL1 CPS>/10’9 : pembro+ chemo(pacli, nab pacli or gem and carboplatin)
PDL1 CPS <10’9 and no BRCA: systemic chemo:
PARP inhibitors: olaparib, talazaparib
2nd line
PARP inhibitors
Fam trastuzumab deruxtecan
Sacituzumab govitecan
3rd line
Targeted drug
PIK3CA alpelsib+ fulvestrant
NTRK larotrectinib, entrectinib
RET selpercatinib
What is CPS?
CPS stands for Combined Positive Score and is a scoring system used to evaluate the expression of PD-L1 protein in cancer cells ¹. It is calculated by dividing the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) by the total number of viable tumor cells, multiplied by 100 ¹. The FDA has approved the use of PDL1 (22C3) as a companion diagnostic assay for pembrolizumab in certain clinical scenarios, including triple negative breast cancer ¹. In triple negative breast cancer, PDL1 (22C3) is scored using CPS, with a cutoff of CPS ≥ 10 ¹.
Indication of MRI in breast cancer:
- For staging evaluation To define extent of cancer or presence of multifocal or multicentric cancer in the ipsilateral breast
- Breast cancer evaluation before and after preoperative systemic therapy to define extent of disease
- Identifying otherwise clinically occult disease in patients with axillary nodal metastases.
Indication of neo adjuvant chemotherapy in carcinoma breast
patients with inoperable breast cancer
IBC
Bulky or matted cN2 axillary nodes
CN3 nodal disease
CT4 tumors
in selected with operable breast cancer
preoperative breast cancer is preferred for
-HER2 positive disease and TNBC if >/cT2 or >/cN1
-large primary tumor relative to breast size in a patient who desire breast conservation
-cN+ disease likely to become N0 with preoperative systemic therapy
can be considered for cT1c , cN0 Her2 +ve disease and TNBC
-patients in whom definitive surgery may be delayed
What is visceral crisis?
severe organ dysfunction, as assessed by signs and symptoms, laboratory studies and rapid progression of disease. Visceral crisis is not the mere presence of visceral metastases but implies important organ compromise leading to a clinical indication for the most rapidly efficacious therapy.”
