breast cancer Flashcards
symptoms of metastatic breast cancer
bone (eg, back or leg pain), liver (abdominal pain, nausea, jaundice), and lungs (eg, shortness of breath or cough)
how to differentiate malignant vs. benign mass
US
most common type of invasive breast cancer
infiltrating ductal carcinoma
mammogram is…
x-ray
USPSTF mammography recommendation
every 2 years after age of 50
what does DCIS mean?
group of precancerous lesion confined to breast ducts and lobules
microinvasive breast cancer
DCIS w/ microinvasion. associated with high-grade DCIS.
cancer workflow
ddx –> determine hormone receptor status –> surgery –> staging –>
prognostic factors
- receptor positivity
- lymph node involvement
abnormal imaging finding followed by…
stereotactic biopsy, US, or MRI
breast mass workup…
FNA or core needle biopsy –> biopsy positive then axillary node dissection, biopsy negative sentinel lymph node biopsy.
ALSO if negative axillary examination clinically then sentinel lymph node biopsy.
signs of inflammatory breast cancer then…
full-thickness skin biopsy
Stage IA…
T1, N0, M0
Stage IB…
T0/1, N1, M0
Stage IV means
distant mets
Stage II means
basically N2
early stage stages
I, IIA, or subset of IIB
locally advanced stages
IIIA to IIIC
treatment of early-stage breast cancer
local treatment with –> lumpectomy or mastectomy with or without radiation therapy
THEN –> adjuvant systemic therapy based on ER/PR/HER2
breast-conserving therapy (BCTT)
lumpectomy + radiation therapy
when RT is indicated post mastectomy..
patients at high risk for local recurrence (cancer involves deep margins and axillary lymph nodes)
endocrine therapy used for…
hormone receptor-positive patients
chemotherapy used for…
1) early-stage hormone receptor-positive cancers with high-risk characteristics
2) non hormone receptor positive for tumor size greater than 0.5 cm
mgmt of locally advanced breast cancer
neoadjuvant systemic therapy before surgery
BCT vs. mastectomy depends on…
- breast size in relation to residual tumor size
- large breast lesion then mastectomy
mgmt of HER2-positive breast cancer
1 yr of trastuzumab following completion of surgery
after mastectomy then…
RT, but depends on pretreatment stage
people with hormone receptor negative, HER2 negative breast cancer get…
chemo
For patients with hormone receptor-negative, HER2-positive metastatic breast cancer, we recommend…
HER2-directed therapy in combination with chemotherapy.
For patients with hormone receptor-positive, HER2-negative breast cancer, we recommend…
endocrine therapy. no evidence for concomitant use of chemo
