Chapter 11: Breast Cancer Staging & Treatment

Breast Cancer Staging: Stage 0?

- Size = In Situ - Lymph Nodes = no cancer - Mets to distant site = no

Breast Cancer Staging: Stage IV?

- Size = any size - Lymph Nodes = probable (very likely) - Mets to distant site = YES

Breast Cancer Staging: Stage I?

- Size = ≤ 2cm - Lymph Nodes = no cancer - Mets to distant site = no

What is a lumpectomy?

- removal of a breast lump and a small amount of surrounding tissue - 10-20 lymph nodes are also removed and evaluated (ALND) - usually followed by radiation - a type of breast conservation therapy

Which surgeries are common amongst patient's that have breast cancer?

- Lumpectomy - Total or Simple Mastectomy - Modified Radical Mastectomy - Radical Mastectomy - Axillary Lymph Node Dissection (ALND)

Breast Cancer Staging: II?

- Size = 2-5cm - Lymph Nodes = possible - Mets to distant site = no

Breast Cancer Staging: Stage III?

- Size = > 5cm - Lymph Nodes = most likely - Mets to distant site = no

What are the factors that contribute to the treatment of breast cancer?

- type of cancer - whether the tumor is a hormone receptor (positive or negative) - stage of cancer - age of patient - patient's menopausal status - general health of the patient - patient's feelings about treatment and side effects

What are the two types of radiation therapy for breast cancer?

1. External Beam Radiation Therapy (EBRT) = radiation is delivered from a machine outside of the body 2. Brachitherapy = a radioactive seed is placed inside the breast at the site of the lumpectomy, radiation is delivered internally

What are the two main categories for breast cancer treatment options?

1. Local-Regional Therapy: - goal is to eradicate the disease in the breast and lymph nodes - types include surgery and radiation 2. Systemic Therapy: - goal is to eradicate disease in all parts of the body - types include chemotherapy, hormone therapy, and others

Hormone Therapy in Breast Cancer?

Def = oral drugs that are designed to block estrogen and progesterone from reaching the malignant tumor, thus not allowing the tumor to continue to grow - Medications = Tamoxifen and Raloxifene (ER+) - Dose = 1 tablet daily - reduces the risk of invasive breast cancer - for IN SITU Cx = Tamoxifen only - Raloxifene = lower risk of side effects (endo cancer and blood clots) - Side effects: hot flashes, vaginal discharge, hair thinning, and increased risk of endometrial hyperplasia and possibly endometrial cancer (esp with Tamoxifen)

Biological Therapy in Breast Cancer?

Def = targeted biologic therapy allows antibodies to recognize a specific protein on cancer cells and signals the body's immune system to destroy the cell - common protein in breast cancer = Human Epidermal growth factor Receptor 2 (HER2) - Treatments = Herceptin & Tykerb (through IV) - Side effects = heart disease, nausea, vomiting, fever, cough, headache, etc.

What is the TNM classification system?

Used to help stage cancer: - T (Tumor) = tumor size and spread within the breast is considered - N (Lymph Nodes) = spread to lymph nodes is considered - M (Metastases) = involves spread to distant organs such as the lungs, bones, or liver

What is an Axillary Lymph Node Dissection (ALND)?

a procedure in which many lymph nodes are removed and sampled for the detection of cancer - usually with a lumpectomy or modified radical mastectomy - metastatic progression of cancer through the axillary lymph nodes usually proceeds in an orderly manner: Level 1 (lateral to pec minor muscle); Level 2 (posterior to pec minor muscle); Level 3 (medial to pec minor muscle) - usually only Level 1 & 2 ALNDs performed; if negative then Level 3 is most likely negative as well - Lymphedema is the most common complication of ALND = scar tissue forms in the ducts which prevents drainage

What is a Modified Radical Mastectomy?

a procedure in which the entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes, but the pectoralis muscles are spared *gold standard for the treatment of breast cancer*

What is a Radical Mastectomy?

a procedure in which the entire breast is removed, including the skin, areola, nipple, axillary lymph nodes, as well as the pectoralis muscles (major and minor) - extremely disfiguring - OUTDATED - only performed in extreme cases

What is Chemotherapy?

a therapy for breast cancer that uses anti-cancer drugs given through an IV or orally that destroy cancer cells from inside the body - systemic therapy - 6-12 months of treatment - side effects: fatigue, hair loss, nausea, and vomiting, may kill bone marrow cells - In Sono: a positive response to chemo = decreased tumor size & decreased blood flow around the tumor

What is Radiation therapy?

a therapy for breast cancer that uses high energy x-rays or protons to kill cancer cells in the affected areas - local or regional therapy - 6-7 weeks of daily radiation treatments - side effects = radiation burn to the chest wall, treatment kills normal cells too, fatigue

What is a total (simple) mastectomy?

surgery in which the whole breast is removed, including the nipple, the areola, and most of the overlying skin

What does it mean if the tumor is a hormone receptor (positive or negative)?

the cancer cells either have or don't have hormone receptors for estrogen and progesterone that causes them to grow - positive = have estrogen and/or progesterone receptors; means the tumor uses these hormones to grow; hormone therapy can be used as treatment - negative = do not have these receptors; HRT not an option

What is staging?

the process of gathering information from all diagnostic studies available to determine how widespread the cancer is - following a biopsy confirmation = more testing such as blood tests, chest xray, bone scan, CT, MRI, or PET scan may be performed to assess spread of disease