Breast Cancer pt. 2
Nodal Dissections
Sentinel Lymph Node Biopsy:
Mapped via:
radiotracer/lymphoscintigraphy
okay in pregnancy
isosulfan blue
contra-indicated in pregnancy
can cause type 1 hypersensitivity reaction
Typically get 1-3 lymph nodes
*IF NO SENTINEL NODES FOUND, patient gets Axillary Node Dissection
Axillary Node Dissection:
Levels I and II for breast disease
see axilla section for more information
Complications:
infection
lymphedema
lymphangiosarcoma
venous thrombosis
nerve injury
from cancer.gov
Radiation Therapy:
Accompanies Breast Conserving Therapy
or
After mastectomy if:
T3-T4
Advanced nodal disease
skin/chest wall involvement
positive margins
Tamoxifen and Anastrazole are for ER/PR + patients
Give Tamoxifen to NON-menopausal women
Give Anastrazole to POST-menopausal women
Trastuzumab is for HER2/Neu positive patients
Known side effects:
Adriamycin (doxorubicin)- Cardiomyopathy
Taxanes- Neuropathy
Cyclophosphamide- hemorrhagic cystitis
Mammography and Ultrasound Study
MLO = medial-lateral view (gives you vertical/up-down information)
CC = cranio-caudal (gives you horizontal/side to side information)
Special Considerations:
Breast MRI:
- Adjunct for inconclusive disease
- Nodal/metastatic disease w/ unknown primary
- Pagets w/o mammo or sono mass
- Chest wall invasion
- Mantle radiation
- BRCA1/2
Male Breast Cancer:
Poor prognosis as typically presents late
<1% of breast cancers
RF: Klinefelter syndrome, steroid use, XRT, family history
Tx: MASTECTOMY + SLNB vs. MRM (+/- hormonal/chemo/rads as above)
Breast Cancer in Pregnancy:
Isosulfan Blue is CONTRA-INDICATED (teratogenic effects)
Radiotracer is okay
NO XRT in pregnancy; if presents later in pregnancy can undergo BCT then XRT post-partum; otherwise needs MRM
Genes:
BRCA1 (chromosome 17)- breast, ovaries, prostate, colon
BRCA2 (chromosome 13)- as above, larynx, pancreas
STK11 (peutz-jeugher)- breast, pancreas, mucocutaneous
PTEN (cowden)- breast, thyroid, lung, bladder, uterus
p53 (li-fraumeni)- breast, brain, adrenals
Lynch syndrome (MLH gene)
Luminal A: ER/PR +, HER2Neu -, Low Ki67 = favorable
Luminal B: ER/PR +, HER2Neu + OR high Ki67 = more aggressive
Her2Neu enriched: Her2Neu +à grow/spread faster, improved w/ anastrazole
Basal or triple negative = aggressive. Poor prognosis