Ultrasound

Determining the Nature of a Breast Abnormality It is a procedure that may be used to

determine whether a lump is a cyst (sac containing fluid) or a solid mass.

Ultrasound can also be used to precisely locate the position of a known tumor in order to guide the physician during a biopsy or aspiration procedure.

Supplemental Breast Cancer Screening

Today, ultrasound is being investigated for use as ascreening tool for women who:

are at high risk for breast cancer and unable to tolerate an MRI examinations.

are at intermediate risk for breast cancer based on family history, personal history of breast cancer, or prior biopsy showing an abnormal result.

have dense breasts. have silicone breast implants and very little tissue can be

included on the mammogram. are pregnant or should not to be exposed to x-rays (which is

necessary for a mammogram). are at high risk for breast cancer based on family history,

personal history of breast cancer, or prior atypical biopsy result.

Ultrasound

CT scan

To assess whether or not the cancer has moved into the chest wall. This helps determine whether or not the cancer can be removed with mastectomy.

To examine other parts of the body where breast cancer can spread, such as the lymph nodes, lungs, liver, brain, and/or spine.

If advanced breast cancer is found, CT scan may be helpful to assess whether or not it is responsive to treatment.

After treatment, CT scans may be used if there is reason to think the breast cancer has spread or recurred outside the breast.

Bone scan

An imaging test used to determine whether breast cancer has traveled to the bones. at initial diagnosis, to make sure your bones

are healthy, as well as to create a set of “baseline images” that could be compared to any future bone scans that are done

during and after treatment, if you experience persistent bone and joint pain, or if a blood test suggests the possibility that the breast cancer has traveled to the bones

FACTORS AFFECTING TREATMENT

Microscopic findings Invasive breast cancer — Invasive breast

cancers usually require surgical treatment (mastectomy or breast conserving therapy) as well as treatment after surgery (called adjuvant treatment).

Noninvasive (in situ) breast cancer — Noninvasive or in situ breast cancer is divided into two types: lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS).

Size of the breast tumor  Spread to the lymph nodes 

MASTECTOMY VERSUS BREAST CONSERVING THERAPY

Factors to consider : Tumor size Tumor margins Need for future surgery Individual needs and expectations

Reasons to avoid BCT — Certain factors clearly favor mastectomy over BCT. These include: Having two or more separate tumors in different areas of the breast Having tumor spread throughout the breast tissue Previous radiation of the breast or chest, which makes future radiation

inadvisable Pregnancy in the first or second trimester, which makes radiation inadvisable

Factors that do not affect your decision — Several factors do not play a role in the choice between BCT and mastectomy: The spread of cancer cells to lymph nodes in the armpit The specific location of the tumor within the breast; however, certain tumor

locations may negatively affect the cosmetic results of BCT A family history of breast cancer A high likelihood that cancer will metastasize (recur elsewhere in the body)

Another important question is the use of induction chemotherapy in the management of resectable breast cancer.

Although available randomized studies have shown that disease-free and overall survival rates after chemotheraphy are at least equivalent to those observed after classic postoperative systemic treatment, only large well designed trials with newer effective regimen will demonstrate the worthiness of this approach.

Induction Chemotherapy

Induction Chemotherapy

Advantages Neoadjuvant chemotherapy is most often done to

reduce the size of the cancerous tumor. Neoadjuvant chemotherapy can also tell you

whether your cancer is sensitive to the particular combination of drugs that is being tried. If the tumor shrinks, you know it is responding to the drugs.

Disadvantages One is purely psychological. Neoadjuvant

chemotherapy means that you live with the tumor for a few months before surgery. Some of the cancer cells are still dividing and growing while the chemotherapy is killing others.