SYB Case 2

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SYB Case 2. By: Amy. History. 63 y/o female History of left breast infiltrating duct carcinoma s/p mastectom y in 1996 and chemotherapy ER negative, PR negative, HER-2/Neu negative. - PowerPoint PPT Presentation

Transcript of SYB Case 2

  • SYB Case 2By: Amy

  • History63 y/o female History of left breast infiltrating duct carcinoma s/p mastectomy in 1996 and chemotherapyER negative, PR negative, HER-2/Neu negative

  • Focal opacity in the right anterior lung base and small opacity in the left lateral lung base - likely atelectasis but cannot r/o metastases

  • nodule in the left upper lobe - increased in sizeInterim decrease in size in all but one metastatic lung nodules.nodule in the left upper lobe - decreased in size

  • Left sternal lesion with increased sclerosisSurgical clips in left axillaLesions involving anterior aspect of the left second and third ribs are slightly more prominent on this exam

  • Stable to slightly smaller size of mediastinal lymph node

  • Breast CancerMost common female cancer in the U.S.Infiltrating ductal most common type (70-80%)Second most common cause of cancer death in womenMain cause of death in women ages 45-55

  • Most common sites of metastasisBone most common, particularly the spine, ribs, pelvis, proximal long bones, and skullLiverLungsBrainSubcutaneous tissues

  • TNM Breast Cancer Staging Primary tumor (T) TXPrimary tumor cannot be assessedT0No evidence of primary tumorTisCarcinoma in situT1Tumor 2 cm or less in greatest dimensionT2Tumor more than 2 cm but not more than 5 cm in greatest dimensionT3Tumor more than 5 cm in greatest dimensionT4Tumor of any size with direct extension to (a) chest wall, (b) skin, (c) both chest wall and skin, or (d) inflammatory carcinoma

    Regional lymph nodes (N): Clinical classification NXRegional lymph nodes cannot be assessed (eg, previously removed)N0No regional lymph node metastasesN1Metastasis to movable ipsilateral axillary lymph nodesN2Metastasis to ipsilateral axillary lymph nodes, or in clinically apparent ipsilateral internal mammary nodes in the absence of evident axillary node metastasesN3Metastasis to ipsilateral infraclavicular lymph nodes with or without clinically evident axillary lymph nodes, or in clinically apparent ipsilateral internal mammary lymph node(s) and in the presence of clinically evident axillary lymph node metastases, or metastasis in ipsilateral supraclavicular lymph nodes with or without axillary or internal mammary nodal involvement

  • TNM Staging contd.Regional lymph nodes: Pathologic classification (pN)-Classification is based upon axillary lymph node dissection +/- sentinel lymph node dissection. pNXRegional lymph nodes cannot be assessed (eg, previously removed, or not removed)pN0No regional lymph node metastasis; no additional examination for isolated tumor cells (i.e. single tumor cells or small clusters not greater than 0.2 mm, usually detected only by immunohistochemical or molecular methods but which may be verified on hematoxylin and eosin stains)pN1Metastasis in 1 - 3 ipsilateral axillary lymph nodes and/or in internal mammary nodes with microscopic disease detected by sentinal lymph node dissection but not clinically apparentpN2Metastasis in 4 - 9 axillary lymph nodes or in clinically apparent internal mammary lymph nodes in the absence of axillary lymph nodespN3Metastasis in 10 or more axillary lymph nodes, or in infraclavicular lymph nodes, or in clinically apparent ipsilateral internal mammary lymph nodes in the presence of one or more positive axillary nodes; or in more than three axillary lymph nodes with clinically negative microscopic metastasis in internal mammary lymph nodes; or in ipsilateral supraclavicular lymph nodes

    Distant metastasis (M) MXDistant metastasis cannot be assessedM0No distant metastasisM1Distant metastasis

  • Stage Groupings by TNM Classification

    Stage 0Tis N0 M0Stage IT1 N0 M0 (including T1mic)Stage IIAT0 N1 M0; T1 N1 M0; T2 N0 M0Stage IIBT2 N1 M0; T3 N0 M0Stage IIIAT0 N2 M0; T1 N2 M0; T2 N2 M0; T3 N1 M0; T3 N2 M0Stage IIIBT4 Any N M0Stage IIICAny T N3 M0Stage IVAny T Any N M1

  • Metastatic work-upPhysical Exam - skin, breasts, lymph nodes, and abdomenDiagnostic bilateral mammography (+/- ultrasound)Blood tests CBC, LFTsChest imagingCT scanning of the liver and pelvis and radionuclide bone scans have a low diagnostic yield in women with early stage (TI-II; N0-I) breast cancer and are not routinely necessaryChest CT is performed for radiation planning in women, but is not necessary for routine staging of the thorax in women with early stage diseaseStaging CT of the abdomen and pelvis and a radionuclide bone scan is more likely to influence therapy in patients with stage III disease and are therefore recommended in these patients

  • Management of Metastatic Breast CancerRelapses are most common in the initial 5 years after treatment for early stage disease, but can occur up to 30 years laterPrognostic factors include the interval between initial therapy and relapse, number of metastatic sites, presence/absence of visceral involvement, age and stage at diagnosis, and hormone receptor statusPatients with metastases are unlikely to be cured of their disease by any meansComplete remissions from chemo are uncommon Serial plain radiographs, CT scans, or MRI allow assessment of tumor responsePlain radiographs showing sclerosis of previously lytic lesions is highly indicative of response, while enlargement of the lytic area suggests progressionIn pts with mainly sclerotic lesions, serial plain films are less helpful because the healing cannot be observed

  • ReferencesUpToDate; all accessed 1/25/09Hirsch, A., et al. Management of locoregional recurrence of breast cancer after breast conserving therapy. Bleiweiss, I. Pathology of breast cancer: The invasive carcinomas. Esserman, L., and Joe, B. Diagnostic evaluation and initial staging work-up of women with suspected breast cancer.Hurria, A., and Come, S. Follow-up for breast cancer survivors: Recommendations for surveillance after therapy. Hayes, D. General principles of management of metastatic breast cancer.