Test 10_01_12 Breast Cancer PowerPoint Cards _cb.

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RadTherapy
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174548
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Test 10_01_12 Breast Cancer PowerPoint Cards _cb.
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2012-09-30 19:25:00
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Test 10 01 12 Breast Cancer PowerPoint Cards cb
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Test 10_01_12 Breast Cancer PowerPoint Cards _cb
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    • author "CB"
    • tags "Test 10/01/12 Breast Cancer PowerPoint Cards"
    • description "Test 10/01/12 Breast Cancer PowerPoint Cards"
    • fileName "Test 10/01/12 Breast Cancer PowerPoint Cards /cb"
    • freezingBlueDBID -1.0
    • Most common malignancy in women is
    • Breast Cancer
  1. Ratio of women that will develop breast cancer
    1 in 8
  2. Note:
    Caucasian and European women have higher incidence than other nationalities
  3. Incidence _____ with age and peak is 60. 1 in 420 women at age 60 and 1 in 5900 at age 30.
    Increases
  4. Breast cancer is the leading cause of death in ages
    40-55
  5. _____ % have no evident risk factors
    70%
  6. 90% of recurrences will happen in ____ years.
    3
  7. Most common disease of the breast
    Fibrocystic disease (benign condition)
  8. ____ % of diagnosed cases are men and the disease is ____ aggressive
    • 1%
    • More
  9. Breast cancer appears more frequently in which breast
    Left
  10. Breast cancer in the quadrants of the Breast
    • 50% in Upper Outer Quadrant
    • 15% in Upper Inner Quadrant
    • 10% in Lower Outer Quadrant
    • 5% in Lower Inner Quadrant
    • 15% are sub areola (behind the nipple)
  11. Risk Factors of Breast Cancer
    • Female
    • Age
    • Family history (genes BRCA1 & BRCA2)
    • Oral contraceptives
    • Alcohol and tobacco use
    • Hormone replacement therapy
    • High ingestion of of fat
    • History of benign breast disease
    • Nulliparous or women who have their first child child after age 30
    • Early menarche and late menopause
    • Radiation exposure during adolescence
  12. 4 prognosis indicators
    • Lymph node status
    • Tumor Extent
    • Histology
    • Estrogen, progesterone and Her-2/neu
  13. Prognosis indicators: The higher the number of nodes involved the poorer the progress
    Lymph node status
  14. Prognosis indicators: Ductal carcinoma in situ (DCIS), Ductal or infiltrating ductal carcinoma (Most Common), Lobilar (can present bilateral) and Inflammatory
    Histology
  15. Survival: overall 5 year is 89%; 5 year decreases to _____% if evidence exist of regional spread and 20% if distance Mets is present at time of diagnosis.
    83%
  16. _____ year survival is NOT the best indicator of survival for breast cancer because of it _______ _______. Patients may relapse up to 20 years after treatment.
    • 5
    • Systemic nature
  17. Grows locally involving ducts and adjacent tissues and local or regional lymph nodes. Nodes are positive in 55%-70% of cases. Orderly and progressive manner.
    Tumor progression
  18. Can recur locally, in lymph nodes or at distance metastatic sites
    Recurrance
  19. Invasion of blood vessels: bone, brain, lung
    Distant Mets
  20. The most common distant met
    Bone
  21. Most common lump is
    Painless
  22. Usually a breast lump >0.5 is
    Palpable
  23. During clinical presentation of a breast lump, you must assess:
    • Size
    • Shape
    • Consistency
    • Mobility
    • Pain or tenderness
    • Location and relationship to skin and chestwall
  24. During clinical presentation, look for nipple _____, _____, or _____.
    • Discharge
    • Retraction
    • Pain
  25. Clinical presentation: skin changes and alterations look for:
    • Dimpling
    • Warmth
    • irritation
    • Ulceration
    • (Peau d' orange)
  26. Clinical Presentation: Enlargement of axillary lymph node, arm edema
    Lymphadenopathy
  27. 6 ways of detection of breast cancer
    • Breast Self Exam (BSE)
    • Clinical breast exam
    • Mammogram
    • Sonography (ultrasound)
    • MRI
    • PET/CT
  28. Detection: Exam that should be done monthly and Most lesions (90%) are found by
    Breast Self Exam (BSE)
  29. Detection: Baseline at 35, every other year starting at age 40, and every year after age 50. Can miss 10%-15% of lesions
    Mammogram
  30. This exam shows if it is solid or cystic
    Ultrasound
  31. 4 biopsies to get a diagnosis:
    • Fine-needle biopsy
    • Core needle biopsy
    • Incisional biopsy
    • Excisional biopsy
  32. Which biopsy is the method of choice for removing small lesions
    Excional biopsy
  33. The 5 stages of breast cancer
    • Tis
    • T1
    • T2
    • T3
    • T4
  34. Staging: Carcinoma in situ
    Tis
  35. Staging: 2 cm or less
    T1
  36. Staging: More than 2 cm but not more than 5 cm
    T2
  37. Staging: Greater than 5 cm
    T3
  38. Staging: Any size with direct ex tension to chestwall or skin
    T4
  39. Treatment Management:
    • Surgery
    • Chemotherapy
    • Endocrine therapy
    • Radiation therapy
  40. 6 surgical procedures for breast cancer treatment management
    • Radical Mastectomy
    • Modified Radical Mastectomy
    • Lumpectomy
    • Axillary Dissection (consequences of removing too many lymph nodes in chronic lymphadema)
    • Sentinel Node Biopsy
    • Breast Reconstruction
  41. Treatment Management: Tamoxifen or Femara
    Endocrine Therapy
  42. Treatment Management: CAF and CMF
    Chemotherapy
  43. What is CMF
    Cytoxan, methotrexate and 5-fluorouracil (5-FU)
  44. What is CAF
    Cytoxan, adriamycin and 5-FU
  45. Radiation Therapy: Field Borders for Tangents
    • Superficial
    • Inferior
    • Medial
    • Lateral
    • Include 1-2 cm of Lung
  46. Field Borders for Tangents: 1st intercostal space
    Superior
  47. Field Borders for Tangents: 1-2 cm below inframammary fold
    Inferior
  48. Field Borders for Tangents: Midline
    Medial
  49. Field Borders for Tangents: Mid Axillary Line
    Lateral
  50. Field Borders for Tangents: Beams should be ______.
    Coplanar
  51. Breast are treated with _____, and chest wall can be treated with ______ or abutting electrons.
    • Photons
    • Photons
  52. Radiation Doses: 4500-5000 cGy with boost of 6000-6600 cGy
    Tangents (Breast or Chest wall)
  53. Radiation Doses: 4500-5000 cGy
    SCV
  54. Radiation Doses: Boost mid line 4500-5000 cGy
    PAB (Posterior Axillary Boost)
  55. Radiation Doses: 4500-5000 cGy
    Internal Mammary Nodes
  56. Note: Radiation Positioning
    • Arms above head in immobilization device. Breast boards are sometimes used depending on size of breast
    • Supine and straight on table (including feet)
    • Head turned to contralateral side
  57. The 4 borders of PAB (Posterior Axillary Boost):
    • Superior
    • Inferior
    • Medial
    • Lateral
  58. PAB: bisect the clavicle and bisect the humeral head
    Superior
  59. PAB: The field matches the superior border of the tangential field
    Inferior
  60. PAB: To include the axillary nodes that lie close to the chest wall (a small margin of the lung is necessary)
    Medial (remember: the level III nodes lie medial to the coracoid process and the level II nodes are medial to the humeral head)
  61. PAB: the latissimus dorsi muscle
    Lateral
  62. 3 borders of the Internal Mammary Irradiation Field (commonly used method):
    • Superior
    • Inferior
    • medial
  63. Borders of the internal mammary field: to match the supraclavicular field
    Superior
  64. Borders of the internal mammary field: the xiphoid process
    Inferior
  65. Borders of the internal mammary field: 1 cm past mid line on the contralateral side (or to midline)
    Medial
  66. Side Effects
    • Skin changes - peak 2-3 weeks after treatment
    • Fatigue
    • Cardiac effect
    • Pulmonary effects (radiation pneumonitis)
    • Lymphedema
    • Brachial Plexopathy
    • Myelopathy
    • Osteoradionecrosis
    • Hyperpigmentation
    • Telangectasia
    • Rib fractures
  67. Anatomy of Breast Diagram

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