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Breast Cancer

Understanding the disease


Treatment options
Side effects of treatment
Basic Breast Anatomy

1. Pectoralis Muscle, 2. Fatty


Breast Tissue, 3. Breast Cancer,
4. Breast Glands (lobules), 5.
Milk Ducts
Mammogram

Cancer, deep in
the right breast
MRI

Cancer, deep
in the right
breast
Cancers are named after
the cell that goes bad, so
ductal or lobular
carcinoma

There is a risk of
spread to the near
by lymph nodes
(level I or II)
Location of
the lymph
nodes
Lymph Nodes
supraclavicular Internal mammary

axillary
Sentinel Node
Technique and Biopsy

Sentinel Node
ductal cells

ductal carcinoma In situ Invasive ductal carcinoma


(DCIS)
Earliest form of cancer is
often DCIS (ductal
carcinoma in situ) then it
progresses to invasive
ductal carcinoma
Stage: How far has the cancer spread based on three things referred to as T,N,M.

T (tumor size) T1 = 2cm, T2 = 2-5 cm T3 = larger, T4 = more advanced


N (node involvement) N0 = no nodes, N1 =1-3 involved, N2= 4-9. N3= 10
M (metastases) any spread to bone, liver, brain

Stage 0 = Tis = ductal carcinoma in situ


Stage I = T1N0; IIA = T1N1 or T2N0; IIB = T2N1 or T3N0
Stage IIIA = T3 or N2; Stage IIIB = T4; Stage IIIC = N3,
Stage IV = metastases

Histology appearance of the cells under the microscope. Most cancers arise from
milk duct cells and are called invasive ductal carcinoma. (The earliest form, before
any invasion is called ductal carcinoma in situ or DCIS.) Other types include
lobular and medullary and very favorable types like tubular or mucinous.
Grade how mutated the cells have become. The closer the cells resemble normal
breast cells, the less serious (slower growing, less likely to spread.)
Grade 1 or well differentiated slow growing, most favorable
Grade 2 or moderately differentiated most common, average
Grade 3 or poorly differentiated fast growing, more serious

Hormone Receptors normal breast cells are sensitive to hormones and have
positive receptors for estrogen (ER+) or progesterone (PR+). If the hormone
receptors are present (called positive) the cancer is less serious and more likely to
respond to a hormone therapy drug like tamoxifen (Nolvadex), Arimidex
(anastrazole) , Femara (letrozole) or Aromasin (exemestine).

DNA Studies: the more mutated the cells, the more serious. If there is an abnormal
number of chromosomes (aneuploid), rapidly dividing numbers of cells (high S-
phase) or abnormal genes (HER-2/Neu), this may effect the choice of
chemotherapy drugs used (like Adriamycin, Taxol or Herceptin.)
CT scan is obtained at the time of simulation

CT images are then imported


into the treatment planning
computer
In the simulation
process the CT
images are used
to create a
computer plan
Typical
technique for
external beam
Radiation beam skims over the surface of
the chest wall, ribs and luring
Computer generated breast radiation

Spinal
cord lung

breast
lung

heart

surface doses of
radiation

Internal doses of
radiation

Tumor site in
breast
Computer generated anatomy images that will identify all the
important structures to be sure the radiation covers the area
of breast cancer and limits the dose to other areas
Viewed
from the
side, the
radiation
stops
before
hitting the
lung
Radiation field to left breast
First the whole breast is
treated for 25 to 30
treatments

Then additional radiation is


gievm to the incision site,
called boost field radiation
Sometimes along with radiation to the breast,
the high nodes in the neck (supraclavicular
nodes) may be treated
In the treatment the
lasers are used to
line up the beam,
then rotated to the
correct angle and
the patient receives
the radiation
treatment
Balloon
therapy for
breast cancer
Twice a day
for 5 days
Partial Breast
Irradiation

Utilizing a balloon
inside the
lumpectomy cavity
and completing the
radiation in 5 days
Advantages of
multi-dwell
catheter
compared to
single dwell
CT Scan of woman with breast balloon
CAT Scan picture with balloon in right breast
Distance of the balloon surface from the
skin should be greater than 8mm
the balloon is too close to the skin
Side Effects of Breast Radiation
Generally the side effects of breast radiation do not become
noticeable until the woman has received about 10
treatments, and then become somewhat more noticeable
through the rest of the treatment. The most common side
effects:
skin irritation - the skin that is radiated gets red, itchy and
may blister (like a sun burn)
breast or chest wall tenderness or mild pain
tiredness or fatigue (some women feel a little light-headed)
are swelling or edema (usually slight, see section below
about avoiding lymphedema)
Radiation Prescription for #

diagnosis: Stage # infiltrating ductal


carcinoma of the breast

number of radiation treatments: #