Wednesday, August 1, 2007

Breast Cancer Handout

This is a reproduction of a handout I use when discussing breast cancer with patients. Trying to process the sheer volume of information involved in breast cancer while you're still reeling from the news that you've been diagnosed can be overwhelming so I've found it helpful to give handouts as we talk our way through the maze of diagnostic and treatment options. (Sorry for formatting errors; hard to transfer from Word to blogger form)

Breast Cancer


1. Ductal Hyperplasia
- Abnormal growth of normal ductal cells
- Slight increased risk of developing future cancer

2. Ductal Carcinoma in Situ (DCIS)
- Neoplastic, preinvasive cancerous cells
- Has not yet invaded normal tissue barriers
- Natural history is to progress to frankly invasive cancer
- Surgical intervention indicated

3. Lobular Carcinoma in Situ (LCIS)
- Preinvasive cancerous cells involving breast lobules
- Suggests markedly increased risk of cancer in either breast
- Close surveillance indicated

4. Invasive Ductal Carcinoma
- Invasive cancer of ductal cells

5. Invasive Lobular Carcinoma
- Invasive cancer of lobular cells

6. ER/PR Receptors
- Estrogen and progesterone receptors
-If positive, portends a better prognosis

Diagnostic Modalities

1. Physical exam
- Palpable lumps
- Monthly self exams!
2. Ultrasound
- Determines whether lesions are “cystic” or “solid”
- Complementary to mammograms
3. Mammography
- Identifies early, non-palpable lesions
- Suspicious calcifications should be investigated

Biopsy Techniques

1. Fine Needle Aspiration (FNA)
- Useful for palpable lesions
- Your surgeon often can perform this biopsy at initial office visit
- Cannot tell the difference between invasive and pre-invasive cancer

2. Core Needle Biopsy
- Usually done with some sort of radiographic guidance (ultrasound or stereotactic)
- Multiple “cores” of tissue are extracted
- Can determine invasive from pre-invasive cancers
- Usually performed by either radiologist or surgeon

3. Open Excisional Biopsy
- Also known as “lumpectomy’
- Done in the operating room by your surgeon
- Completely removes the area of concern

Stereotactic Core Biopsy
Pros: -Minimally invasive
- Allows for complete pathologic dx prior to definitive surgery
Cons:- Small risk of false negative result
- Does not completely remove area of concern, lifelong surveillance!

Open Excisional Biopsy
Pros: - Allows for complete pathologic diagnosis.
- Completely removes the area of concern
- Often is diagnostic and therapeutic
Cons: - More invasive, increased pain
- Complications of surgery such as bleeding, infection, seroma
- Cosmesis

DCIS Treatment

1. Lumpectomy + Radiation
- Clean margins are essential
- Post operative radiation reduces recurrence rate
- Leaves a scar of about two inches
- Role of Tamoxifen/Arimedex (anti-estrogen drugs) depends on final pathology report.

2. Simple Mastectomy +/- Immediate Reconstruction
- Removes 97% of breast tissue on affected side
- No indication for axillary lymph node dissection (except in select circumstances)
- Absolute indications:
* High grade, multifocal DCIS
* Larger tumors relative to breast size
* Patient inability to receive radiation
* Patient choice

LCIS Treatment

-LCIS increases your risk of invasive cancer equally in both breasts.
-Lumpectomy is not indicated.
-Close Surveillance
-Consideration of phophylactic bilateral simple mastectomy in select scenarios

Invasive Ductal Carcinoma Treatment Options

1. Lumpectomy + Axillary lymph node dissection + Radiation +/- chemotherapy and/or hormonal treatment.
- Also known as Breast Conservation Surgery
- Ask your surgeon about sentinel node biopsy
- Equivalent long term survival compared with mastectomy
- Slightly higher rate of cancer recurrence
- Lower incidence of arm swelling and nerve injuries

2. Modified Radical Mastectomy (MRM) +/- Reconstruction +/- chemotherapy and/or hormonal treatment
- Removes 97% of breast tissue
- Complete level I and II axillary lymph node dissection
- Higher rate of complications


Sid Schwab said...

I wrote such a handout, also. Yours is very concise and to the point. One suggestion: definition of "invasive" cancer, and a distinction (probably unnecessary, really) with the use of the same term in describing less-"invasive" tests. I made a little diagram showing a duct with in-situ cells vs ones crossing into the surrounding tissues.

Jeffrey Parks MD FACS said...

Thanks for the tip. Pictures are really the only way to describe the differecen between in-situ cancers and frankly invasive cancer.

rlbates said...