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Tumor Board 2014-Feb13-v7_(copy01)

pathologicalsubtypesof pathologicalsubtypesof

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Unformatted text preview: gnostic Workup Diagnostic Workup Mammogram – – – Clustered microcalcifications Soft tissue “spiculated” mass Architectural distortion Ultrasound – Focused breast, axilla Biopsy Role of breast MRI??? Pathological Subtypes of Pathological Subtypes of Breast Cancer Ductal carcinoma in­situ (DCIS) – 5 subtypes, comedo most aggressive Invasive carcinoma – Ductal (76%) – Lobular, mixed (15%) – Others including mucinous, tubular, medullary, papillary (< 10%) Case ­ continued Case ­ continued Ms. K had bilateral mammogram and U/S Biopsy of the lesion showed invasive ductal carcinoma Mammogram Mammogram Screening MLO view Spiculated lesion in upper inner quadruant Screening CC view Diagnostic ML view http://www.mypacs.net/cases/INVASIVEDUCTAL-CARCINOMA--432216.html Breast US ­ example Breast US ­ example Hypoechoic mass with irregular border and posterior acustic shadowing Locoregional Management of Locoregional Management of Breast Cancer ­ Surgery Breast – Lumpectomy + radiation – Mastectomy Axilla – Sentinel lymph node biopsy – Full lymph node dissection Mastectomy Mastectomy Mastectomy – Complications Mastectomy – Complications Lymphedema Skin necrosis Sentinel Lymph Node Biopsy Sentinel Lymph Node Biopsy Reconstruction – TRAM Reconstruction – TRAM flaps Reconstruction ­ Implants Reconstruction ­ Implants Pathology Pathology Ms. K had a lumpectomy and sentinel lymph node biopsy Tumor is T2(2.5cm) N0(0/2) Grade 3, ER+, PR+, Her2­ Staging workup – Tests selected based on stage of disease and patient symptoms – CXR, CT, Bone Scan, US, MRIcan be used Locoregional Management ­ Locoregional Management ­ Radiotherapy • Radical Mastectomy – en bloc...
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