Mandatory

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¡5P]ZgZ5WgZVhi5XdchZgk^c\5hjg\Zgn5]Vh5WZZc5jcYZgiV`Zc!5VY_jkVci5gVY^di]ZgVen5^h5 mandatory. ¡56m^aaVgn5^ggVY^Vi^dc5h]djaY5WZ5\^kZc5[dg5cdYZ5edh^i^kZ5^c5M&5VcY5M'5ijbdjgh05l]ZgZ5i]Z5 axillary nodes are negative in T1 and T2 tumours there is no role for axillary irradiation.
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National Guidelines for Cancer Management Kenya 35 ¡56m^aaVgn5cdYVa5^ggVY^Vi^dc5XVc5cdl5WZ5hV[Zan5VYb^c^hiZgZY5^chiZVY5d[5Vm^aaVgn5Y^hhZXi^dc5 where sentinel node is positive especially in T1/T2 tumours. If sentinel nodal mapping cannot be carried out, good imaging of the axilla, by ultrasonography for example may be used to detect nodal involvement. If positive then axillary irradiation should be considered as a replacement for axillary dissection. This should be more attractive in our set-up where practitioners generally find axillary dissection quite challenging. The only problem is limited radiotherapy facilities. ¡5AdgbdcVa5i]ZgVen5h]djaY5WZ5\^kZc5V[iZg5XdbeaZi^dc5d[5X]Zbdi]ZgVen5VcY5gVY^di]ZgVen5 for ER+ tumours T3 & T4 tumours ¡5Ljg\Zgn!5Z^i]Zg5h^beaZ5bVhiZXidbn5dg5bdY^ÑZY5gVY^XVa5bVhiZXidbn!5^h5i]Z5bV^chiVn5 of treatment. ¡5GZdVY_jkVci5X]Zbdi]ZgVen5^h5gZXdbbZcYZY5[dg5YdlchiV\^c\5WZ[dgZ5hjg\Zgn# ¡5Enbe]5cdYZh5VgZ5]VcYaZY5i]Z5hVbZ5lVn5Vh5[dg5M&"M'5ijbdjgh# ¡5M]Z5bVg\^ch5h]djaY5WZ5XdcÑgbZY5i]gdj\]5]^hideVi]dad\n!5[dg5l]^X]5i]Z5Zci^gZ5 specimen should be sent to the laboratory for examination. ¡58]Zhi5lVaa5^ggVY^Vi^dc5^h5bVcYVidgn5[dg5M(5VcY5M)5ijbdjgh# ¡56m^aaVgn5^ggVY^Vi^dc5^h5^cY^XViZY5[dg5anbe]5cdYZ5edh^i^kZ5M(5VcY5M)5ijbdjgh# ¡5Bc5h^ijVi^dc5l]ZgZ5Wdi]5VY_jkVci5gVY^di]ZgVen5VcY5X]Zbdi]ZgVen5VgZ5^cY^XViZY!5 radiotherapy should follow completion of the chemotherapy. ¡5AdgbdcVa5i]ZgVen5h]djaY5WZ5\^kZc5V[iZg5XdbeaZi^dc5d[5X]Zbdi]ZgVen5VcY5gVY^di]ZgVen5 for ER+ tumours. 4.5.2 Chemotherapy A multiplicity of chemotherapy regimens are in use for adjuvant treatment. 4.5.3 Metastatic Disease ¡5M]ZgZ5^h5cd5hiVcYVgY5VeegdVX]5id5igZVibZci5d[5bZhiVhiVi^X5Y^hZVhZ!5l]^X]5^h5bV^can55 palliative. ¡5AdgbdcVa5i]ZgVen5^h5egZ[ZggZY5jcaZhh5i]ZgZ5^h5a^[Z5i]gZViZc^c\5Y^hZVhZ5[dg5l]^X]5 chemotherapy is preferred. ¡58]Zbdi]ZgVen5gZ\^bZch!5h^c\an5dg5^c5kVg^djh5XdbW^cVi^dc5dg5hZfjZci^Vaan!5bVn5WZ5jhZY ¡5KVY^Vi^dc5i]ZgVen5[dg5adXVa^oZY5Y^hZVhZ5bVn5WZ5\^kZc5id5Xdcigda5hnbeidbh!5VcY5bVn5 also be used for localized bone and CNS metastases. ¡57^e]dhe]dcViZh5h]djaY5WZ5d÷ZgZY5[dg5eVi^Zcih5l^i]5WdcZ5bZiVhiVhZh!5h^cXZ5i]Zn5]VkZ5 been shown to reduce incidence of skeletal related events.
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National Guidelines for Cancer Management Kenya 36 4.5.4 Non-Invasive Tumours (DCIS, LCIS) Non-invasive tumours (intraductal carcinoma, ductal carcinoma in situ, DCIS) may be treated with breast conserving surgery providing negative tissue margins >10mm can be achieved (<1mm is considered inadequate excision on pathological specimens). Adjuvant radiation therapy decreases the risk of local recurrence, and should be used for high-risk DCIS. Low risk DCIS (focus size <10mm, low/intermediate nuclear grade with adequate surgical margins) may not require radiation therapy. Hormonal therapy may be considered
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