Breast Cancer

Understanding the disease Treatment options Side effects of treatment

1. Pectoralis Muscle, 2. Fatty Breast Tissue, 3. Breast Cancer, 4. Breast Glands (lobules), 5. Milk Ducts

Basic Breast Anatomy

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

Internal mammarysupraclavicular

axillary

Lymph Nodes

Sentinel Node Technique and Biopsy

Sentinel Node

ductal cells

ductal carcinoma In situ (DCIS)

Invasive ductal carcinoma

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 situStage I = T1N0; IIA = T1N1 or T2N0; IIB = T2N1 or T3N0Stage 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

Internal doses of radiation

surface doses of radiation

Computer generated breast radiation

Tumor site in breast

lung

lung

Spinal cord

heart

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: #