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locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
locally advanced Breast Cancer
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locally advanced Breast Cancer

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by Elshami Elamin, Consultant Oncologist, Wichita, KS

by Elshami Elamin, Consultant Oncologist, Wichita, KS

Published in: Health & Medicine
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  • 1. LOCALLY ADVANCEDBREAST CANCER Elshami M.Elamin, MD Medical Oncologist Central Care Cancer Center www.cccancer.com Wichita, KS - USA
  • 2. Inoperable Locally advanced-Non inflammatoryIIIA: ◦ T0-3, N2 ◦ T3, N1 (operable = not included)IIIB: ◦ T4 , any N0-2 IIICN3  Any T, N3 3
  • 3. Inoperable locally advanced Non-inflamatory Stage IIIA (T0-3N2), IIIB-C1- Preop chemo/hormone (anthrac+/-Taxane preferred)  Any adj regimen or  A.I. for postmenopausal or  Trastuzumab-based for at least 9wk for her2-neu +ve2- According to preop chemo response: ◦ Response:  Mastectomy + LND + RT or  Consider lumpectomy + LND + RT ◦ Xeloda as radiosensitizer ◦ No response:  Additional chemo and/or RT3- Adj therapy may include: ◦ Chemo if not completed preoperatively ◦ Trastuzumab ◦ Hormonal therapy 01/03/13 4
  • 4. INFLAMMATORYBREAST CANCER
  • 5. INFLAMMATORY DISEASE Do you need both for diagnosis? CLINICAL: ◦ T4d ◦ Triad erythema  Skin erythema affecting > 1/3 of breast  Diffuse breast warmth  Skin edema and ridging (peau d’orange) caused by engorged dermal lymph ◦ Nipple retraction ◦ Adenopathy is common ◦ 35% presents with mets ◦ May mimic Cellulitis and Mastitis PATHOLOGIC: ◦ Dermal lymphatic involvement  70% of clinically inflammatory carcinoma 6
  • 6. Do you need both clinical and pathologic features for diagnosis?Dermal lymphatic invasion is neither required nor sufficient by itself to make the diagnosis 01/03/13 7
  • 7. Grave signs Grave signs Local recurr 5Y DFSSkin edema 32% 23%Skin ulceration 14% 36%Fix to chest wall 40% 5%> 2.5 cm axillary LN 13% 38%Fixed axillary nodes 13% 13% Haagensen Ann Surg: 1943 8
  • 8. Multimodality TherapySurgery + RT:  5YS <5%Chemotherapy → MRM/RT  5Y DFS 25-30%  5Y S > 40% ◦ Response to chemo is an important predictor of survival? ?? High-dose chemo with ABMT? Breast conservation ◦ only in clinical trial 9
  • 9. Thanks 10

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