locally advanced Breast Cancer

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by Elshami Elamin, Consultant Oncologist, Wichita, KS

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locally advanced Breast Cancer

  1. 1. LOCALLY ADVANCEDBREAST CANCER Elshami M.Elamin, MD Medical Oncologist Central Care Cancer Center www.cccancer.com Wichita, KS - USA
  2. 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. 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. 4. INFLAMMATORYBREAST CANCER
  5. 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. 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. 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. 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. 9. Thanks 10

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