diagnosing and treating breast cancer

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

3. Mammogram Cancer, deep in the right breast

4. MRI Cancer, deep in the right breast

6. 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)

7. Location of the lymph nodes

8. Internal mammary supraclavicular axillary Lymph Nodes

10. Sentinel Node Technique and Biopsy Sentinel Node

11. ductal cells ductal carcinoma In situ (DCIS) Invasive ductal carcinoma

12. Earliest form of cancer is often DCIS (ductal carcinoma in situ) then it progresses to invasive ductal carcinoma

13. 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 situ Stage I = T1N0; IIA = T1N1 or T2N0; IIB = T2N1 or T3N0 Stage 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.

14. 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 .)

15. CT scan is obtained at the time of simulation CT images are then imported into the treatment planning computer

16. In the simulation process the CT images are used to create a computer plan

17. Typical technique for external beam

18. Radiation beam skims over the surface of the chest wall, ribs and luring

19. Internal doses of radiation surface doses of radiation Computer generated breast radiation Tumor site in breast lung lung Spinal cord heart breast

20. 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

21. Viewed from the side, the radiation stops before hitting the lung

25. Radiation field to left breast

26. First the whole breast is treated for 25 to 30 treatments Then additional radiation is gievm to the incision site, called boost field radiation

27. Sometimes along with radiation to the breast, the high nodes in the neck (supraclavicular nodes) may be treated

29. 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

30. Balloon therapy for breast cancer Twice a day for 5 days

31. Partial Breast Irradiation Utilizing a balloon inside the lumpectomy cavity and completing the radiation in 5 days

32. Advantages of multi-dwell catheter compared to single dwell

35. CT Scan of woman with breast balloon

36. CAT Scan picture with balloon in right breast

38. Distance of the balloon surface from the skin should be greater than 8mm

39. the balloon is too close to the skin

41. Radiation Prescription for # diagnosis: Stage # infiltrating ductal carcinoma of the breast number of radiation treatments: #