Locally advanced breast cancer
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LOCALLY ADVANCED BREAST CANCER. Elshami M.Elamin, MD Medical Oncologist Central Care Cancer Center www.cccancer.com Wichita, KS - USA. IIIA: T0-3, N2 T3, N1 (operable = not included) IIIB: T4 , any N0-2 IIICN3 Any T, N3. Inoperable Locally advanced-Non inflammatory.

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LOCALLY ADVANCED BREAST CANCER

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Locally advanced breast cancer

LOCALLY ADVANCED BREAST CANCER

Elshami M.Elamin, MD

Medical Oncologist

Central Care Cancer Center

www.cccancer.com

Wichita, KS - USA


Inoperable locally advanced non inflammatory

  • IIIA:

    • T0-3, N2

    • T3, N1 (operable = not included)

  • IIIB:

    • T4 , any N0-2

    • IIICN3

      • Any T, N3

Inoperable Locally advanced-Non inflammatory


Inoperable locally advanced non inflamatory stage iiia t0 3n2 iiib c

1-Preop chemo/hormone (anthrac+/-Taxane preferred)

  • Any adj regimen or

  • A.I. for postmenopausal or

  • Trastuzumab-based for at least 9wk for her2-neu +ve

    2- According to preop chemo response:

  • Response:

    • Mastectomy + LND + RT or

    • Consider lumpectomy + LND + RT

      • Xeloda as radiosensitizer

  • No response:

    • Additional chemo and/or RT

      3-Adj therapy may include:

  • Chemo if not completed preoperatively

  • Trastuzumab

  • Hormonal therapy

  • Inoperable locally advancedNon-inflamatoryStage IIIA (T0-3N2), IIIB-C


    Inflammatory breast cancer

    INFLAMMATORYBREAST CANCER


    Inflammatory disease

    • 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

    • Do you need both for diagnosis?

    INFLAMMATORY DISEASE


    Do you need both clinical and pathologic features for diagnosis

    • Dermal lymphatic invasion is neither required nor sufficient by itself to make the diagnosis

    Do you need both clinical and pathologic features for diagnosis?


    Grave signs

    Grave signsLocal recurr5Y DFS

    • Skin edema32%23%

    • Skin ulceration14%36%

    • Fix to chest wall40%5%

    • > 2.5 cm axillary LN13%38%

    • Fixed axillary nodes13%13%

      Haagensen Ann Surg: 1943

    Grave signs


    Multimodality therapy

    • Surgery + RT:

      • 5YS<5%

  • Chemotherapy  MRM/RT

    • 5Y DFS25-30%

    • 5Y S> 40%

      • Response to chemo is an important predictor of survival

  • ? ?? High-dose chemo with ABMT

  • ? Breast conservation

    • only in clinical trial

  • Multimodality Therapy


    Locally advanced breast cancer

    Thanks


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