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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

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

    Do you need both clinical and pathologic features for diagnosis?


    Grave signs

    Grave signs Local recurr 5Y DFS by itself to make the diagnosis

    • 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

    Grave signs


    Multimodality therapy

    • Surgery by itself to make the diagnosis+ 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

  • Multimodality Therapy


    Thanks by itself to make the diagnosis


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