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Staging Exercises

Staging Exercises. MCR Show Me Healthy Women March 27, 2008. Steps for Staging. 1) Determine primary site & histology 3) Is histology included? 4) Review list of regional LNs 5) Review rules of classification 6) Find staging information in chart 7) Determine T, N, M and group stage.

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Staging Exercises

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  1. Staging Exercises MCR Show Me Healthy Women March 27, 2008

  2. Steps for Staging 1) Determine primary site & histology 3) Is histology included? 4) Review list of regional LNs 5) Review rules of classification 6) Find staging information in chart 7) Determine T, N, M and group stage

  3. PE: R breast: 5x3 cm mass noted on PE by physician. No pain/tenderness; no nipple discharge; no skin changes. Slight nipple retraction; freely movable mass. L breast: No masses palpated. No enlarged LNs Imaging: CXR –w/in normal limits; BNS: No evidence of skeletal mets; Thoracic and lumbar spine: Neg for mets Labs: SMA 12: w/in normal limits. ER+ Sx observations: bx r breast mass followd by R MRM Path: Bx – adenoca w/+ margins R MRM: infiltrating ca w/dermal invasion; 32 neg nodes; tumor attached to fat; 5.5x4x4 cm; located at 12:00, grade 2 Treatment: RMR w/ ALND Hormone: Arimidex Breast Case #1

  4. Answer – Breast Case #1 • Primary site: Breast • Histology: adenocarcinoma, grade 2 • Tumor size: > 5cm • 32 negative axillary lymph nodes • No distant mets • T3 N0 M0, Stage Group IIB

  5. PE: R breast: 4x3 cm firm, irregular mass. No skin changes, dimpling, or nipple discharge. Freely movable mass. Imaging: Mamm – suspected lesion r breast w/faint calfications l breast; CXR – normal Labs: ER mildly+, PR- SX observations: Bil breast biopsies followed by R simple mastectomy, R SLND Path: Bx R breast: intraductal ca, comedo type, nuclear grade 3, + marging. L breast: fibrocystic changes, no evidence of malignancy. R mastectomy, R SLN: Extensive intraductal comedocarcinoma w/lobular extension; 4.1x3.5x3.0 cm; two sln negative Treatment: Surgery Breast Case #2

  6. Answer – Breast Case #2 • Primary site: breast • Histology: intraductal comedocarcinoma • Tumor size: 4.1x3.5x3.0 cm • 2 neg SLNs • Tis (DCIS) N0 M0, Stage Group 0

  7. PE:40 year-old woman w/3 month hx of worsening vaginal bleeding. PE – 5 cm friable mass extends from cervix into vaginal wall. Imaging: CXR – normal. ABD/Pelvic CT: Fullness noted in region of cervix. No gross lymphadenopathy or sidewall involvement. Scopes: EUA: lg exophytic cervical mass approx 5 cm across. No parametrial or sidewall involvement. Cystoscopy: bladder neg. Path: cervix bx: infiltrating wd adenoca. Stains strongly support endocervical origin. Treatment: XRT to whole pelvis, followed by HDR and chemo, NOS Cervix Case #1

  8. Answer - Cervix Case #1 • Primary site: endocervix • Histology: infiltrating wd adenocarcinoma • Extent of disease: Invades vagina, but not parametrium; no mention of adenopathy; CXR normal • T2a N0 M0, Stage Group IIA (clinical) • Tx Nx Mx, Stage Group UNK (pathologic)

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