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CHAPTER 23

CHAPTER 23. Breast Cancer Treatments. THE GOAL: SURVIVAL. Patients do whatever it takes to survive 87% alive after 5 years 80% alive after 10 years. THE GOAL: SURVIVAL. Localized disease (confined to breast) 97.6% alive after 5 years 93.5% alive after 10 years

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CHAPTER 23

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  1. CHAPTER 23 Breast Cancer Treatments

  2. THE GOAL: SURVIVAL • Patients do whatever it takes to survive • 87% alive after 5 years • 80% alive after 10 years

  3. THE GOAL: SURVIVAL • Localized disease (confined to breast) • 97.6% alive after 5 years • 93.5% alive after 10 years • Regional disease (spread beyond breast) • 80% alive after 5 years • 67% alive after 10 years

  4. CELLULAR PROGRESSION TO BREAST CANCER

  5. SPECIMEN MARGIN A. Tumor extends to edge of specimen. B. Tumor surrounded by 1-2 cm of normal tissue.

  6. SURGICAL CHOICES A. Mastectomy B. Lumpectomy; diagonal line shows extent of tumor; dotted line signifies area surgeon will remove

  7. LUMPECTOMY • Removes tumor plus small amount of healthy tissue • Lymph node evaluation • Radiation therapy kills cancer cells left behind after surgery.

  8. 6 TYPES OF MASTECTOMY • Simple (total) • Modified radical • Radical • Partial • Nipple sparing • Skin sparing

  9. MODIFIED RADICAL MASTECTOMY • Most common mastectomy • Entire breast is removed • Pectoral muscles left intact • Lymph node evaluation

  10. LYMPHATIC DRAINAGE • Axillary lymph node basin is primary route • Internal mammary and supraclavicular regions are secondary routes

  11. LYMPH NODE SAMPLING • Axillary dissection • Sentinel lymph node

  12. SENTINEL LYMPH NODE (SLN) • First lymph node that receives lymphatic drainage from tumor bed • If negative for tumor, no need to check further • Pathologist able to check for micrometastases

  13. SLN PROCEDURE A. SLN drains tumor bed B. Radioactive material injected in tumor bed C. Massage breast D. Geiger counter locates SLN E. Hot spot identifies SLN

  14. EXTERNAL RADIATION THERAPY • Can reduce recurrence up to 70%

  15. RADIATION THERAPY IS REGIONAL TREATMENT • Always given with lumpectomy • May/may not be given with mastectomy

  16. BRACHYTHERAPY • Internal radiation therapy A. Device implanted in lumpectomy cavity C. Device easily removed upon conclusion of this week-long treatment

  17. RECONSTRUCTION AFTER MASTECTOMY • TRAM flap • DIEP flap • Latissimus dorsi flap • SGAP/IGAP flap

  18. TRAM FLAP • Transverse rectus abdominis muscle • Most common surgery

  19. DIEP FLAP • Deep inferior epigastric perforator • Main blood vessel in donor tissue

  20. LATISSIMUS DORSI FLAP A. Portion of back muscle becomes donor tissue B. Tissue tunneled to chest wall C. Disadvantage: Visible “divot” at donor site

  21. SGAP/IGAP FLAP • Rarely done • High failure rate

  22. HORMONE THERAPY • Tamoxifen • Raloxifene • Aromatase inhibitors

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