DIAGNOSIS AND STAGING OF BREAST CANCER - Relias
4/1/2020DIAGNOSIS AND STAGING OFBREAST CANCERTheresa HarringtonMSN, ANP-BC, OCNDisclosureTheresa Harrington, MSN, ANP-BC, OCN, Adult Nurse Practitioner, LombardiComprehensive Cancer Center, MedStar Georgetown University Hospital, hasno financial relationships to disclose.The planners and authors of this course have declared no relevantconflicts of interest that relate to this educational activity.Relias LLC guarantees this educational activity is free from bias.There is no commercial support provided for this online educational activity.This presentation is the sole property of Relias LLC and cannot be reproduced or usedwithout written permission.21
4/1/2020DIAGNOSIS AND STAGING OFBREAST CANCERTheresa HarringtonMSN, ANP-BC, OCNYour Presenter Board Certified Adult NursePractitioner (ANP-BC) Nurse Practitioner LombardiComprehensive Cancer CenterGeorgetown University Hospital Oncology Certified Nurse (OCN) Adjunct Faculty, GeorgetownUniversity School of MedicineTheresa HarringtonMSN, ANP-BC, OCN42
4/1/2020Objectives The goal of this presentation is to provide information on thecurrent risk factors, screening recommendations, and stagingmethodology of breast cancer. Upon completion of the webinar, learners will be able to:– Identify breast screening guidelines and current imagingoptions– Develop a general understanding of the current multimodalitytreatments of breast cancer– Describe the changes and rationale for the recent updates tothe AJCC Staging 8th Edition5What Is Cancer? Uncontrolled division and growth ofabnormal cells Multiple changes occurto the cell Normal cells divide and stop Cancer cells keep dividing, growing,mutating63
4/1/2020Cell Division Control of cell division resides in thegenes When genes fail to work it results in:– Mutation– Altered protein production– Abnormal function of the cell– Disease (cancer)7Breast Cancer Most cancer occurs in cells that divide quickly The quicker cells divide, the more chance of damage (multiplemutations to occur) Epithelial cells divide the quickest Surface of the body Lining of internal organs: intestine, bronchi, and mammary ductsHarris et al. 201484
4/1/2020Breast Cancer ctalHyperplasiawith AtypiaTIMEIntraductalCarcinomaIn SituInvasive DuctalCancer8-10 yearsHarris et al. 20149Breast Cancer Incidence increases with age Majority arise from the ducts Mammogram does not detectall breast cancers (lobularcancers) Can occur in males– Genetic mutations– Alcoholics– Chromosomal abnormalities105
4/1/2020Breast Cancer Risk iaMenarche 12HormonesFFTP 30XRTLate menopause 55ACS 2017HRT(first full-term pregnancy: FFTP; hormone replacement therapy: HRT; family medical history: FMH; radiation therapy: XRT)11Breast Density Dense breast tissue is common and normal inpremenopausal woman More likely to have dense breasts if younger, lowBMI, or take HRT Dense breast tissue is an independent risk factorfor breast cancer development Density of tissue is largely an inherited trait Categorized on mammogram– Heterogeneously dense (C) or extremely dense (D) Risk of breast cancer increases with increaseddensity This is separate from the ability to detectabnormal findings on mammogram12National Cancer Institute (NCI), 20186
4/1/2020Breast Cancer Statistics Breast Cancer remains the most common female cancer: 2007-2013– 30% of all female cancer (lung 13%, colorectal 7%)– 14% of all female cancer deaths (lung 25%, colorectal 8%) Lifetime probability of breast cancer is 12.4% or 1 in 8 woman Survival rates continue to improve– 91% 5 year survival rate (2008-2014)– 84% 5 year survival rate (1987-1989)– 75% 5 year survival rate (1975-1977) Continues to be a discrepancy in race and survival 2008-2014– 92% 5 year survival for Caucasians– 83% 5 year survival for African Americans13National Cancer Institute (NCI); American Cancer Society (ACS) 2018Screening Recommendations forAverage Risk WomanIMAGINGPALPATION Digital 3D imaging (tomosynthesis)MammogramClinical Breast Exam Not a screening toolUltrasoundBaron et al, 2018 Used to further evaluatemammography/MRI finding orquestionable area on examSelf examination/observation/awareness147
4/1/2020Screening Recommendations forAverage Risk 5 U.S Preventive ServicesTask Force (1/2016)Decision should beindividual. Discusspotential risk/ benefitand patient can chosebiennial mammoEvery 2 yearsEvery 2 yearsEvery 2 yearsInsufficient evidenceto balance benefitsand harms ofscreeningAmerican College ofObstetricians andGynecologist (11/2017)Every 1-2 yearsDecision based onshared decisionmakingEvery 1-2 yearsDecision based onshared decisionmakingIf not started in 40’s,begin age 50, every 12 years, shareddecisionEvery 1-2 years, shareddecision makingShared decisionMakingAmerican Cancer Society(5/2018)Annual if patientdesiresAnnuallyAnnuallyAnnuallyContinue while goodhealth life expectancy 10 yearsContinue while ingood healthLife expectancy 10 yearsNational ComprehensiveCancer NetworkAnnuallyAnnuallyAnnuallyAnnuallyUse clinical judgment15Baron et al., 2018; USPS Task Force, 2016; ACOG 2017; Keating & Pace, 2018Screening Recommendations forAverage Risk WomanBreast ExaminationRecommendation40-4445-4950-5455-7475 U.S Preventive ServicesTask Force (1/2016)Insufficient evidence tosupport CBEInsufficient evidenceto support CBEInsufficient evidence tosupport CBEInsufficient evidence tosupport CBEInsufficient evidence tosupport CBEAmerican College ofObstetricians andGynecologist (11/2017)Annual clinical breastexam (CBE) and breastawarenessAnnual clinical breastexam and breastawarenessAnnual clinical breastexam and breastawarenessAnnual clinical breastexam and breastawarenessAnnual Self-awarenessAmerican Cancer Society(5/2018)No clear benefit of CBEWoman should befamiliar with breast andreport a changeNo clear benefit of CBEWoman should befamiliar with breastand report a changeNo clear benefit of CBEWoman should befamiliar with breastand report a changeNo clear benefit of CBEWoman should befamiliar with breastand report a changeNo clear benefit of CBEWoman should befamiliar with breastand report a changeNational ComprehensiveCancer NetworkAnnual CBESelf-awarenessAnnual CBESelf-awarenessAnnual CBESelf-awarenessAnnual CBESelf-awarenessAnnual CBESelf-awarenessUpper age limit notestablishedBaron et al, 2018; USPS Task Force, 2016; ACOG 2017168
4/1/2020Breast MRI for High Risk Woman Lifetime risk of breast cancer of20% or greater Can consider if risk is between15-20% BRCA 1/2 carriers, TP53mutation Consider for following mutations:ATM, CDH1, CHEK2, NBN, NF1,PALB217Risk Assessment Models Gail Model Risk Assessment– http://www.cancer.gov/bcrisktool/– Factors in age, race, menarche, FFTP, biopsies, FMH of first-degreerelatives IBIS– http://www.ems-trials.org/riskevaluator/– Factors in age, menarche, FFTP, biopsies, height and weight– Menopausal status, HRT use, breast (uni/bilateral) and ovarian cancer,1st and 2nd generation, room to add males, cousins, nieces, genetictesting, Ashkenazi descent, includes likelihood of BRCA geneThe Breast Cancer Risk Assessment Tool. NIH; IBIS Breast Cancer Risk Evaluation Tool189
4/1/2020Findings Which May WarrantFurther Evaluation Mammogram– Calcifications– Persistent asymmetrictissue– Mass– Persistent distortion Ultrasound– Solid mass– Distortion MRI– Mass like enhancement– Non-mass likeenhancement Exam– Breast mass– Adenopathy– Skin changes– Retraction– Asymmetry19Breast Cancer Diagnosis Biopsy for microscopic analysis – mandatory fordiagnosis– Core needle biopsy (tissue biopsy) Palpable and non palpable lesions Image guided (Mammogram, US, or MRI) Clip is placed to mark area biopsied Possible under classification with smaller tumor at time ofsurgery– Fine needle biopsy (cytology) Consider for palpable lesions Quick diagnosis, lower cost If questionable findings, may need to proceed with Corebiopsy– Surgical Should be performed only if core needle biopsyinconclusive or not feasible, i.e. location of abnormality2010
4/1/2020Types of Breast Cancer In situ Invasive– Cancer cells arecontained within theducts– Ductal Carcinoma InSitu (DCIS)– May or may notprogress to invasivecancer– Cancer cells havebroken outside of theducts or lobules andinto the surroundingbreast tissue– 80% of breast cancersare invasive Ductal Lobular Inflammatory21Invasive ductal carcinome (IDC)Breast Cancer Breast cancer is now felt to be a groupof diseases Breast cancer groups have differentmolecular characteristics Molecular characteristics can effect– Prognosis– Rate/Pattern of Recurrence– Treatment Recommendations Type of treatment Order of therapyAJCC Breast 20182211
4/1/2020Tumor GradeGrade is determined byGXCan not be assessedassessing themorphologic features ofthe tumorG1G2G3Low combined histologic featuresFavorableIntermediate combined histologic featuresModerately favorableHigh combined histologic featuresUnfavorable23Molecular Biomarkers ER status (Estrogen Receptor)– When positive, cancer cells are stimulated by estrogen– 1% or more of cells stain positive for ER expression– Tested on invasive and non invasive disease– 80% of breast cancers are ER positive PR Status (Progesterone Receptor)– When positive, cancer cells are stimulated by progesterone– 1% or more of cells stain positive for PR expression– Tested on invasive and non invasive disease– 65% of breast cancers are ER/PR positive HER2 (Human Epidermal Growth Factor Receptor 2)– A protein which promotes growth of cancer cells– 1 in 5 breast cancers have a gene mutation that makes an excess of the HER2 protein– Tested on invasive cancer only, not non invasive24AJCC Breast 201812
4/1/2020HER2 Testing Immunohistochemistry staining (IHC)– 0 to 1 Negative– 2 Equivocal– 3 Positive Fluorescent in situ hybridization (FISH)– HER2/CEP17 ratio 2.0 AND HER2 copy number 4 Negative– HER2/CEP17 ratio 2.0 Positive– HER2/CEP17 copy number 6 regardless of ratio Positive– HER2/CEP17 ratio 2.0 AND copy number 4 but 6 EquivocalAJCC Breast 201825Four Main Molecular Subtypes Luminal A HER2 Amplified– Hormone Receptor positive/HER2 negative– HER2 positive– Low proliferation rate– ER/PR positive or negative– Usually grade I or II tumors– Usually grade III tumors– Most favorable prognosis– Aggressive but when treated withanti Her2 therapy have a goodprognosis Respond well to endocrine therapy but notchemotherapy Luminal B– ER and/or PR but lower receptor % status– High Ki67 High number of actively dividing cells - highproliferation rate Basal– ER negative, PR negative, HER2negative– Usually grade III tumors– Usually grade III Less likely to respond to endocrine therapybut better to chemotherapy compared toLuminal AAJCC Breast 20182613
4/1/2020TreatmentModalities Local– Surgery– Radiation Systemic– Chemotherapy– Endocrine Therapy– HER2 targetedTherapy– Immunotherapy27Surgery for Breast Cancer Mastectomy Lumpectomy The type of breast surgery is based on the extent of the disease inthe breast along with personal preference– Extensive DCIS (Stage 0) in multiple quadrants requires mastectomy– A large breast tumor contained to one quadrant, independent offeatures, may be able to be treated with a lumpectomy Nodal Evaluation– Sentinel Node Biopsy– Axillary Node Dissection2814
4/1/2020Radiation Therapy Postoperative– Whole breast radiation– Partial breast radiation Intraoperative (IORT) Proton Therapy Lumpectomy Radiation Therapy Mastectomy in terms of overall survival Postmastectomy radiationUpdated ASTRO guideline expands pool of suitable candidates for accelerated partial breast irradiation 2016; ASCO,ASTRO and SSO update guideline on postmastectomy radiotherapy 2016; Recht 2017; Shaikh Jr. 2017.29Systematic Therapy Chemotherapy HER2 targeted Therapy– Neoadjuvant– Trastuzumab– Adjuvant– Pertuzumab– IV– Neratinib– Oral agents– TDM1 Endocrine Therapy– Tamoxifen Immunotherapy– Aromatase Inhibitors (AI)– Approved in PDL1 positive triplenegative metastatic breast cancer– Ovarian Suppression AI– Clinical Trials3015
4/1/2020AJCC (American Joint Committee on Cancer)Cancer Staging Tumor Staging began in 1959with T, N, M staging T Size of the tumor– Maximum dimension of the largestinvasive tumor– Anatomic extent of disease– Developed to help predictprognosis, risk of distantrecurrence/death– Primary treatment was localtherapy (surgery/radiation)– Satellite foci or multiple tumors arenot added to the maximum size N Lymph node involvement– Largest contiguous deposit is used– Adjacent deposits are not addedtogether M Distant Metastasis Now on the 8th edition/revision31American Joint Committee on Cancer(AJCC) Updated AJCC effective January 2018 nowincludes TNM PLUS:– ER Status– PR Status– HER2 Status– GradeTumor biology canbetter define prognosisthan anatomic extent ofdisease How much the cells look (or don’t look) likenormal breast cells under the microscope I, II, III Important prognostic factor independent oftumor size or nodal status Should be reported on all invasive cancers– Oncotype DX recurrence score when applicable/available AJCC Breast 2018Recurrence Score (RS) 11 low risk3216
4/1/2020Oncotype Dx Genomic Test based on 21 genes Provides an estimated 10 year risk ofdistant recurrence for ER , HER2negative tumor with use of endocrinetherapy Prospective trial showed a very lowrecurrence rates in individuals with arecurrence score (RS) of 11 Considered Level I Evidence AJCCGiuliano et al. 201733AJCC Staging System 8th EditionThree Stage GroupsAnatomic StageClinical Prognostic StagePathological Prognostic Stage Based on T, N, M Used where biomarkers can notbe routinely performed Based on: Used for patients who have hadsurgery as the initial treatment Based on: History and physical exam/imagingstudies Tumor grade ER/PR/HER2 Pathology from surgery Biomarkers (ER/PR/HER2) Clinical information34AJCC Breast 20183417
4/1/2020AJCC 8th Edition Staging Assigns stage based on overall prognosis with treatment Lower stage equals– Favorable biology– Effective therapies available– Favorable biopsy plus effective therapy Lower stage does not mean less treatment is needed Clinical and Pathological Prognostic Stage resulted in reassignment of 35% of patients (either higher or lower stage) than with use ofanatomic stage aloneAJCC Breast 201835AJCC 8th Edition Pathologic Stage– Abbreviated as (p)– Based on the findings at time of surgery– Does not apply to those who received neoadjuvant systemic therapy Clinical Stage– Abbreviated as (c)– Based on physical exam and imaging findings– Used to provide guidance for sequence of treatment recommendations Response to Neoadjuvant Systemic Therapy– Clinical Response abbreviated a ycT, ycN– Surgical pathology findings following systemic therapy are abbreviated as ypT, ypNAJCC Breast 20183618
4/1/2020Multigene Genomic Profile Assays Stage 1A– T1 or T2– N0– M0– ER , HER2 negative– OncotypeDX RS 11 Results of other genomic profilescurrently not assigned pathologicprognosis stage– More limited level 1 evidence– Shorter interval updates plannedAJCC Breast 201837Tumor Size Measured to the NearestMillimeter If multiple areas, the sum of theareas is not added together– TX: Primary tumor can not beassessed For invasive disease, only theinvasive component is measured– T1: 2 cm or less in size T1mi- microinvasion 1 mm orsmaller– T0: No evidence of the primarytumor– T2: 2 cm to 5 cm in size– Tis: in situ– T3: 5 cm in size only the invasivecomponent is measured Tis (DCIS) Tis (Paget)– Only if not associated with invasivedisease or DCIS– RareAJCC Breast 2018– T4: Any size tumor invading thechest wall or skin Inflammatory breast cancer Involvement of the pectoralismuscle without invasion into chestwall structures (ribs, intercostalmuscle, serratus anterior muscle) isbased on tumor size3819
4/1/2020Nodal Anatomy Breast drains via three major pathways– Axillary Inframammary nodes are within the breast tissue. Considered axillary nodesfor staging purposes– Interpectoral– Internal mammary Supraclavicular nodes– Considered regional nodes for purpose of staging Cervical or contralateral nodes are considered metastatic– Internal mammary or axillary nodes on the opposite side (M1)39Lymph Nodes4020
4/1/2020Nodal Involvement Further Defined Macrometastasis– Area of cancer involvement measures 2 mm Micrometastasis– Area of cancer involvement measures between 0.2 mm (200 cells) to 2mm Isolated tumor cells– Fewer than 200 cells, less than a 0.2 mm area of involvement– Does not change the cancer stage Excluded from the total positive nodal count Are included in the total number of nodes evaluated– Is recorded as i or mol 41AJCC Breast 2018Nodal InvolvementNX:Lymph nodes can not be assessedNo longer a valid category unless nodes have been removed and can not beexamined by imaging or physical examN0:Cancer has not spread to the Lymph nodesN0(i ): less than 200 cells were seen with routine stains orimmunohistochemistry stainingN1:1 to 3 Lymph nodes are involved with cancerN1mi: Micro metastasis in axillary LN 0.2 mm – 2 mmN2:4 to 9 axillary lymph nodes or involvement of internal mammary nodeN3:10 or more positive axillary nodes OR involvement of other nodesinfraclavicular, supraclavicular, internal mammary nodeAJCC Breast 20184221
4/1/2020Metastasis (M) Cancer has spread to distant sites Spread via lymphatics and vascularsystem Most common sites in breast cancer– Bone, lung, liver, brain43Biopsy for Confirmation of Metastasis Should be performed whenever possible ER/PR/HER2 should be repeated Caution needs to be taken with bone biopsies andpotential false negative resultsAJCC Breast 20184422
4/1/2020Metastatic Disease45Metastases cM0– Radiologic evaluation (CT scan/bonescan/PET/CT) not necessary Not warranted in asymptomatic T1/T2N0 disease– Radiologic work varies by T and N Mixed recommendations for T2N1disease– Radiologic work should be based onlevel of suspicion M1– cM1 Clinical and/or radiologicevidence– pM1 Biopsy proven metastaticdisease Circulating Tumor Cells(CTC) are not consideredM1 disease History, physical examination and labs4623
4/1/2020Pathologic Response to Neoadjuvant Therapy Pathologic complete response (pCR) improved disease free survival Pathologic complete response (pCR) improved overall survival The pathologist measures the largest single focus of disease in breastand/or lymph node but should not include areas of fibrous tissue A “y” will be placed in front of the pathologic findings to indicate thepatient received systemic treatment before surgery Example: ypT0 ypN0 complete response (pCR) Example: ypT1 ypN1 the amount of remaining disease in thebreast/LNAJCC Breast 201847Posttreatment Pathologic Stage If evidence of metastatic disease before systemic therapy remains asM1 if proceeds to surgery following systemic therapy If develops metastatic disease after the start of neoadjuvant therapythis is disease progressionAJCC Breast 20184824
4/1/2020Stage GroupsAJCC Breast 201849For further details, the updated BreastChapter for the 8th edition AJCC CancerStaging Manual is available for deskreferences/Pages/Breast-CancerStaging.aspx5025
4/1/2020References ACOG Revises Breast Cancer Screening Guidance: Ob-Gyns Promote Shared Decision Making. The American College ofObstetricians and Gynecologists Web site. dance--ObGyns-Promote-Shared-Decision-Making. Published June 22, 2017. AccessedOctober 17, 2019. ASCO, ASTRO and SSO update guideline on postmastectomy radiotherapy. American Society of Clinical Oncology (ASCO)Web site. stectomy. Published September 19, 2016. Accessed October 17, 2019. Baron R, Drucker K, Lagdamen L, Cannon M, Mancini C, Fischer-Cartlidge E. CE: Breast cancer screening a review ofcurrent guidelines. Am J N. 2017;118(7):34-41. doi: 10.1097/01.NAJ.0000541435.60875.eb. Breast cancer. American Cancer Society Web site. https://www.cancer.org/cancer/breast-cancer.html. Updated September2017. Accessed October 17, 2019. Breast cancer: screening. U.S. Preventive Services Task Force Web eening1?ds 1&s breast cancer screening. Published January 2016. Accessed October 16, 2019. Cancer facts and figures 2018. American Cancer Society Web site. -2018.html. Accessed October 17, 2019.51References Cancer staging manual. American Joint Committee on Cancer. Cancerstaging.org web skreferences/Pages/Breast-Cancer-Staging.aspx. Updated March 13, 2018.Accessed October 17, 2019. Dense breasts: answers to commonly asked questions. National Cancer Institute Web anges/dense-breasts. Updated September 7, 2018. Accessed November 8,2019. Giuliano AE, Connolly JL, Edge SB, et al. Breast cancer- major changes in the American Joint Committee on cancer eighthedition cancer staging manual. CA Cancer J Clin. 2017; 67(4):291-303. https://doi.org/10.3322/caac.21393 Harris JR, Lippman ME, Marrow M, Osborne CK, eds. Diseases of the Breast. 5 th ed. Philadelphia, PA: Wolters KluwerHealth; 2014. Hortobagyi GN, Connolly JL, D’Orsi CJ, et al. Breast. In Amin MB, Edge S, Greene F, et al., eds. AJCC Cancer StagingManual. 8th ed. Chicago, IL: Springer;2017:589-636. doi: 10.1007/978-3-319-40618-3 48. IBIS Breast Cancer Risk Evaluation Tool. Ems-trials.org web site. http://www.ems-trials.org/riskevaluator/ UpdatedSeptember 17, 2017. Accessed October 16, 2019. Invasive ductal carcinoma (IDC). Breastcancer.org Web site. https://www.breastcancer.org/symptoms/types/idc. ModifiedMarch 9, 2019. Accessed October 16, 2019.5226
4/1/2020References Keating NL, Pace LE. Breast cancer screening in 2018: time for shared decision making. JAMA. 2018;319(17):1814-1815.doi:10.1001/jama.2018.3388. NCCN clinical practice guidelines in oncology (NCCN Guidelines ). Genetic/familial high-risk assessment:breast andovarian. Version 3.2019. National Comprehensive Cancer Network Web site. cal/english/genetic familial.pdf. Published January 18, 2019. Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, AmericanSociety for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Ann Surg Oncol.2017;24(1):38-51. doi: https://doi.org/10.1245/s10434-016-5558-8 Shaikh Jr., MP, Alite Jr,. F, Wu MJ, Altoos T, Jacobson GM. Postmastectomy radiation therapy for node-negative breastcancer with tumor size of five centimeter or more: a meta-analysis. Int J Radiat Oncol Biol Phys. 2017; 99(2):S5. doi:https://doi.org/10.1016/j.ijrobp.2017.06.028. Table 4.13 Cancer of the female breast (invasive). National Cancer Institute Web site.https://seer.cancer.gov/csr/1975 2015/browse csr.php?sectionSEL 4&pageSEL sect 04 table.13. Accessed October 17,2019. The Breast Cancer Risk Assessment Tool. NIH: National Cancer Institute. https://bcrisktool.cancer.gov/ Accessed October16, 2019. Updated ASTRO guideline expands pool of suitable candidates for accelerated partial breast irradiation. ASTRO -ASTRO-guidelineexpands-pool-of-suitable-c. Published November 16, 2016. Accessed October 17, 2019.53Continuing Education Credit For a listing of upcoming webinars:– Nurse.com/Webinars– ContinuingEducation.com– Search by your profession for webinars For a listing of available FREE online CE courses:– Nurse.com/FreeCE– ContinuingEducation.com– Search by your profession for any available free courses5427
4/1/2020THANK YOU!28
Breast Cancer Statistics 13 Breast Cancer remains the most common female cancer: 2007-2013 -30% of all female cancer (lung 13%, colorectal 7%) -14% of all female cancer deaths (lung 25%, colorectal 8%) Lifetime probability of breast cancer is 12.4% or 1 in 8 woman Survival rates continue to improve -91% 5 year survival rate (2008 .
Diagnostic services for breast cancer Clinical assessment of breast complaints is a crucial first step in breast cancer diagnosis. Patient access to imaging services to confirm suspicion of breast cancer is essential. Breast cancer characterization and staging is a critical com - ponent of diagnosis and treatment planning.
Alcohol before breast cancer diagnosis and breast cancer mortality . 81 Alcohol less than 12 months after diagnosis and breast cancer mortality . 86 Alcohol intake 12 months or more after primary breast cancer diagnosis and breast . Before diagnosis BMI and cardiovascular disease mortality . 317 BMI less than 12 months after .
4 Breast cancer Breast cancer: A summary of key information Introduction to breast cancer Breast cancer arises from cells in the breast that have grown abnormally and multiplied to form a lump or tumour. The earliest stage of breast cancer is non-invasive disease (Stage 0), which is contained within the ducts or lobules of the breast and has not spread into the healthy breast tissue .
All breast cancer cases ER Positive ER Negative 0246810 B: Year after diagnosis 0 204 060 P e rc ent annual haz ard rate All breast cancer cases 02468 C: Year after diagnosis 040 80 % s u rv i v i ng free of breast c ancer death Inflammatory breast cancer 02468 D: Year after diagnosis 020 40 60 P e rc ent annual haz ard rate Inflammatory breast .
Stages of Breast Cancer Staging is the process of determining to what extent a tumor has spread within the body. Staging takes place after breast cancer has been diagnosed. Breast cancer is staged from 0 to 5, depending upon how far it has spread. Both the stage and type of breast cancer are important to determine the best treatment plan.
1.2 Clinical impact of breast cancer. The diagnosis, staging and treatment of patients with breast cancer requires multidisciplinary . care in an acute hospital setting. The majority of patients will require diagnostic tests (radiology, pathology) and depending on the treatment plan may require surgery, chemotherapy and radiation therapy.
Breast Cancer: A Review of the Literature Rodney C. Richie, MD, FACP, FCCP; John O. Swanson, MD This article presents a comprehensive review of the Breast Cancer literature examining epidemiology, diagnosis, pathology, ''benign'' breast disease, breast carcinoma in situ syndromes, staging, and post-treatment surveillance among many topics.
AJCC 8th edition Prognostic Staging in Breast Cancer Triple negative breast cancer poor prognostic subtypes higher recurrence rates higher metastatic rates lower PFS and OS earlier staging system didn't take TNBC character in to account ie treated tumor of 1 cm that is hormone ve similarly to TNBC tumor
