Difference between revisions of "Invasive breast cancer"

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Invasive breast cancer (view source)

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=Staging breast cancer=
=Staging breast cancer=
==Sentinel lymph node sampling in breast cancer==
{{Main|Breast cancer staging}}
{{Main|Sentinel lymph node|Lymph node metastasis}}
===General===
*Selective sampling of lymph nodes.
*Used for staging.
*Positive LNs = poorer prognosis.
 
Notes:
*If there is no palpable disease, there is '''no''' mortality benefit from axillary lymph node dissection, i.e. positive axillary lymph nodes can be left in situ without affecting outcome.<ref>{{cite journal |author=Giuliano AE, Hunt KK, Ballman KV, ''et al.'' |title=Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial |journal=JAMA |volume=305 |issue=6 |pages=569–75 |year=2011 |month=February |pmid=21304082 |doi=10.1001/jama.2011.90 |url=}}</ref>
**This does not negate the fact that a positive sentinel LN biopsy (vs. negative sentinel LN biopsy) portends a poorer prognosis.
 
===Microscopic===
Features:
*Atypical cells.
**Nuclear changes of malignancy:
***Nuclear enlargement + variation in size.
***Variation in shape.
***Hyperchromasia and variation in staining.
**Usually in the subcapsular sinuses.
 
Pitfalls:
*Naevus cell rests.<ref>URL: [http://www.breastpathology.info/Case_of_the_month/2007/COTM_1107%20discussion.html http://www.breastpathology.info/Case_of_the_month/2007/COTM_1107%20discussion.html]. Accessed on: 28 November 2010.</ref>
 
===IHC===
Some hospitals use:
*CAM5.2 (LMWK) - to look for isolated tumour cells and small lymph node metstases.
 
==N stage==
Sampling usually selective, i.e. [[sentinel lymph nodes]] only.
===Indications for lymph node sampling===<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf]. Accessed on: 2 April 2012.</ref>
*Extensive [[DCIS]].
*Biopsy suspicious for invasion ''or'' with microinvasion.
*Clinical findings (large palable mass) or radiology findings (irregular features) suggestive of invasion.
*Planned mastectomy.
 
===Definitions===
Definitions:<ref name=acs_website>URL: [http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging]. Accessed on: 8 July 2010.</ref>
*Isolated tumour cells: <=0.2 mm ''or'' <=200 cells -- in a single cross-section. †
*Micrometastasis: <=0.2 cm ''and'' ( >0.2 mm ''or'' >200 cells ).
*Macrometastasis: >0.2 cm.
 
Notes:
* † The ''American Cancer Society'' web site says "or".<ref name=acs_website/>  The CAP protocol says "and/or" and notes it is all subjective.
*Isolated tumour cells are essentially ignored if the there is at least one macrometastasis.
 
===Details===
Lymph nodes:<ref>URL: [http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging]. Accessed on: 8 July 2010.</ref>
*pN0: nil.
**pN0(i+): <=0.2 mm ''and'' <200 cells.
*pN1: 1-3 axillary LNs ''or'' internal mammary LNs.
**pN1mi: <=0.2 cm ''and'' ( >0.2 mm ''or'' >=200 cells ).
**pN1a.
**pN1b.
**PN1c.
*pN2 4-9 positive LNs; internal mammary LNs ''or'' axillary LNs.
*pN3.
 
==T stage==
Tumour:<ref>URL: [http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-staging]. Accessed on: 8 July 2010.</ref><ref>URL: [http://www.cancerhelp.org.uk/type/breast-cancer/treatment/tnm-breast-cancer-staging http://www.cancerhelp.org.uk/type/breast-cancer/treatment/tnm-breast-cancer-staging]. Accessed on: 9 July 2010.</ref>
*pT1: <= 20 mm.
**pT1mic <= 1 mm.
**pT1a > 1 mm ''and'' <= 5 mm.
**pT1b > 5 mm ''and'' <= 10 mm.
**pT1c > 10 mm ''and'' <= 20 mm.
*pT2: > 20 mm and <= 50 mm
*pT3: > 50 mm.
*pT4: chest wall or skin involvement.
 
Notes:
*Values should be rounded to the nearest millimetre.
**Therefore:
***1.4 mm would be ''pT1mic''.
***1.5 mm would be ''pT1a''.
 
==M stage==
Distant metastasis:
*cM0(i+) <=0.2 mm focus of tumour cells, without clinical signs and symptoms.
*pM1 focus of tumour cells > 0.2 mm.


=Lymphovascular invasion=
=Lymphovascular invasion=
Michael
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