EARLY BREAST CANCER

1
(No Transcript)
2
LOCALLY ADVANCED BREAST CANCER

• Elshami M.Elamin, MD
• Medical Oncologist
• Central Care Cancer Center
• www.cccancer.com
• Wichita, KS - USA

3
Inoperable Locally advanced-Non inflammatory

• IIIA
• T0-3, N2
• T3, N1 (operable not included)
• IIIB
• T4 , any N0-2
• IIICN3
• Any T, N3

4
Inoperable locally advancedNon-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

5
INFLAMMATORYBREAST CANCER
6
INFLAMMATORY DISEASE

• CLINICAL
• T4d
• Triad erythema
• Skin erythema affecting gt 1/3 of breast
• Diffuse breast warmth
• Skin edema and ridging (peau dorange) 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?
7
Do you need both clinical and pathologic features
for diagnosis?

• Dermal lymphatic invasion is neither required nor
  sufficient by itself to make the diagnosis

8
Grave signs

• Grave signs Local recurr 5Y DFS
• Skin edema 32 23
• Skin ulceration 14 36
• Fix to chest wall 40 5
• gt 2.5 cm axillary LN 13 38
• Fixed axillary nodes 13 13
• Haagensen Ann Surg 1943

9
Multimodality Therapy

• Surgery RT
• 5YS lt5
• Chemotherapy ?? MRM/RT
• 5Y DFS 25-30
• 5Y S gt 40
• Response to chemo is an important predictor of
  survival
• ? ?? High-dose chemo with ABMT
• ? Breast conservation
• only in clinical trial

10
Thanks