breast%20cancer
BREAST CANCER
Breast cancer is the presence of malignant breast nodule, mass or abscess.
Most common symptom of breast cancer is a new lump or mass in the breast. The lump or mass is usually painless, hard & irregular but it can also be tender, soft, rounded or painful.
Other signs & symptoms include breast pain or nipple pain, nipple discharge, nipple retraction and presence of breast skin changes (eg peau d' orange, nipple excoriation, scaling, inflammation, skin tethering, ulceration, abscess).

Radiotherapy

  • Treatment with high-energy rays or particles that destroy cancer cells
  • Also used to treat cancer that has metastasized to other organs
  • Breast RT strongly recommended after breast-conserving surgery to decrease the chance of recurrence
  • Can be given as external beam radiation or brachytherapy

Radiotherapy for Invasive Breast Cancer Stage I, IIa, IIb, IIIa (T3N1M0)
Postmastectomy Radiotherapy

  • Radiotherapy to the chest wall, infraclavicular area, & internal mammary nodes & to any area of involved axillary nodes is recommended for patients with ≥4 positive axilllary nodes
  • Radiotherapy to the chest wall, infraclavicular & supraclavicular area, & internal mammary nodes & to any area of involved axillary nodes should be considered in patients with 1-3 positive axilllary nodes
  • Radiotherapy to the chest wall, with or without coverage of the supraclavicular & infraclavicular area, & internal mammary nodes & any area of involved axillary nodes, may be considered in patients without any involved axilllary nodes but with tumor >5 cm in size & those with positive margins
  • Radiotherapy to the chest wall, with or without regional nodal radiation in patients with central or medial tumors, tumor >2 cm in size, negative margins but with high-risk features
  • Commonly done after chemotherapy except in patients with negative axillary nodes & tumor with ≤5 cm in size& margins ≥1 mm
Post-Lumpectomy Radiotherapy
  • Radiotherapy to the whole breast with or without boost to tumor bed, supraclavicular and infraclavicular areas, and internal mammary nodes, and within the area of involved axillary nodes is recommended for patients with ≥4 positive axilllary nodes
  • Radiotherapy to the whole breast with or without boost to tumor bed is recommended for patients with 1-3 positive axillary nodes, with consideration for supraclavicular, infraclavicular, & internal mammary node radiotherapy & to any area of involved axillary nodes
  • Radiotherapy to the whole chest with or without boost to tumor bed is recommended in patients negative for axillary node involvement-
    • May consider regional nodal radiation in high-risk patients with tumors >2 cm in size or with tumors located near or at the center
  • Commonly done after chemotherapy

Radiotherapy for Invasive Breast Cancer Stage IIIa (except T3N1M0), IIIB, IIIC

  • Radiotherapy to the chest wall, infraclavicular area, & internal mammary nodes and to any area of involved axillary nodes should be considered in postmastectomy patients at risk of invasive disease and axillary lymph node involvement
    • Whole breast radiotherapy instead of chest wall radiotherapy is recommended for postlumpectomy patients
  • Presence of axillary node involvement even after chemotherapy is an indication for radiotherapy of the chest wall, infraclavicular region, supraclavicular area, internal mammary nodes and to any area of involved axillary nodes
    • Whole breast radiotherapy instead of chest wall radiotherapy is recommended for postlumpectomy patients
  • For patients with inoperable tumor upon initial diagnosis with positive response to preoperative systemic therapy and subsequently underwent surgery, radiotherapy to the breast/chest wall, infraclavicular region, supraclavicular area, internal mammary nodes and to any area of involved axillary nodes is recommended
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