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Breast CA cards
Breast Cancer, Rad Therapy, Treatment, Treatment Field
| Question | Answer |
|---|---|
| In regards to the extent of anatomical makeup, what does the adult breast tissue cover | 2nd and 6th ribs in the sagittal plane, and covers from the sternochondral junction to the midaxillary line. |
| What is the name of the tissue that references breast tissue in the axilla | Axillary tail of Spence |
| The breast tissue consists of how many lobes and what are they encased in | 15-20 and they are in fat tissue |
| How are the lobes drained in the breast | By ducts located at the nipple |
| What surrounds the nipple and what is the structure as well as the nipple composed of | The circular area surrounding the nipple is the areola and they are both composed of smooth muscle tissue as well as sweat and sebaceous glands |
| What muscles are in close proximity of the breast | pectoralis major, minor, serratus anterior, and latissimus dorsi. |
| What connective tissue attaches the breast to the pectoralis major and serratus anterior | The deep pectoral fascia |
| What encompasses the breast tissue and how is it connected | Superficial pectoral fascia, it attaches by bands of connective tissue (Cooper's suspensory ligaments) |
| What is the major supply of blood from | branches of the IM artery |
| What plays a big role in development of blood-borne mets in the reference of breast cancer | 3 venous routes, the IM vein, axillary vein, and intercostal vein. |
| Why do the IM vein, axiallary vein, and intercostal vein play a large role in mets from breast cancer | they empty into the pulmonary capillaries viia the SVC (lung mets) |
| What is also another reason for mets due to the intercostal vein | The intercostal vein also comes into contact with a system of veins call the Batson, which run through the vertebral column. |
| What is the most common type of breast ca | infiltrating ductal carcinoma (IDC) |
| What is the second most common breast cancer | Infiltrating lobular carcinoma (ILC) |
| What are rare types of breast cancer | mucinous, tubular, papillary. |
| What type of breast tumor classification is characterized by a visible appearance of discoloration and given poor prognosis | Iinflammatory breast cancer, caused by erythema and is referred to as peau d'orange |
| What else is mucinous breast cancer also referred to as | colloid |
| What receptors are associated with a better prognosis in breast cancer | estrogen/progesterone receptor positive (ER/PR) |
| What receptors are associated with a poor prognosis in breast cancer | HER-2/neu expression |
| What genes are breast cancer risk factors associated with | BRCA1/2 |
| What are the two groups of lymphatic channels associated with the breast | group one is a superficial network that drains the skin and the second is a group that drains the internal tissues. |
| What node group of the breast are the primary deep lymphatic drainage | axillary lymph nodes, ipsilateral axilla. |
| How many axillary lymph nodes are there approximately in each ot the axilla | 10-38 |
| What are the major sections of axillary lymph nodes | level I - lateral axillary lymph nodes (lowest)level II - central axillary lymph nodes (inbetween both levels in position)level III - apical axillary lymph nodes (highest group of nodes) |
| What does level I of axillary lymph nodes represent | Most superficial, first station of drainage from breast |
| How much drainage is done by the axillary lymph nodes | 80% |
| What are the IM nodes and where are their location | Internal mammary lymph nodes, near edge of sternum embedded in fat in the intercostal spaces. |
| How many IM nodes does the average person have | 8, 4 per side |
| What are the three areas of lymph nodes in regards to the breast | axillary lymph nodes, im lymph nodes, and supraclavicular lymph nodes |
| What might a multidsciplinary approach include in regards to breast cancer | surgery, radiation, and chemo. |
| Historically how was breast cancer treated | radical mastectomy, with pending RT |
| What is breast cancer considered to be in its progression | systemic |
| Who is responsible for the radical mastectomy technique | William Halstead |
| What does the radical mastectomy include | removal of breast, overlying skin, axillary lymph nodes, and the pectoral muscles. |
| What technique has been adapted from the initial radical mastectomy | Modified radical mastectomy, these surgeries preserve muscle, some skin, lymphatics, and blood vessels. |
| What are some of the complications of radical mastectomies | concave chest wall, arm weaknesss, shoulder stiffness, and lymphedema |
| What preservative surgery is used in smaller tumors of the breast | lumpectomy, also referred to as tylectomy. overlying and underlying tissue is left intact, while the removal of the tumor with a margin is performed. |
| What is necessary for staging a breast cancer patient's disease | axillary dissection. the involvement of these nodes influences the treatment technique |
| What may be used often when staging patients with negative axillary nodes | sentinel node biopsy, first group of nodes to which the tumor will spread. |
| What is used in a sentinel node biopsy | 99TC colloid/ isosulfan blue dye |
| What types of systemic therapy may be used in breast cancer | chemotherapy/endocrine therapy |
| what is the goal of systemic treatment in regards to breast ca patients | destruction, prevention, and delay of tumor spread to distant sites in the body. |
| What chemo agents may be used in breast cancer | cyclophosphamide, doxorubicin/adriamycin, and paclitaxel |
| What are the most common endocrine therapy drugs | tamoxifen and aromitase |
| What may some patients experience from tamoxifen | hot flashes, due to lowered levels of estrogen |
| What may be a permanent side effect due to chemo/hormonal tx | cardiac damage due to doxorubicin, also chemo can cause a second cancer |
| How many critical elements are used to select patients for breast conservation | four |
| More than 70% of invasive breast cancers are what type | infiltrating ductal carcinomas |
| What type of breast cancer makes up about 5-10% of breast cancers | Infiltrating lobular carcinoma |
| What breast cancer is less than 1% of all breast cancer and what histologic type does it usual comprise of | Fnflammatory breast and it can be any type. |
| How is inflammatory breast cancer characterized | peau d'orange, thickening, warmth, diffuse induration (due to dermal lymphatic involvement). Enalrged and tender breast |
| When inflammatory breast cancer is diagnosed what tends to be the treatment | combined-modality; surgery/chemo/RT |
| What histologic typing is included in lobular breast cancers | in site, invasive with predominant in situ component, invasive |
| What histologic typing is included in nipple breast cancer | paget's disease (NOS), paget's disease with intraductal carcinoma, paget's disease with invasive ductal carcinoma |
| How is breast cancer graded | By differentiation of the moprhologic features of tuble formation, nuclear pleomorphism, and mitotic count of tissue being reviewed. Basicially morphology, nucleus formation, and mitotic function of cell culture. |
| In breast cancer how is the number created for grading | between the three (nucleus, morphology, mitotic rate/count) a 1 to 3 is given to each and added together. |
| What is the purpose for staging in breast cancers | It can help in choosing treatment techniques as well as the prognosis. |
| What does clinical staging of breast cancer use | physical exams, imaging, patho reports of primary tumor/surround/related tissues |
| What does the pathologic staging involve when referring to breast cancer | physical exams, imaging, patho results as well as surgical procedures and patho evaluation of primary tumor, lymph node, and mets |
| What staging system is used for breast cancer | TNM based staging that the AJCC has come up with. |
| With bilateral breast cancers how are the tumors staged | Independently |
| how can breast cancer spread in regards of involvement of tissues | Progressive involvement of the ducts, as well as the lymph system |
| At what depth can the Im nodes be found below the skin | 2-3 cm |
| Where are the supraclavicular nodes located | sup to clav and lateral to sternocleidomastoid |
| At what depth are the axillary lymph nodes located | 6-8 cm |
| Why must a small amount of lung be included in tangents in breast tx | To ensure that the whole of the breast and chest wall are irradiated |
| What are the borders used for breast tangents | medial is used at the midline, the lateral border is at the mid-axillary line (2cm beyond all breast tissue), the superior border is the first costal interspace (may be limited by the arm), and the inferior border is 1.5 cm below inframammary fold |
| Why is a slant board used in breast cancer tx | compensate for sternal slope, it also helps prevent the breast from falling superiorly on the patients chest. |
| When giving a boost field with electrons where must the 80% isodose line fall | chest wall, or below the deepest part of the tylectomy cavity. |
| What are the critical structures that may be involved in the treatment of breast cancer | heart, lung, brachial plexus, and the humoral head |
| When is a superclav field used in breast cancer patients | 4 or more positive axillary nodes or extracapsular extension |
| What is the medial border to the supraclav | Medial border, virtical line 1 cm across midline or at midline, to exclude the thyroid. |
| What is the superior border to the supraclav field | Superior border is to extend laterally across neck and trap to acromial process |
| What is the lateral border for a supraclav field | Lateral border acromioclavicular joint, bisecting the humeral head, exclude as much of the shoulder as possible, a block may be used to block humeral head. It should be remembered that the axillary nodes lie medially to the humeral head |
| What is the inferior border of the supraclav field | Inferior border At first intercostal interspace, abutting the tangential breast field. |
| What angle may be used to prevent cord and esophagus damage on a supraclav field | 10-15 degrees. |
| What dose should breast tangents be treated to | 46.8-50.4 Gy at 1.8-2.0 Gy per fraction. |
| What energy should breast tangents be treated with | 4-6 mv |
| What are often used to achieve dose homogeneity? | Wedges |
| Is bolus recommended to intact breast | no because the skin is not at risk for recurrence |
| What should the tumor bed be boosted to for intact breast tx | 60 Gy |
| What is the supraclav field treated to anteriorly | 46.8 Gy at 1.8 Gy per fraction, depth of 3cm |
| What are the field borders for a chest wall tx that did not have the IM nodes irradiated | The same as the partial breast with supraclav field |
| If wishing to treat the IM nodes what should be done | Creating a separate field as opposed to trying to include them in the tangent fields. |
| Why should IM nodes not be included in tangent fields | There is a lack of consistency within the tx of the nodes, increased morbidity, inconsistency of dose homogeneity and also a chance of treating what would be the other breast's field. |
| What would be the superior border of the IM nodal field | match the supraclav field |
| What should the inferior border be for an IM node field | the xiphoid process |
| What should be the medial border for an IM node field | 1cm past midline on the contralateral side (or to midline) |
| What should the lateral border be for the IM node field | 5cm past midline on the ipsilateral side to include the internal mammary nodes |
| In referencing the borders of a tangential field and an IM field, what is used | A matchline between the lareal border of the IM field with the medial border of the tangent field |
| To prevent hot spots or overdose to mediastinum what can be done | mixed beam fields, electron to deliver 90% to 5cm |
| What energy should be used on an IM field if using electron | 12-15 MeV with a 5 degree angle to prevent cold spots |
| What would be cause for a PAB on breast tx | 4 or more positive axillary nodes, greater than 2.5 cm in dimension, fixed nodes, extranodal extension, inadequately dissected axilla. |
| What is a PAB field used to do generally | raise the dose to midline and posterior axillary nodes that would have been underdosed |
| What is the superior border for a PAB | bisect the clavicle and bisect the humeral head |
| What is the inf border of the PAB | matchline to sup border of tangential field |
| What is the medial border to the PAB field | include axillary nodes that are close to chest wall (level III are medial to coracoid process and level II are medial to humeral head) |
| What is the lateral border to a PAB field | lat muscle |
| What is the dose for a chestwall tx | 50.4 Gy at 1.8 Gy per fraction |
| What is the dose brought to with a boost | 60 Gy |
| WIth a chestwall tx what is the protocol for bolus | .5-1cm bolus used every other or every third day |
| In chestwall tx/breast tx, when is bolus especially important | recurrent disease or patients with inflammatory breast cancer |
| Regarding dose what is the purpose of the PAB | To bring the midline dose up to 46.8 Gy |
| What is an important feature of the tangential field arrangement | coplanar nature of deep margin of fields |
| What are some special considerations with breast tx | lack of arm mobility may compromise setup, patients with large breast cause reproduction compromising. |
| What are the most likely sites of regional involvement for breast cancer | lymph nodes in the axilla and IM chain |
Created by:
emeriken1277
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