Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
age
|
60-79
|
|
|
etiology
|
Female, family history, BRCA1, BRCA2, early menarche, late menopause, no pregnancies
|
|
|
symptoms
|
painless lump, skin changes, nipple discharges
|
|
|
histology (2)
|
noninvasive carcinomas,
invacive adenocarcinomas |
|
|
noninvasive carcinoma histology
|
1. DCIS (Intraductal carcinoma) 15%
2. LCIS (lovular carcinoma in situ) 2% |
|
|
Invasive adenocarcinoma histology
|
1. Infiltrating ductal carcinoma, NOS 60%
2. Infiltrating lobular carcinoma 5-10% 3. Mucinous (colloid) carcinoma 2-5% 4. Medullary carcinoma 1-5% 5. Tubular carcinoma 2-5% 6. Papillary carcinoma 2-5% 7. Other types 1-5% |
|
|
3 lymph node chains involved
|
subclavian
axillary supraclavicular rotter's |
|
|
surgical procedures performed
|
i. OLD no longer used –Halstead’s Radical Mastectomy (removed pectoralis major muscle)
ii. Lumpectomy iii. Modified radical mastectomy (does not remove pectoralis major muscle) |
|
|
Role of RT: radiosensitivity
|
relatively radiosensitive
|
|
|
role of RT: TRRT role:
|
>1
|
|
|
RT role
one positioning device |
breast board
vac-loc |
|
|
RT role
role of CT |
lung placement, tx planning
|
|
|
RT role
pt's tx positioning |
supine, head turned away from breast being treated, arms above head
|
|
|
TX fields (beam energy, dose)
|
a. 4-6 MV photons, 46.8-50.4 Gy with 1.8-2.0 Gy/fx over 5 wks
b. Boost 15Gy |
|
|
TX fields Internal mammary (IM)
borders beam angles beam energy |
a. Superior - Match supclav fld
b. Inf – the xyphoid process c. Medial – 1 cm past midline on the contralat side ( or to midline) d. Lateral – 5 cm past midline (ipsilat side) e. AP, Mixed beam portal, e- to deliver 90% of the dose to 4cm (usually 12-15 MeV) |
|
|
tx fields
MED TANG. borders beam entries |
a. Med – midline
b. Lat – mid-ax line (2 cm flash) c. Sup – 1st costal interspace (or as sup as possible, may be limited to the ipsilat arm) d. Inf – 1.5 cm below imframammary fold e. Beam entry – anterior oblique (dependent on side as to R or L) |
|
|
tx fields
LAT TANG borders beam entries |
a. Med – midline
b. Lat – mid-ax line (2 cm flash) c. Sup – 1st costal interspace (or as sup as possible, may be limited to the ipsilat arm) d. Inf – 1.5 cm below imframammary fold e. Beam entry – posterior oblique (dependent on side as to R or L) |
|
|
tx fields
SUPRACLAV borders beam entries |
a. Med – 1 cm across (or at) midline extending from 1st costal interspace to the thyro-cricoid groove, medial to the sternocleidomastoid muscle to include the lymph nodes of the cervical chain
b. Lat – from acromioclavicular joint, bisecting the humeral head, to exclude as much of the shoulder as possible c. Sup – extends lat across the neck and trapezius to the acromial process d. Inf – at 1st costal interspace, abutting the tangential field e. Beam entry – AP, may be angled 10-15° to prevent espoph. And spinal cord exposure |
|
|
tx fields
PAB borders beam entries |
a. Med – include axillary nodes that lie close to the chest wall
b. Lat – the latissimus dorsi muscle c. Sup – bisect the clavicle and bisect the humeral head d. Inf – fld matches the sup. Border of the tang. Fld e. Beam entry –PA f. Direct mirror of SC beam from |
|
|
chemotherapy
|
a. Doxorubicin
b. Paclitaxel c. Cyclophosphamide d. Methrotrexate e. 5-FU |
|
|
2 late complications
|
a. Ischemic heart disease
b. Lung fxn decrease |
|
|
current ACS recommendations for screening breast cancer
|
a. Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
b. Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over. c. Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s. d. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%. |
|
|
ways to reduce mortality from breast cancer
|
a. Good screening
i. CBE, SBE, mammogram ii. BRCA analysis |
|
|
2 acute side efetcs during RT
|
erythema
moist desquamation |
|
|
2 actue side effects following RT and lumpectomy
|
breast edema
breast fibrosis |
|
|
depth of nodes -axillary nodes
|
6-8cm, located near midline
2nd and 3rd intercostal space |
|
|
depth of nodes- internal mam
|
3-4cm depth
|
|
|
depth of nodes-SC
|
2.5-3cm depth
|
