Breast Cancer, Rad Therapy, Treatment, Treatment Field
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| show | 2nd and 6th ribs in the sagittal plane, and covers from the sternochondral junction to the midaxillary line.
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| What is the name of the tissue that references breast tissue in the axilla | show 🗑
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| The breast tissue consists of how many lobes and what are they encased in | show 🗑
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| show | By ducts located at the nipple
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| show | 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
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| What muscles are in close proximity of the breast | show 🗑
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| What connective tissue attaches the breast to the pectoralis major and serratus anterior | show 🗑
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| show | Superficial pectoral fascia, it attaches by bands of connective tissue (Cooper's suspensory ligaments)
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| What is the major supply of blood from | show 🗑
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| What plays a big role in development of blood-borne mets in the reference of breast cancer | show 🗑
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| Why do the IM vein, axiallary vein, and intercostal vein play a large role in mets from breast cancer | show 🗑
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| show | The intercostal vein also comes into contact with a system of veins call the Batson, which run through the vertebral column.
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| show | infiltrating ductal carcinoma (IDC)
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| What is the second most common breast cancer | show 🗑
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| What are rare types of breast cancer | show 🗑
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| What type of breast tumor classification is characterized by a visible appearance of discoloration and given poor prognosis | show 🗑
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| What else is mucinous breast cancer also referred to as | show 🗑
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| show | estrogen/progesterone receptor positive (ER/PR)
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| show | HER-2/neu expression
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| show | BRCA1/2
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| What are the two groups of lymphatic channels associated with the breast | show 🗑
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| show | axillary lymph nodes, ipsilateral axilla.
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| How many axillary lymph nodes are there approximately in each ot the axilla | show 🗑
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| What are the major sections of axillary lymph nodes | show 🗑
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| show | Most superficial, first station of drainage from breast
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| How much drainage is done by the axillary lymph nodes | show 🗑
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| show | Internal mammary lymph nodes, near edge of sternum embedded in fat in the intercostal spaces.
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| show | 8, 4 per side
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| What are the three areas of lymph nodes in regards to the breast | show 🗑
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| What might a multidsciplinary approach include in regards to breast cancer | show 🗑
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| Historically how was breast cancer treated | show 🗑
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| show | systemic
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| Who is responsible for the radical mastectomy technique | show 🗑
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| What does the radical mastectomy include | show 🗑
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| show | Modified radical mastectomy, these surgeries preserve muscle, some skin, lymphatics, and blood vessels.
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| show | concave chest wall, arm weaknesss, shoulder stiffness, and lymphedema
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| What preservative surgery is used in smaller tumors of the breast | show 🗑
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| show | axillary dissection. the involvement of these nodes influences the treatment technique
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| What may be used often when staging patients with negative axillary nodes | show 🗑
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| show | 99TC colloid/ isosulfan blue dye
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| show | chemotherapy/endocrine therapy
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| what is the goal of systemic treatment in regards to breast ca patients | show 🗑
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| show | cyclophosphamide, doxorubicin/adriamycin, and paclitaxel
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| What are the most common endocrine therapy drugs | show 🗑
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| show | hot flashes, due to lowered levels of estrogen
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| show | cardiac damage due to doxorubicin, also chemo can cause a second cancer
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| How many critical elements are used to select patients for breast conservation | show 🗑
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| More than 70% of invasive breast cancers are what type | show 🗑
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| What type of breast cancer makes up about 5-10% of breast cancers | show 🗑
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| What breast cancer is less than 1% of all breast cancer and what histologic type does it usual comprise of | show 🗑
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| show | peau d'orange, thickening, warmth, diffuse induration (due to dermal lymphatic involvement). Enalrged and tender breast
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| show | combined-modality; surgery/chemo/RT
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| What histologic typing is included in lobular breast cancers | show 🗑
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| What histologic typing is included in nipple breast cancer | show 🗑
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| How is breast cancer graded | show 🗑
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| In breast cancer how is the number created for grading | show 🗑
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| What is the purpose for staging in breast cancers | show 🗑
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| show | physical exams, imaging, patho reports of primary tumor/surround/related tissues
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| show | physical exams, imaging, patho results as well as surgical procedures and patho evaluation of primary tumor, lymph node, and mets
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| What staging system is used for breast cancer | show 🗑
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| show | Independently
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| how can breast cancer spread in regards of involvement of tissues | show 🗑
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| show | 2-3 cm
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| Where are the supraclavicular nodes located | show 🗑
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| show | 6-8 cm
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| Why must a small amount of lung be included in tangents in breast tx | show 🗑
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| What are the borders used for breast tangents | show 🗑
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| show | compensate for sternal slope, it also helps prevent the breast from falling superiorly on the patients chest.
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| show | chest wall, or below the deepest part of the tylectomy cavity.
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| show | heart, lung, brachial plexus, and the humoral head
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| show | 4 or more positive axillary nodes or extracapsular extension
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| What is the medial border to the supraclav | show 🗑
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| show | Superior border is to extend laterally across neck and trap to acromial process
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| show | 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
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| What is the inferior border of the supraclav field | show 🗑
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| show | 10-15 degrees.
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| What dose should breast tangents be treated to | show 🗑
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| show | 4-6 mv
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| What are often used to achieve dose homogeneity? | show 🗑
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| show | no because the skin is not at risk for recurrence
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| What should the tumor bed be boosted to for intact breast tx | show 🗑
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| show | 46.8 Gy at 1.8 Gy per fraction, depth of 3cm
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| show | The same as the partial breast with supraclav field
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| If wishing to treat the IM nodes what should be done | show 🗑
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| Why should IM nodes not be included in tangent fields | show 🗑
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| What would be the superior border of the IM nodal field | show 🗑
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| show | the xiphoid process
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| What should be the medial border for an IM node field | show 🗑
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| show | 5cm past midline on the ipsilateral side to include the internal mammary nodes
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| In referencing the borders of a tangential field and an IM field, what is used | show 🗑
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| show | mixed beam fields, electron to deliver 90% to 5cm
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| What energy should be used on an IM field if using electron | show 🗑
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| What would be cause for a PAB on breast tx | show 🗑
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| What is a PAB field used to do generally | show 🗑
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| show | bisect the clavicle and bisect the humeral head
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| show | matchline to sup border of tangential field
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| What is the medial border to the PAB field | show 🗑
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| What is the lateral border to a PAB field | show 🗑
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| What is the dose for a chestwall tx | show 🗑
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| show | 60 Gy
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| show | .5-1cm bolus used every other or every third day
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| show | recurrent disease or patients with inflammatory breast cancer
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| show | To bring the midline dose up to 46.8 Gy
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| show | coplanar nature of deep margin of fields
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| show | lack of arm mobility may compromise setup, patients with large breast cause reproduction compromising.
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| What are the most likely sites of regional involvement for breast cancer | show 🗑
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