Breast Cancer Staging – Flashcards

Tx: Primary tumor cannot be assessed T0: No evidence of primary tumor Tis: Carcinoma in situ Tis DCIS: Ductal carcinoma in situe Tis LCIS: Lobular carcinoma in situ Tis Pagets: Paget's disease of the nipple not associated with invasive carcinoma and/or carcinoma in situ

T1: 20 mm or less in greatest dimension T1mi: 1, 5, 10, <=20 mm in greatest dimension

T2: >20 mm, 50 mm in greatest dimension T4: Tumor of any size with direct extension to chest wall and/or to the skin T4a: Extension to chest wall, not including only pectoralis muscle invasion/adherence T4b: Ulceration and/or ipsilateral satellite nodules, and/or edema, which do not meet criteria for inflammatory carcinoma T4c: T4a + T4b T4d: Inflammatory carcinoma

Clinically detected: Detected by imaging studies or clinical examination + characteristics highly suspicious for malignancy.

pN1: micromets, or mets in axillary 1-3 axillary LN's, and/or in IM nodes with mets detected by SNLBx but not detected clinically pN1mi: micrometastases pN1a: Mets in 1-3 axillary LN's, at least 1 greater than 2 mm pN1b: Mets in internal mammary nodes, with micromets or macromets detected by SNLBx but not clinically detected pN1c: Mets in axillary + IM nodes, with micromets or macromets detected by SNLBx but not clinically detected

pN2: Mets in 4-9 axillary LN's, or in clinically detected IM LN's in absence of axillary nodes pN2a: Mets in 4-9 axillary LN's, at least one met > 2 mm. pN2b: Mets in clinically detected IM LN's, in the absence of axillary LN mets

pN3: >=10 axillary LN's, or in infraclavicular LN's, or in clinically detected ipsilateral IM lymph nodes, in presence of 1 or more + level 1-2 axillary LN's, or in more than than 3 axillary LN's and in IM lymph nodes detected by SNLBx, or in ipsilateral SC nodes. pN3a: Mets in >=10 axillary LN's, or mets to infraclavicular (level 3 axillary) Ln's pN3b: Mets in clinically detected ipsilateral IM lymph nodes, in presence of 1 or more + level 1-2 axillary LN's, or in more than than 3 axillary LN's and in IM lymph nodes detected by SNLBx pN3c: ipsilateral SC nodes.

M0: No clinical or radiographic evidence of distant metastatic disease. M1: Distant mets

Tis N0 M0

T1 N0 M0

T0 N1mi M0 T1 N1mi M0

T0 N1 M0 T1 N1 M0 T2 N0 M0

T2 N1 M0 T3 N0 M0

T0 N2 M0 T1 N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0

T4 N0 M0 T4 N1 M0 T4 N2 M0

Any T, N3, M0

Any T, any N, M1

1. If biopsy was core needle biopsy, perform surgical excision. 2. If only LCIS on excision --> surveillance and risk reduction per NCCN guidelines

1. Diagnostic work-up: diagnostic bilateral mammo, path review, Determine ER status, +/- Breast MRI 2. Primary treatment: Cat 1: Lumpectomy without LN surgery + breast RT Cat 2B: Total mastectomy, or lumpectomy without RT 3. Risk reduction: Consider Tamoxifen x 5 yrs if ER+ (benefit in ER neg uncertain)

T1aN0: No adjuvant tx; consider endocrine therapy for disease prevention T1bN0: Endocrine therapy T1b N1mic: Endocrine tx +/- chemo (Oncotype DX score) T1c-T3, N0/N1mic: Endocrine therapy + chemotherapy

T1a, N0: No adjuvant therapy; consider endocrine therapy for disease prevention T1bN0: Endocrine tx +/- chemotherapy, + trastuzumab T1b, N1mic OR T1c-Tr, N0/N1mic: Endocrine + chemo + trastuzumab

T1aN0: No adjuvant therapy T1aN1mic or T1bN0/N1mic: +/- chemotherapy T1c-T3, N0 or node pos: Chemotherapy

AC x 4 cycles TC x 4 cycles ddAC x 4 cycles -->dd Paclitaxel x 4 cycles AC x 4 cycles --> paclitaxel x 12 weeks TAC x 6 cycles

AC x 4 cycles followed by 12 weeks of paclitaxel/trastuzumab followed by 40 weeks trastuzumab Docetaxel/carbo/trastuzumab x 6 cycles, followed by trastuzumab x 34 weeks Adjuvant chemo followed by 1 year of trastuzumab