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Cancer, deep in
the right breast
MRI
Cancer, deep
in the right
breast
Cancers are named after
the cell that goes bad, so
ductal or lobular
carcinoma
There is a risk of
spread to the near
by lymph nodes
(level I or II)
Location of
the lymph
nodes
Lymph Nodes
supraclavicular Internal mammary
axillary
Sentinel Node
Technique and Biopsy
Sentinel Node
ductal cells
Histology appearance of the cells under the microscope. Most cancers arise from
milk duct cells and are called invasive ductal carcinoma. (The earliest form, before
any invasion is called ductal carcinoma in situ or DCIS.) Other types include
lobular and medullary and very favorable types like tubular or mucinous.
Grade how mutated the cells have become. The closer the cells resemble normal
breast cells, the less serious (slower growing, less likely to spread.)
Grade 1 or well differentiated slow growing, most favorable
Grade 2 or moderately differentiated most common, average
Grade 3 or poorly differentiated fast growing, more serious
Hormone Receptors normal breast cells are sensitive to hormones and have
positive receptors for estrogen (ER+) or progesterone (PR+). If the hormone
receptors are present (called positive) the cancer is less serious and more likely to
respond to a hormone therapy drug like tamoxifen (Nolvadex), Arimidex
(anastrazole) , Femara (letrozole) or Aromasin (exemestine).
DNA Studies: the more mutated the cells, the more serious. If there is an abnormal
number of chromosomes (aneuploid), rapidly dividing numbers of cells (high S-
phase) or abnormal genes (HER-2/Neu), this may effect the choice of
chemotherapy drugs used (like Adriamycin, Taxol or Herceptin.)
CT scan is obtained at the time of simulation
Spinal
cord lung
breast
lung
heart
surface doses of
radiation
Internal doses of
radiation
Tumor site in
breast
Computer generated anatomy images that will identify all the
important structures to be sure the radiation covers the area
of breast cancer and limits the dose to other areas
Viewed
from the
side, the
radiation
stops
before
hitting the
lung
Radiation field to left breast
First the whole breast is
treated for 25 to 30
treatments
Utilizing a balloon
inside the
lumpectomy cavity
and completing the
radiation in 5 days
Advantages of
multi-dwell
catheter
compared to
single dwell
CT Scan of woman with breast balloon
CAT Scan picture with balloon in right breast
Distance of the balloon surface from the
skin should be greater than 8mm
the balloon is too close to the skin
Side Effects of Breast Radiation
Generally the side effects of breast radiation do not become
noticeable until the woman has received about 10
treatments, and then become somewhat more noticeable
through the rest of the treatment. The most common side
effects:
skin irritation - the skin that is radiated gets red, itchy and
may blister (like a sun burn)
breast or chest wall tenderness or mild pain
tiredness or fatigue (some women feel a little light-headed)
are swelling or edema (usually slight, see section below
about avoiding lymphedema)
Radiation Prescription for #